General ophtalmology

• What is cataract?

Cataract is a vision disorder that occurs when the lens (oval lens located behind the color of the eye) loses its transparency.
We can compare the crystalline lens to the lens of a camera which allows us to focus the image. When the lens becomes opaque, the light rays reach the retina less well. The outside world is seen as through a waterfall and can no longer be perceived clearly.
Most often, cataracts occur with age and evolve slowly so that the person affected does not notice it at first.

• What are the signs of cataracts?

The view is gradually more veiled or obscured. There is a gradual decline in vision with the impression that glasses are no longer suitable, especially for distance vision, while near vision is often preserved at the beginning. Vision may be double with glare. A less contrasting view, with a perception that things are washed out, with less vibrant colors. When the cataract is more advanced, the pupil may appear gray or slightly white.

• What screening methods?

Cataracts are often detected during an eye exam. It is therefore important to consult as soon as you notice any changes.
in your vision.
At an early stage of cataract, wearing glasses may be enough to improve visual ability. However, at later stages,
the only possible treatment is surgery.

• What is the treatment for cataract?

When the lens has become opaque, it is not possible to "clean" it, only surgery using ultrasound or laser methods can remove the cloudy lens. It is replaced by a synthetic lens which is placed in the eye for the rest of the life. These lenses are also used during cataract surgery in children. In this case, they remain in place for several decades.
The operation is performed under local anesthesia only with drops and lasts between 15 and 30 minutes. In principle, only one eye is operated on at a time. After the operation, stay calm and do not rub your eye under any circumstances.

Already after a few weeks, the eye is completely healed. Driving may not be possible for a few weeks while the brain readjusts to this new balance of vision. There is no age limit for cataract surgery.
The intervention is indicated when your visual capacity prevents you from correctly carrying out the activities of daily living. Only regular monitoring can diagnose a cataract and, if necessary, treat it effectively.

• Risk factors

Age, eye trauma, diseases such as diabetes, serious internal eye inflammation, smoking and alcohol, ultraviolet rays, taking medication (neuroleptics, steroids, etc.)

Cataract surgery is the most performed surgery in the world and has one of the highest success rates

• What is glaucoma?

First cause of irreversible blindness in the world, glaucoma is an eye disease that mainly affects the elderly. It is characterized by the progressive destruction of the nerve fibers of the optic nerve. First, peripheral vision is lost, but in advanced stages central vision is also affected, which can lead to irreversible blindness. Early diagnosis and appropriate treatment can slow disease progression and prevent blindness. Most glaucoma is caused by increased pressure inside the eye, but there are other causes.

• What are the signs of glaucoma?

In the early stage, glaucoma goes unnoticed: it does not cause pain and vision is preserved. It is therefore not easy to detect, hence the importance of getting tested regularly.

As the disease progresses, the visual field gradually narrows, from the periphery (little noticeable and not very annoying) to the central vision that allows us to read and recognize faces. Untreated, glaucoma leads to complete and irreversible blindness.

• What screening methods?

It is generally accepted that around 50% of cases go undiagnosed and therefore not treated in time. It is necessary to combine several examinations that only the ophthalmologist can interpret:

eye pressure measurement
optic nerve examination
visual field to identify possible blind areas
other tests may be needed for diagnosis
How to treat glaucoma?
If it is not possible to regain the vision already lost, treatment can stop the progression of glaucoma and its progression to blindness.

Depending on the case, the ophthalmologist may prescribe:

one or more eye drops,
laser treatment or
surgical treatment.
A very rigorous observance of the long-term treatment is absolutely necessary, otherwise the disease progresses again.

• Who is screening for?

Everyone is advised to get tested

– from the age of 40, since glaucoma affects 2% of people over 40, and 15% of people over 70,

– or if you have any of the following risk factors, regardless of your age:

• Family history of glaucoma

African or Hispanic origin
High myopia or hypermetropia
High blood pressure
Vascular problems
Diabetes
Prolonged treatment with cortisone or other medications
Previous eye trauma.

• What is diabetic retinopathy?

Diabetes can affect the eyes and cause visual problems. The most significant eye problem that can develop is a condition called diabetic retinopathy, which is characterized by dysfunction of the small blood vessels in the retina resulting in retinal edema or blood vessel growth and intraocular hemorrhage. Diabetic retinopathy can seriously affect eyesight if neglected. If left untreated, it can cause severe vision loss and even blindness.

• What are the symptoms of diabetic retinopathy?

The majority of people with diabetes have healthy eyes in the initial phase. Diabetic retinopathy causes no symptoms for most of its course. Moving spots in the visual field or a significant loss of vision are often signs of hemorrhage of the retinal vessels. Central vision discomfort, difficulty reading, decreased contrast, distorted vision can be signs of macular edema.

• What are the screening methods?

As diabetic retinopathy can develop without signs or complaints in the early stages, regular screening is mandatory: ophthalmological follow-up with in-depth examination of the retina, the rhythm of which is determined from the diagnosis of diabetes and according to the state of the eyes and disease progression.

This screening is done every year. During the first visit, patients benefit from a complete ophthalmological examination to screen for diabetic retinopathy as well as any other common problems (e.g. cataracts, glaucoma). If there are no signs, examinations will be carried out during the following 3 years, using a device that allows an automated and finer analysis for the monitoring of diabetic retinopathy. Every 5 years, patients, even without signs of diabetic retinopathy, are reviewed for consultation. If signs are observed, the patients are seen the same day by the ophthalmologist who explains the pathology, the therapy and the follow-up plan.

All of these measures strike an optimal balance between safe screening and comfort for the patient.

• What are the treatments ?

The best treatment for diabetic retinopathy is the proper balance of diabetes. Blood pressure and dyslipidemia (cholesterol levels) must also be stabilized.

In most cases, mild forms of diabetic retinopathy do not affect vision, and treatment is not needed at this stage. Patients who develop retinal edema (diabetic macular edema) or growth of blood vessels (proliferative diabetic retinopathy) should be treated promptly. When this treatment is started in the early stages of these complications, the results and prognosis are generally good.

Diabetic macular edema is treated with intraocular injections (with proteins that are vascular endothelial growth factor inhibitors, anti-VEGFs) and sometimes, in a later phase, with laser treatment (photocoagulation) .

Proliferative diabetic retinopathy is treated with lasers, and sometimes with additional intraocular injections (anti-VEGF) and/or eye surgery (vitrectomy).

These treatments aim to stabilize vision and try to regain visual acuity.

• What are the risk factors?

The overall prevalence of diabetic retinopathy is estimated at one third of patients with type 1 and type 2 diabetes and in a small proportion of these patients vision is seriously damaged.

• Recognized risk factors:

The values ​​of the glycated form of hemoglobin, a marker of blood sugar balance (blood glucose concentration) over three months.
High blood pressure (especially systolic pressure)
Hyperlipidemia (an abnormality in the level of fat in the blood)
Obesity (high body mass index)
smoking
The duration of diabetes
Specific states: pregnancy and puberty

• What is age-related macular degeneration?

Age-related macular degeneration (AMD) is a disease that progressively damages the macula, which is located in the center of the retina. She causes
deterioration or loss of vision in this area where visual acuity
and color vision are maximized. At an advanced stage of the disease, the eye only sees the periphery of the image.
In the Western world, AMD is the most common cause
severe visual impairment in people over 50.
The older you get, the greater the risk of developing AMD.

• What are the signs of AMD?

Difficulty adapting to sudden changes in light. Reading (near vision) becomes difficult and requires better lighting.
Straight lines seem to wave and distort (Amsler grid test). The central vision deteriorates, blurs, a black spot appears.

• What screening methods?

Early detection limits the progression of the disease and allows
to preserve vision. To make your diagnosis, the ophthalmologist will examine your fundus, with or without dilation. According to the shape
(dry or wet) and the stage of the disease, he may request additional examinations.

• What is the treatment for AMD?

Taking prescribed antioxidant food supplements
by the ophthalmologist can slow down the evolution of an early form
to an advanced form.

The dry form, (disappearance of retinal cells), evolves over several years. Many treatments are currently in the pre-clinical phase.
The wet form, which evolves more rapidly, is due to the formation
abnormal vessels under the macula (resulting in bleeding
and exudation).

Urgent treatment is needed to maintain or recover
of sight. Currently, the first-line treatment
is the repeated injection of proteins
therapeutics (anti-VEGF). Other therapies exist such as
laser photocoagulation or photodynamic therapy (PDT).

AMD does not cause blindness, since only central vision is impaired, but it leads to an inability to read and recognize faces
(this is social blindness). Low vision rehabilitation allows better
use the peripheral vision that is preserved. Only regular monitoring by a specialist can diagnose AMD
and, if necessary, to deal with it effectively.

• Risk factors

Age, genetic factors, smoking (smoking increases the risk
by 3), hypertension, circulatory diseases, vitamin or mineral deficiency, intense UV light, saturated fatty acids.

From the age of 40, have your vision checked by an ophthalmologist every year.

1- STRABISMUS

• What is strabismus?

Strabismus is a lack of coordination and alignment of the eyes. Normally the axes of the eyes are parallel both when looking far and near, the 2 eyes fixing together the object that we are looking at. In strabismus, this cooperation of the two eyes is compromised.

• What are the signs ?

In convergent strabismus (or esotropia), one eye looks more toward the nose ("cross-eyed").

In divergent strabismus (or exotropia), one eye looks more towards the temple.

In a vertical strabismus (hyper- or hypotropia), one eye looks too far up or too far down.

The deviation can be constant or intermittent, stable or fluctuating, present since childhood or acquired in adulthood. Sometimes the patient complains of double vision.

The angle of deviation is sometimes too small to be seen with the naked eye. This is called a "micro-strabismus", but it has the same consequences as a wider-angle strabismus.

• What are the screening methods for strabismus?

In children, screening is carried out by the pediatrician who performs several tests during controls from 0 to 6 months, then at each visit. If the pediatrician or parents notice strabismus, even intermittent, a consultation with an ophthalmologist is indicated. The presence of strabismus or poor vision in children - called amblyopia - in the family justifies an early check-up with the ophthalmologist, around the age of 1 year, even in the absence of strabismus.

In adults, screening is done by an ophthalmologist.

Different ages, different problems
In children: Vision is not mature at birth, but develops over the first few years of life. If one eye is working and seeing well, but the other is not well aligned, the brain ignores the image of the deviated eye, and only learns to see with the eye that fixes what the child wants to watch. The deviated eye does not develop its vision, which remains very poor. This is called amblyopia, or "lazy eye", which needs to be taken care of as soon as possible. In addition, if a squinting eye in early childhood, the brain cannot develop binocular vision, that is, the ability to see in relief (3D).

In adults: The onset of strabismus in adults is most often accompanied by double vision (diplopia), headaches (headaches), and/or significant visual fatigue. An acquired strabismus can occur following the deterioration of a childhood strabismus, but can also be the sign of a neurological problem (stroke, for example), and require urgent investigations.

• What are the risk factors?

Cases of strabismus or poor vision in children in the family put a slightly higher risk for the child to have strabismus. Perinatal problems, in particular neurological, as well as significant refractive disorders (need for glasses), in particular strong hyperopia, also constitute a greater risk of developing strabismus.

• What are the treatments ?

In children, treatment most often consists of prescribing glasses, which provide a good image to both eyes, as well as hiding the "better" eye with a self-adhesive patch (also called occlusion), in order to force the brain to use and "learn to see" with the deviated eye. Once the situation has stabilized, an operation can be considered to realign the eyes.

In adults, glasses with a light-bending prism or an occlusion can be useful to suppress double vision. After stabilization, an oculomotor operation (i.e. of the muscles responsible for eye movements) can be considered.

2- AMBLYOPIE

• What is amblyopia?

Vision is not mature at birth, but develops over the first few years of life. The brain will gradually learn to "see" during this time.
The two eyes are in competition throughout the development of vision. If during the first years of life, the brain receives images of different quality from each eye, it will prioritize learning vision using the higher quality images, and will neglect to "learn to see" with the most evil eye. If the cause of the impaired image quality is not corrected in childhood, the abnormal visual development will cause permanent poor vision in one or both eyes.

Amblyopia can be caused by:

a refractive disorder (hyperopia, myopia, astigmatism), responsible for a blurred image. It is the most common cause of amblyopia.
strabismus, which causes only one eye to stare at the object of interest because the other eye is out of alignment. The brain will then ignore the images transmitted by the deviated eye.
much more rarely, an anatomical abnormality that prevents the formation of an image on the retina (for example an eyelid that covers the eye (ptosis), corneal opacity, or a cataract).

• What are the signs ?

Even if they cannot see well, children rarely complain of a sight problem.

If it is of refractive origin, amblyopia can go completely unnoticed, the child adapting to living with only one functional eye. It is only when the good eye is hidden, during a game or a medical examination, that the poor vision of the other eye can be detected. A strabismus, an anomaly of the eyelids or the anterior part of the eye can be visible, and thus constitute the warning sign of a probable asymmetry of vision.

• What are the screening methods for amblyopia?

Early visual screening is essential. In the very young child, we will try to observe an asymmetrical reaction when one eye is hidden. If the child does not react when one of the eyes is hidden, but cries when the other is hidden, a difference in vision should be suspected.

In older children, it becomes possible to test the visual acuity of each eye, looking for a difference between the two eyes.

If poor vision is suspected, additional examinations must be carried out by the ophthalmologist to find the cause. The ophthalmologist, who often works with an orthoptist, examines refraction, checks for strabismus and examines ocular anatomy.

• What are the treatments ?

Treatment for amblyopia has 3 components:

Providing an image to the eye: operating an eyelid that completely covers the eye, removing opacity from the transparent media of the eye (cornea, lens, vitreous body), for example a cataract.
Make the image sharp: correct if necessary a refractive disorder (hyperopia, astigmatism, myopia), by glasses or contact lenses
Force the brain to use the "weak" eye: most often by hiding the "better" eye with a patch for a few hours a day.
The earlier the treatment is carried out, the more effective it is. After a certain age, it is no longer possible to retrain the brain to "see" with both eyes. Early detection is therefore essential.

• At what age should occlusion treatment (wearing a patch) be started?

The earlier amblyopia treatment begins, the faster and more effective it is. Treatment should therefore be started as soon as the visual problem is identified. Initially, glasses will be prescribed if necessary. The vision is then checked after 4 to 6 weeks. Depending on the improvement obtained by wearing the glasses, the ophthalmologist can choose to continue monitoring the evolution of the vision, or to start the occlusion treatment.

• How do I get my child to agree to wear their glasses?

The glasses modify the images perceived by the child. To help him get used to glasses, it is recommended that he wear them as soon as he wakes up. The child will thus immediately see the image corrected by his glasses, without having to get used to the transition from the image perceived without glasses to the corrected image. It is also recommended that the child wear their glasses constantly during the day. In addition, the glasses must have lenses large enough to properly cover the different directions of gaze, a nose bridge and comfortable temples that ensure good stability.

• During what activities should my child wear the patch?

The child should wear their patch during activities that stimulate vision, such as near-vision games, reading a book, in front of the television or other screen. It is of course unnecessary to wear the patch during naps.
Depending on the duration of the treatment, the patch must sometimes be worn at school. It is therefore recommended to explain the situation and its issues to the teacher, who can talk about it in class.

• What if my child refuses to wear the patch?

The patch is accepted in a wide variety of ways, but is supported without too much difficulty in the vast majority of cases. Children who refuse the patch at the start of treatment, or who constantly remove it, most often get used to it gradually. Decorated patches often help the child to better accept wearing them. As time passes, the vision in the "weak" eye improves, making the obstruction of the good eye easier to bear. The adherence of the parents to the treatment is of course essential, since they are the ones who will carry it out at home. The patience and perseverance of the parents is essential for the success of the treatment. Today, decorated patches often help the child to better accept wearing them.

• How long will my child have to wear the patch?

The treatment should ideally be continued until symmetrical vision is obtained, and/or alternating fixation in the event of strabismus (i.e. until it is observed that the child is sometimes cross-eyed one eye, sometimes the other). The duration of the treatment therefore depends on the individual evolution, which is different for each child. Treatment usually lasts from a few months to a few years. The earlier the treatment is started, the faster and more effective it is.

• Are there alternatives to the patch?

In some cases, especially in the presence of significant farsightedness, it is possible to "penalize" the image of the good eye with atropine eye drops. Atropine prevents the good eye from focusing (accommodation), creating blurred vision which will promote the brain's use of images from the "weak" eye.

• What happens if amblyopia is not treated?

The brain will continue to neglect learning the vision of the weaker eye.

Beyond a certain age, the situation becomes irreversible, and the poor vision of the weak eye can no longer be improved.

Living with only one working eye is entirely possible. But if the good eye is damaged or "lost" due to illness or accident, the situation can become dire. It is mainly to avoid this risk that the treatment of amblyopia is essential.

• What are the risk factors?

The presence of eye problems in the family, such as wearing glasses with a large correction, strabismus, cataracts or childhood glaucoma, represents a slightly higher risk for children to also present a visual disorder. . Certain problems occurring during pregnancy or premature birth also represent a risk. If in doubt, it is important to discuss the situation with your pediatrician and not hesitate to consult an ophthalmologist.

Dr Bela provides vision checks and screening for vision disorders.

HYPERMETROPIA:

What is hypermetropia?
The hyperopic eye does not properly focus near objects. The refractive power of the cornea is insufficient or the eye itself is too short. The light rays are consequently focused behind the retina, and the retina receives a blurred image of the environment.

Unlike myopia, the lens can compensate for hyperopia, up to a certain age. Indeed, the lens can change shape, and therefore increase its refractive power, which compensates for the defect of the hyperopic eye for distance vision.

The farsighted is able to see well from near and far, but at the cost of effort and fatigue. As the image forms behind the retina, the lens must change shape (accommodate). The closer the object gets, the greater the necessary accommodation. Mild hyperopia often goes unnoticed until the age of 35/40 because the eye is constantly adapting. Afterwards, the ability to accommodate begins to decrease and farsightedness is revealed.

• What are the signs ?

If significant, farsightedness causes blurred near vision. If it is moderate, it can be compensated by a visual effort to focus, called accommodation. The ability to compensate for farsightedness through accommodation depends on age and decreases over time. The accommodation effort can cause visual fatigue, headaches, or even strabismus if the farsightedness is significant.

In children, asymmetric farsightedness can cause amblyopia, which is a visual development in which the brain prioritizes learning to see using the images provided by the better eye, and neglects those of the weaker eye, here the most farsighted.

• What are the screening methods?

Hyperopia is detected by an examination of visual acuity, then refraction. In children and young adults, the use of cycloplegiatic drops, which temporarily paralyze the focusing power of the eye (accommodation) is most often necessary to obtain a reliable measurement of hyperopia. Screening and early management of refractive disorders is essential in children, in order to avoid amblyopia.

• What is the treatment for hyperopia?

Hyperopia can be corrected by glasses with convex (positive) lenses, by contact lenses or, in adults and in some cases, by refractive laser surgery.

MYOPIA:

• What is myopia ?

Myopia is a refractive visual disorder that occurs when the eye is too long. The image is formed in front of the retina, and the myope sees blurred in the distance.

• What are the signs ?

Myopia causes blurred vision at a distance, which cannot be compensated by visual effort. On the other hand, vision is sharp up close: the greater the myopia, the more it is necessary to approach objects to see them clearly.

• What are the screening methods?

Myopia is detected by an examination of visual acuity, then refraction. In children and young adults, the use of cycloplegia drops, which temporarily paralyze the focusing power of the eye (accommodation) is most often necessary to obtain a reliable measurement. Screening and early management of refractive disorders is essential in children, in order to avoid amblyopia.

• What are the risk factors?

The presence of myopia in the family constitutes a risk factor. If both parents are nearsighted, their child is 8x more likely to be nearsighted.

In recent years, there has been a significant increase in myopia among young people. This is probably linked to the importance of time spent indoors in artificial light, as well as to the excessive work in near vision, for example on smartphone screens. The simplest recommendations to reduce the risk of onset or deterioration of myopia are to spend at least one hour outside in natural light every day, and to avoid reading or looking at your smartphone too closely. . A reading distance greater than 30 cm is recommended.

• What are the complications related to myopia?

High myopia can be complicated by retinal detachment, glaucoma, macular problem, or early cataract. Regular ophthalmological follow-up is therefore essential.

• What are the treatments ?

Myopia can be corrected by glasses with concave (negative) lenses, by contact lenses or, in adults, by refractive laser surgery. In children, the progression can, in some cases, be slowed by the instillation of very dilute Atropine eye drops, or by the use of certain types of contact lenses.

ASTIGMATISM

• What is astigmatism?

Astigmatism is a refractive visual defect characterized by an irregularity of the cornea (the transparent structure at the front of the eye, the "glass" of the eye). Rather than being smooth like the surface of a football, the cornea is distorted, its curvature varying along the axis, much like a rugby ball. Astigmatism is very often associated with myopia or hyperopia.

• What are the signs ?

Astigmatism causes blurred and distorted vision at all distances, often more marked in a certain orientation. Visual blurring can also cause confusion of letters or numbers. Visual blurring can cause or aggravate eyestrain, especially when reading, and cause headaches.

• What are the screening methods?

Astigmatism is detected by an examination of visual acuity, then refraction. In children and young adults, the use of cycloplegiatic drops, which temporarily paralyze the focusing power of the eye (accommodation) is most often necessary to obtain a reliable measurement of hyperopia. Screening and early management of refractive disorders is essential in children, in order to avoid amblyopia.

• What are the risk factors?

The irregularity of the cornea can be aggravated by frequent rubbing of the eyes. An infection or injury to the eye can also cause or worsen astigmatism.

• What are the treatments ?

Astigmatism can be corrected by glasses with toric (cylindrical) lenses, by toric contact lenses or, in adults and in some cases, by refractive laser surgery.

PRESBYOPIA

• What is presbyopia?

Presbyopia is a natural evolution of sight that concerns everyone from the age of forty, myopes and farsighted people included. It increases until the age of 65.

The lens gradually loses its ability to change shape and accommodates with difficulty. This results in an increasing difficulty in seeing up close. At first, you can compensate by putting the newspaper further away. Subsequently, this defect is corrected by reading glasses, work glasses, glasses or progressive or multifocal contacts.

• What treatment for presbyopia?

Refractive laser surgery can improve distance vision by slightly modifying the shape of the cornea. However, nothing can be done against the gradual loss of accommodation. After the operation, like anyone with good distance vision, you will probably need to wear reading glasses after age 40.

For myopia, however, it is possible to avoid wearing reading glasses by not completely correcting one eye to help near vision, while treating the other eye for distance vision. This technique, called "monovision", is not always well tolerated due to the imbalance that exists between the two eyes. This is why we only offer monovision to our patients who have previously experienced it with contact lenses and who know that this technique is suitable for them.

Hyperopic patients or patients with normal vision can benefit from a multifocal intraocular implant.

A benign eyelid cyst

• What is a chalazion?

A chalazion takes the form of a benign cyst on the inside or outside of the eyelid, due to inflammation of one or more glands called the Meibomian. These glands produce meibum, an oily substance that contributes to the good health of the eye. Sometimes it happens that this meibum becomes too thick, preventing its outflow from the gland. The latter becomes clogged and encysts, causing a chalazion, a benign cyst of the eyelid.

• What are the symptoms ?

The chalazion tends to grow slowly and sometimes painlessly. It is manifested by the presence of a lump or cyst inside or outside the eyelid. The latter is often inflamed and/or swollen. Yellowish secretions are also observed.

• What are the risk factors?

The origin of the chalazion cannot be precisely defined. However, there are various factors that favor its appearance:

Blepharitis (inflammation of the eyelids)
Seborrheic dermatitis (skin disease causing redness and dry skin)
Allergies
Air pollution
Dry eyes
Wearing contact lenses
Certain autoimmune, bacterial or parasitic diseases
Exposure to solar rays (UV)
How to prevent a chalazion?
Care must be taken to have good eyelid hygiene, in particular by carefully removing make-up and avoiding cosmetics that are too old, which involve a risk of bacterial contamination.

In the event of recurrent chalazion, it is recommended to regularly apply hot water compresses or a washcloth to the closed eyelids for five minutes, then massage them.

Most chalazions resolve on their own by strictly following eyelid hygiene guidelines

• What are the treatments for chalazion?

It is important not to break through a chalazion. Most chalazions can be treated by simply following a few hygiene rules:

First, it's important to wash your hands thoroughly before and after touching your eyes.

It is advisable to apply compresses or a washcloth soaked in warm water on the closed eyelids, two to three times a day minimum, for 5 to 10 minutes.

It is possible to massage the eyelids starting from the center towards the eyelashes, in order to allow the liquid (meibum) to flow out of the glands. If this is not enough, drug treatment may be necessary, in the form of anti-inflammatory or antibiotic ointments to be applied to the eyelid.

When drug treatments have not produced results after two months, surgery under local anesthesia is used to remove the chalazion.

Posterior vitreous detachment and floaters

• What is posterior vitreous detachment?

The vitreous body is a gelatinous substance that fills a large part of the eyeball and is in contact with the retina (nerve tissue that lines the inner wall of the eye). With aging, this gel gradually liquefies, contracts and then detaches from the retina, creating clusters of opaque substance visible in the visual field. In most cases, the presence of these spots, although bothersome, does not prevent good eyesight.

This phenomenon, called posterior vitreous detachment, is therefore a natural process linked to the aging of the eye which affects around two-thirds of people over the age of 80.

• What are the symptoms ?

Symptoms usually appear suddenly and are often seen as a hair in front of the eye or smudges on the glasses.

These vitreous opacities explain the presence of small blackish-grayish spots, called floaters, which move in the field of vision with the movement of the eyes. They are often described by patients as flies, filaments or a spider's web. Although annoying and a source of concern, this phenomenon resolves in the majority of cases without sequelae after a few weeks. Floaters are often accompanied by flashes of light, usually noticed on the side, more visible in dim light or darkness.

• What means of prevention?

Given its natural origin, there is no prevention. However, this vitreous detachment can be favored and accelerated by certain factors such as ocular trauma, eye surgery (for example cataract surgery) and high myopia (vitreous detachment being more frequent and early in These persons).

• What are the treatment options for vitreous detachment?

There is currently no non-invasive treatment. Since vitreous detachment occurs gradually over several weeks, symptoms will persist during this time. In the vast majority of cases, a gradual decrease in symptoms is observed. After a few weeks the floaters will only be seen in certain situations (in front of a screen, looking at the sky or a white wall).

Despite the absence of treatment, it is very important to carry out a control visit approximately 3 weeks after the onset of symptoms in order to quickly detect the occurrence of possible complications, such as hematovitreous (hemorrhage inside the eye) or retinal tear. These complications are rare but require more frequent follow-up and, in the case of a tear, outpatient treatment with laser is necessary.

In the very rare cases where symptoms persist after several months and if they affect quality of life, surgical treatment may be offered to remove all floaters.