Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography

Objective: To promote understanding of the development of posterior vitreou s detachment (PVD) in healthy eyes using optical coherence tomography (OCT) . Methods: We studied 209 eyes of 209 healthy volunteers (165 men and 44 wome n; mean age, 52.3 years [range, 31-74 years]). In addition to biomicroscopy and ophthalmoscopy, OCT was performed to obtain high-resolution cross-sect ional images of the vitreoretinal interface in the posterior fundus. Results: The condition of the posterior vitreoretinal interface was classif ied as 1 of 5 stages, according to biomicroscopic findings and OCT images r elative to discrete linear signals indicating a detached posterior vitreous face: stage 0, no PVD (61 eyes [29.2%]); stage 1, incomplete perifoveal PV D in up to 3 quadrants (100 eyes [47.8%]); stage 2, incomplete perifoveal P VD in all quadrants, with residual attachment to the fovea and optic disc ( 26 eyes [12.4%]); stage 3, incomplete PVD over the posterior pole, with res idual attachment to the optic disc (4 eyes [ 1.9%]); or stage 4, complete P VD identified with biomicroscopy, but not with OCT because of instrument li mitations (18 eyes [8.6%]). Stage 1, 2, and 3 incomplete PVD without subjec tive symptoms was not recognizable on contact lens biomicroscopy. There was a significant age-related progression in the condition of the vitreoretina l interface from stage 0 to stage 4. The superior quadrant was usually the initial site of incomplete PVD. Conclusions: Optical coherence tomography demonstrates that healthy human e yes have incomplete or partial PVD beginning as early as the fourth decade of life. Age-related PVD occurs initially as a focal detachment in the peri fovea of 1 quadrant, with persistent attachment to the fovea and optic nerv e head, with a predilection for the superior quadrant. It extends its range slowly for years and eventually results in complete PVD, associated with r elease of vitreopapillary adhesion.