Rapid Classification of Posterior Vitreous Detachment Status

“This presentation will change your life,” said David M. Brown, MD, during Saturday’s Retina Subspecialty Day. Specifically, he said, a simple five-second OCT scan of the retinal nerve fiber layer (RNFL) can accurately assess posterior vitreous detachment (PVD) status, allowing for better diagnosis and treatment of vitreomacular pathology and retinal detachment surgery. “You no longer have to fret, wondering if there is a PVD or not.”

How old is your patient? Do you think you know what to expect, given a patient’s age? Think again. The commonly used age ranges for PVD are too narrow, Dr. Brown said. “Vitreous separation begins in most eyes before the third decade”—and 35% of those in their 70s and 15% of those in their 80s do not have a total PVD.

Which stage is it? Dr. Brown and his colleagues evaluated 2,002 eyes with RNFL and macular volume scans. Of these, 2,000 eyes (99.9%) could be classified according to the following distinct stages:

• Stage A. “This stage is super simple,” Dr. Brown said, as there is no evidence of RNFL separation.

• Stage B. “B stands for the beginning” of lamellar RNFL vitreous separation, Dr. Brown said. In an illustrative scan taken in a 12-year-old, a distinct linear signal, indicating the initiation of separation, could be seen.

• Stages C and C+. C stands for complications. PVD starts with papillomacular bundle RNFL separation, Dr. Brown said. Vitreomacular traction (VMT) and macular hole may be evident. In every case, vitreopapillary adhesion was confirmed on volume scan over the optic disc. In stage C+, foveal release is involved. “It can separate in a good way, in that you don’t have foveal pathology,” Dr. Brown said. “What this shows us is that you should [take a scan] before you do macular hole surgery, to figure out where to engage the vitreous,” Dr. Brown said. Of note, Dr. Brown said, 83% of VMT/macular holes are at stage C or C+.

• Stage D. D stands for done: “This is easy; you see nothing,” Dr. Brown said. At this point, a complete PVD has occurred.—Jean Shaw

Financial disclosures: Dr. Brown: Adverum: C; Allegro: C,S; Allergan: C,S; annexon: C; Apellis: C,S; Astellas: S; Avalanche: S; Boehringer Ingelheim: C,S; Carl Zeiss: C; Clearside: C,S; Genentech: C,S; Heidelberg: C; Iconic: S; Janssen: C; Johnson & Johnson: C; Kanghong Pharma: C; NEI: S; Notal Vision: C; Novartis/Alcon: C,S; Ohr: C,S; Ophthotech: C,S; Opthea: S; Optos: C,P; Optovue: C; Pfizer: C; PRN: S; Regeneron: C,S; Regenix Bio: C,S; Samsung Bioepsis: C,S; Samsung: C,S; Santen: C,S; SciFluor Life Sciences: S; Second Sight: S; Senju Pharmaceutical: C; Stealth Biotherapeutics: C; Taiwan Liposome: S; ThromboGenics: C,S; Tyrogenix: C,S; Vinci: C.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Lecture Fees; O = Equity Owner; P = Patents/Royalty; S = Grant Support.