Clinically Relevant Posterior Vitreous Detachment Staging Using Circumpapillary and Macular Volume Optical Coherence Tomography

Purpose: This study was designed to investigate retinal nerve fiber layer (RNFL) circumpapillary optical coherence tomography (C-OCT) to determine posterior vitreous detachment (PVD) status and to develop a clinically relevant PVD grading scale based on RNFL C-OCT to determine the incidence of PVD by age and association with vitreomacular traction disorders. Methods: Ophthalmic images and medical records of retina patients were retrospectively analyzed by three masked graders using RNFL C-OCT and macular OCT (M-OCT). Based on PVD status, eyes were categorized into five newly defined PVD stages. Results: Among 2002 eyes, PVD stages were: A) 25 (1.25%); B) 725 (36.21%); C-) 248 (12.39%); C+) 151 (7.54%); D) 851 (42.51%); X) 2 (0.1%). PVD was correlated with advanced age (P<<0.0001). Limited separation or partial separation between lamella within the posterior vitreous cortex (stage B) was noted early (68% of eyes <18 years). 34% of eyes >70 years did not exhibit complete PVD. Of 75 eyes with tractional vitreoretinal disorders, 64 (85.3%) were stage C-/C+, identifying stage C as the high risk “complication” stage. Conclusion: Imaging analyses using RNFL C-OCT and M-OCT scans in conjunction allows rapid assessment of PVD stage. These techniques can assist clinicians and surgeons in counseling patients and planning surgical approach. Observations confirmed progression of PVD through predictable stages and progression of PVD with age.