Lattice Degeneration: Symptoms, Types, Causes and Treatment

Lattice degeneration is a common yet often misunderstood retinal condition that can have serious consequences if left undetected. While many people with lattice degeneration may never experience vision-threatening complications, for others, it can be a precursor to retinal tears and detachment—a leading cause of preventable blindness. In this comprehensive article, we’ll break down the key aspects of lattice degeneration, including its symptoms, types, causes, and the latest evidence-based treatment strategies. Let’s dive in.

Symptoms of Lattice Degeneration

Lattice degeneration often lurks silently, causing no symptoms in many individuals. However, being aware of its possible manifestations is crucial—especially for those at higher risk, such as people with significant myopia or a family history of retinal issues.

Symptom	Description	Frequency/Population	Source(s)
None	Most cases are asymptomatic	General population	2 11 15
Flashes	Brief light streaks, often in peripheral vision	May occur if retinal tears develop	2 9 15
Floaters	Small spots or cobweb-like shadows in vision	Especially with vitreous traction	2 9 15
Visual field loss	Peripheral shadow or loss of vision	If retinal detachment occurs	7 9

Table 1: Key Symptoms

Asymptomatic Nature

In most people, lattice degeneration causes no symptoms at all. It is typically discovered during a routine dilated eye exam by an ophthalmologist or optometrist. The lack of symptoms can be deceptive and underscores the importance of regular eye check-ups, especially for those at risk 2 11 15.

Symptomatic Complications

When symptoms do occur, they are often related to complications:

• Flashes and floaters: These may signal the development of a retinal tear or detachment. Flashes are caused by traction on the retina, while floaters represent small fragments of vitreous gel or blood casting shadows on the retina 2 9 15.
• Peripheral vision loss: Sudden loss or shadowing in the peripheral vision may indicate a retinal detachment, which is a medical emergency 7 9.

When to Seek Medical Attention

If you notice new flashes, a sudden increase in floaters, or any change in your peripheral vision, prompt evaluation by an eye care professional is essential. Early detection and treatment can prevent irreversible vision loss.

Types of Lattice Degeneration

Lattice degeneration is not a one-size-fits-all condition. Its presentations can vary, and understanding its types helps guide monitoring and management.

Type	Key Characteristics	Risk Profile	Source(s)
Typical	Sharply demarcated, circumferential, retinal thinning	Most common, at/near equator	1
Atrophic Holes	Round holes within lattice areas	Higher RD risk in young myopes	7 9
Tractional Tears	Tears at edge due to vitreous traction	Older, less myopic patients	7
Atypical Vessels	Abnormal vessel patterns within lattice	Diagnostic angiographic marker	2

Table 2: Types of Lattice Degeneration

Typical Lattice Degeneration

The classic form is characterized by well-defined, circumferential regions of thinning, often found at or just in front of the eye’s equator. These patches can be accompanied by pigment changes, sclerotic vessels, and overlying vitreous abnormalities 1.

Atrophic Holes

Within areas of lattice, round, atrophic holes can develop. These holes are a key risk factor for retinal detachment, especially in young, myopic individuals. They often lead to slowly progressive, inferior detachments 7 9.

Tractional (Tear-Associated) Lattice

Tears can form at the posterior edge or end of a lattice patch due to abnormal vitreous traction. This is seen more commonly in older, less myopic patients and can result in acute, more rapidly progressing detachments 7.

Lattice with Atypical Vessels

Some cases show characteristic angiographic patterns with atypical vessels within the degenerated area. While primarily a diagnostic finding, it highlights the diversity within lattice degeneration presentations 2.

Causes of Lattice Degeneration

Why does lattice degeneration occur? The answer is multifactorial, involving genetic, anatomical, and possibly environmental influences.

Cause/Factor	Description	Population/Risk Group	Source(s)
Genetic Susceptibility	Variants in COL2A1, COL4A4 genes	Familial clusters; Japanese cohort	8 10
High Myopia	Axial elongation increases risk	Especially without staphyloma	3 12
Age	More common with age, but detachments skew young	Young myopes at greatest risk	9 12
Vitreous Abnormality	Vitreous thinning/traction at lattice sites	Contributes to tears/detachments	1 3 7

Table 3: Causes and Risk Factors

Genetic Factors

Recent genetic studies have identified associations between lattice degeneration and variations in specific collagen genes, such as COL4A4 and COL2A1. These findings suggest a hereditary component, particularly in some populations (e.g., Japanese cohorts) 8 10.

High Myopia

Lattice degeneration is notably more prevalent in individuals with high myopia. In highly myopic eyes, especially those with generalized elongation (without posterior staphyloma), the risk increases significantly 3 12. The stretching of the eye may lead to retinal thinning and predispose to lattice changes.

Age and Refractive Status

While lattice degeneration can occur at any age, it is often detected in young adults, with the risk of retinal detachment clustering in the second to fourth decades of life among those with significant myopia 9 12. In contrast, the risk is much lower in emmetropic (normal) eyes.

Vitreous and Retinal Structural Changes

Abnormalities of the vitreous gel, especially where it adheres tightly to thinned retinal areas, contribute to the development and progression of lattice degeneration. Traction from the vitreous on these weakened areas can lead to tears and, ultimately, detachment 1 3 7.

Treatment of Lattice Degeneration

Managing lattice degeneration requires a nuanced, evidence-based approach. While preventive treatments are available, not every patient with lattice degeneration will benefit from intervention.

Treatment Option	Indication/Use	Evidence/Consensus	Source(s)
Observation	Most asymptomatic cases	Strong; low RD risk	11 12 15
Laser Photocoagulation	Symptomatic tears; high-risk asymptomatic lesions	Select cases; debated	11 13 14
Cryotherapy	Alternative to laser for selected lesions	Similar indications	14 15
Scleral Buckling	Rare; selected high-risk or surgical settings	Limited; rare use	14

Table 4: Treatment Approaches

Observation: The Standard for Most

The vast majority of people with lattice degeneration do not require treatment. Studies show that prophylactic therapy (treating asymptomatic lattice to prevent detachment) offers little benefit for most, especially for those without high myopia or additional risk factors 11 12 15. Regular monitoring with dilated exams is generally recommended.

Prophylactic Treatment: Who Might Benefit?

• Symptomatic Lesions: If a patient has symptoms (flashes, floaters) and a retinal tear or hole is identified, laser photocoagulation or cryotherapy may be recommended to create a barrier and reduce the risk of detachment 11 14 15.
• High-Risk Groups: Patients with high myopia (> -5.0 D), a history of detachment in the other eye, or extensive lattice may be considered for prophylactic treatment, but the benefit remains controversial 12 13 14.
• Fellow Eyes: In patients who have suffered a detachment in one eye, the risk in the fellow eye is elevated. Prophylactic treatment may modestly reduce the risk, but the absolute benefit is small 13 14.

Evidence and Controversies

The current literature does not provide robust evidence supporting routine prophylactic treatment for asymptomatic lattice degeneration. Most recommendations are based on expert consensus, and randomized controlled trials are lacking 11 15. While treatment can reduce the incidence of new breaks or detachments in some high-risk scenarios, it does not eliminate the risk and may not benefit all patients 13 14.

Surgical Options

Surgical approaches like scleral buckling are rarely used as a preventive measure and are generally reserved for complex or refractory cases 14.

Conclusion

Lattice degeneration is a fascinating and important retinal disorder that straddles the line between benign finding and serious risk factor for vision loss. Understanding its symptoms, types, causes, and treatment options empowers patients and clinicians alike to make informed decisions.

Key Takeaways:

• Most cases are asymptomatic and discovered during routine eye exams.
• There are several types, with typical lattice, atrophic holes, and tractional tears carrying different risks for retinal detachment.
• High myopia, genetic predisposition, and vitreous changes are key risk factors.
• Prophylactic treatment is not indicated for most; it may be considered for certain high-risk individuals, but robust evidence is lacking.
• Regular, comprehensive eye exams remain the cornerstone of managing lattice degeneration.

Stay vigilant and proactive with your eye health—especially if you have known risk factors for lattice degeneration. Early detection and timely intervention can make all the difference.