LATTICE DEGENERATION

Lattice Degeneration

Section 1

Definition & epidemiology

Yannuzzi LA. The Retinal Atlas, 2nd ed.

Lattice degeneration is a common peripheral vitreoretinal disorder present in 6–10% of the population. It is a clinically significant finding in that it is associated with approximately 20–30% of rhegmatogenous retinal detachments. However, only approximately 1% of eyes with lattice degeneration develop a retinal detachment.

Lattice degeneration can manifest a variety of fundus appearances, the most common being circumferentially oriented linear or ovoid lesions that are sometimes crossed by whitish lines which represent hyalinized retinal vessels. Other features include a reddish crater-like appearance, superficial whitish yellow flecks, and varying degrees of pigmentary alterations.

On histopathologic examination, lattice degeneration consists of a localized thinning of the inner retinal layers, a pocket of overlying liquefied vitreous, and abnormal attachments of the formed vitreous at the margins of the lesion. In some eyes, retinal detachment may occur secondary to retinal tears that develop in areas remote from the lattice degeneration.

6–10%

Population prevalence

20–30%

Of all RRD cases

~1%

Lifetime RD risk per eye

30–50%

Cases bilateral

Section 2

Clinical images

Peripheral retina showing lattice degeneration with pigment clumps and crosshatching of sclerotic vessels

Fig A — fundus ↗

Photograph of the peripheral retina demonstrates an area of lattice degeneration. Note the retinal thinning, which is characterized by a color change. There are also pigment clumps and crosshatching of sclerotic vessels, two features commonly observed in lattice degeneration. Hamid Ahmadieh, MD, Labbafinejad Medical Center. Retina Image Bank 2015; Image 25882. © 2018, American Society of Retina Specialists.

Ultra-widefield swept-source OCT cross-section of lattice degeneration showing retinal thinning and vitreous traction

Fig B — UWF SS-OCT ↗

UWF SS-OCT cross-section: retinal thinning and vitreous traction at lattice lesion margin. Kim & Choi, Korean J Ophthalmol 2023 (CC BY-NC)

Fig A: Hamid Ahmadieh, MD. Retina Image Bank 2015; Image 25882. © 2018, American Society of Retina Specialists. Used with permission. Fig B: Kim J & Choi KS, Korean J Ophthalmol 2023 (PMC10721405), CC BY-NC 4.0.

Section 3

Treatment options

Based on: Byer NE, Ophthalmology 1989 · Wilkinson C, Cochrane Database Syst Rev 2014 · Curran CD et al., Retina 2024 · Morris RE et al., Clin Ophthalmol 2025 · AAO PPP 2025

✓ Observation — preferred approach for asymptomatic lattice

0.7%

RD rate over avg 10.8 yrs in 423 untreated eyes (Byer 1989)

0.5%

RD risk over ~11 yrs, no fellow-eye RD (Cochrane / Byer 1998)

1.9%

Tractional tear rate — most observed without progression

0 / 74

Asymptomatic operculated holes progressing to RD (Byer + Davis)

Byer’s landmark prospective study of 276 consecutive untreated patients (423 eyes) followed up to 25 years found a clinical RD rate of just 0.7% of eyes. Most tractional tears were observed without treatment; only 1 of 8 led to RD. Subclinical RD in eyes with atrophic holes was common (6.7%) but carried a far more benign prognosis than clinical detachment. The Cochrane review (Wilkinson 2014) found no RCT evidence that prophylactic treatment reduces RD risk vs. observation in asymptomatic eyes.

Key caveat: Risk is not uniform. Observation is appropriate for low-risk asymptomatic eyes (emmetropic, no fellow-eye RD, no acute PVD). High-risk features — symptomatic horseshoe tears, fellow eye of RRD, high myopia with absent PVD — warrant individualized decision-making.

Focal laser retinopexy (photocoagulation)

Effectiveness In high-risk fellow eyes, reduced tear/RD from 41% → 17% (Curran 2024). For phakic eyes prior to cataract surgery: 31% → 22%. No RCT data in the general asymptomatic population; AAO PPP 2025 calls a prospective trial “necessary.”

Risks Epiretinal membrane formation reported. Most RDs still arise from previously normal-appearing retina, limiting overall effectiveness of focal treatment.

Cryotherapy

Effectiveness Alternative for anterior lesions inaccessible by slit-lamp. Cochrane 2014 found no RCT evidence supporting cryotherapy or laser over observation for asymptomatic breaks and lattice.

Risks Greater inflammatory response vs. laser; PVR risk with extensive use. Reserved for cases where laser is not practical.

Treat urgently: symptomatic horseshoe tears post-PVD, progressive subclinical detachment. Observe: asymptomatic lattice without high-risk features.

Definition & epidemiology

Clinical images

Treatment options

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