Lattice degeneration is a condition where patches of the peripheral retina become abnormally thin. It affects roughly 7 to 10% of the general population, making it one of the most common retinal findings eye doctors encounter during routine dilated exams. Most people with lattice degeneration never experience any symptoms or vision problems, but the condition matters because it creates weak spots in the retina that can, in rare cases, lead to retinal tears or detachment.
What Happens in the Retina
The retina is the light-sensitive tissue lining the back of your eye. In lattice degeneration, sharply defined oval or linear patches of this tissue thin out, typically in the far edges of the retina. These patches tend to run in a band-like pattern around the periphery of the eye. The inner layers of the retina are most severely affected. In some areas, the thinning is so pronounced that the normal retinal layers can no longer be distinguished from one another.
Several changes happen at the same time within these patches. The gel-like substance that fills the eye (the vitreous) becomes more liquid directly over the thinned areas. At the edges of each patch, however, the vitreous grips the retina more firmly than normal. This combination of liquefied vitreous over the lesion and tight adhesion at its borders is what creates the potential for problems later. Pigment changes and abnormal material deposits within the patches give them a characteristic appearance that eye doctors can identify during a dilated exam.
Who Gets It
Lattice degeneration peaks in prevalence during the teenage years and appears equally in men and women. It tends to run in families. First-degree relatives of people with lattice degeneration develop the condition about three times more often than the general population. The inheritance pattern is likely polygenic, meaning multiple genes contribute rather than a single one.
Nearsightedness (myopia) is a well-known risk factor. In one study of 218 people with severe myopia, 33% had lattice degeneration, far higher than the general population rate. Interestingly, the relationship isn’t straightforward: among severely nearsighted eyes, those with moderate myopia (roughly minus 6 to minus 9 diopters) had the highest prevalence at about 41%, while the most extremely nearsighted eyes (minus 24 diopters or greater) had a prevalence of only 7%. The condition frequently appears in both eyes.
Symptoms, or Lack of Them
Lattice degeneration by itself causes no symptoms. The thinned patches sit in the far periphery of the retina, an area that doesn’t contribute much to your central or functional vision. Most people learn they have it only when an eye doctor dilates their pupils and examines the retinal periphery for an unrelated reason.
Symptoms only appear if the condition leads to a retinal tear or detachment. Those warning signs include new floaters (small specks or threads drifting across your vision), flashing lights, a shadow or gray curtain blocking part of your visual field, or a sudden change in the clarity of your vision. These symptoms require urgent evaluation.
How Lattice Degeneration Leads to Retinal Tears
Two distinct types of retinal breaks can develop in areas of lattice degeneration, and they form through completely different mechanisms.
The first type is atrophic holes. These are small, round, full-thickness holes that form simply because the retina has thinned so much that it breaks down on its own. They develop slowly, aren’t caused by pulling forces, and usually don’t progress to retinal detachment. Many people with lattice degeneration have these tiny holes without ever knowing it.
The second type is horseshoe tears. These happen when the vitreous gel, which is firmly stuck to the edges of a lattice patch, pulls away from the retina during a process called posterior vitreous detachment (PVD). A PVD is extremely common with aging. As the vitreous separates, the tight adhesion at the lattice border can yank a flap of retina loose, creating a horseshoe-shaped tear. This type of tear is the more dangerous one because liquid vitreous can flow through the opening and peel the retina away from the wall of the eye, causing a retinal detachment.
Actual Risk of Retinal Detachment
Despite the concern lattice degeneration can cause when you first hear about it, the actual risk of retinal detachment is low. If you have lattice degeneration and your other eye has never had a detachment, the chance of developing a retinal detachment is less than 1% over roughly a decade of follow-up. That means the vast majority of people with this condition will never experience a detachment.
The risk goes up if you’ve already had a detachment in one eye. In that scenario, the chance of detachment in the fellow eye over seven years is between 2 and 5%. Even in this higher-risk group, untreated eyes develop detachment less than 10% of the time over five to seven years. That said, lattice degeneration is found in about 30% of retinal detachment cases, which means it’s a meaningful contributing factor when detachments do occur.
Treatment and Monitoring
Most lattice degeneration requires no treatment at all. Small atrophic holes within lattice patches that aren’t accompanied by significant fluid buildup under the retina and haven’t caused a vitreous detachment are generally left alone. They pose very little risk.
Treatment becomes necessary when a horseshoe tear develops, typically during or after a PVD. In that case, laser treatment or a freezing technique called cryotherapy is used to create a seal around the tear, preventing fluid from getting underneath the retina. The goal is to spot and treat these tears before they progress to a full detachment.
Preventive laser treatment of lattice patches that haven’t yet caused tears is a more debated question. A Cochrane review of the available evidence did not find strong support for routinely treating asymptomatic lattice lesions in an effort to prevent future detachments. Given that the baseline risk of detachment is under 1% for most people, blanket preventive treatment would mean treating many eyes that would never have had a problem.
What Follow-Up Looks Like
If you’ve been told you have lattice degeneration, the most important thing is periodic dilated retinal exams so your eye doctor can monitor for any changes. There’s no single recommended exam frequency that applies to everyone, but the key trigger for getting checked sooner is the onset of new symptoms. A sudden increase in floaters, new flashing lights, or any shadow in your peripheral vision should prompt an exam promptly, because these could signal a PVD pulling on a lattice lesion and creating a tear.
Regular monitoring also becomes more important if you’re highly nearsighted, if you have lattice degeneration in both eyes, or if you’ve had a retinal detachment in one eye. Eye surgery or procedures like cataract removal can also change the dynamics inside the eye, so your doctor may recommend an exam before and after such procedures. For most people, though, lattice degeneration is a condition to be aware of and monitor, not one that demands aggressive intervention.