Background

Lattice degeneration is a common, atrophic disease of the peripheral retina characterized by oval or linear patches of retinal thinning.^{[1, 2]}The prevalence peaks by the second decade and is believed to be minimally progressive but may be complicated by retinal breaks and retinal detachment.^[3] Lattice degeneration elevates the risk for retinal detachment but does not require treatment if it is asymptomatic.

Next: Pathophysiology

Pathophysiology

The pathogenesis of lattice degeneration is not well understood, although several theories have been proposed.^[4]Regional maldevelopment or absence of the internal limiting membrane versus abnormal vitreoretinal traction dynamics appear to be the most cogent arguments proposed.

Next: Pathophysiology

Epidemiology

Frequency

United States

Lattice degeneration affects approximately 10% of the population and is bilateral in 30-50% of patients who are affected. A variable familial risk may be present on the basis of various autosomal dominant pedigrees.^[5]An increased prevalence exists in myopic eyes, and its prevalence may be associated with increasing axial length, reaching 15% in the longest eyes.

International

No information is available regarding the international occurrence of lattice degeneration.

Mortality/Morbidity

See discussion of retinal detachment in History and Physical.

Race

No reported racial differences exist in lattice degeneration.

Sex

No reported sex differences exist in lattice degeneration.

Age

See History regarding early onset and progression with age.

Next: Pathophysiology

Prognosis

The prognosis of lattice degeneration is generally good.

Next: Pathophysiology

Patient Education

Educate the patient on signs of retinal detachment.

Encourage annual follow-up for dilated eye examinations.

Patients with lattice degeneration need to be made aware of their condition and should be warned about the increased lifetime risk of retinal tears or detachment. They should be advised to see an eye doctor immediately if they develop symptoms of retinal tears or detachments, including new floaters, flashes of light, decreasing vision, or a "curtain" in their vision.

Clinical Presentation

Straatsma BR, Zeegen PD, Foos RY, et al. Lattice degeneration of the retina. XXX Edward Jackson Memorial Lecture. Am J Ophthalmol. 1974 May. 77(5):619-49. [QxMD MEDLINE Link].
Byer NE. Lattice degeneration of the retina. Surv Ophthalmol. 1979 Jan-Feb. 23(4):213-48. [QxMD MEDLINE Link].
Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. Am J Ophthalmol. 2003 Jul. 136(1):155-60. [QxMD MEDLINE Link].
Meguro A, Ideta H, Ota M, Ito N, Ideta R, Yonemoto J, et al. Common variants in the COL4A4 gene confer susceptibility to lattice degeneration of the retina. PLoS One. 2012. 7(6):e39300. [QxMD MEDLINE Link]. [Full Text].
Edwards AO, Robertson JE Jr. Hereditary vitreoretinal degenerations. Ryan SJ, ed. Retina. 3rd ed. St. Louis: Mosby; 2001. 482-98.
Byer NE. Long-term natural history of lattice degeneration of the retina. Ophthalmology. 1989 Sep. 96(9):1396-401; discussion 1401-2. [QxMD MEDLINE Link].
Foos RY, Simons KB. Vitreous in lattice degeneration of retina. Ophthalmology. 1984 May. 91(5):452-7. [QxMD MEDLINE Link].
Gonzales CR, Gupta A, Schwartz SD, Kreiger AE. The fellow eye of patients with rhegmatogenous retinal detachment. Ophthalmology. Mar 2004. 111:518-521. [QxMD MEDLINE Link].
Gonzales CR, Gupta A, Schwartz SD, Kreiger AE. The fellow eye of patients with phakic rhegmatogenous retinal detachment from atrophic holes of lattice degeneration without posterior vitreous detachment. Br J Ophthalmol. 2004 Nov. 88(11):1400-2. [QxMD MEDLINE Link].
Folk JC, Arrindell EL, Klugman MR. The fellow eye of patients with phakic lattice retinal detachment. Ophthalmology. 1989 Jan. 96(1):72-9. [QxMD MEDLINE Link].
Ho TC, Ho A. Long-term natural course of lattice degeneration of the retina in high myopic eyes - A ten-year long term study. Investigative Ophthalmology & Visual Science. 2015. 56 (7):
Ung T, Comer MB, Ang AJ, Sheard R, Lee C, Poulson AV, et al. Clinical features and surgical management of retinal detachment secondary to round retinal holes. Eye. Jun 2005. 19:665-669. [QxMD MEDLINE Link].
Maltsev DS, Kulikov AN, Shaimova VA, et al. Spotlight on Lattice Degeneration Imaging Techniques. Clin Ophthalmol. 2023. 17:2383-2395. [QxMD MEDLINE Link]. [Full Text].
Avitabile T, Bonfiglio V, Reibaldi M, et al. Prophylactic treatment of the fellow eye of patients with retinal detachment: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2004 Mar. 242(3):191-6. [QxMD MEDLINE Link].
Wilkinson CP. Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration. Ophthalmology. 2000 Jan. 107(1):12-5; discussion 15-8. [QxMD MEDLINE Link].
Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. 2005. CD003170. [QxMD MEDLINE Link].
Mastropasqua L, Carpineto P, Ciancaglini M, Falconio G, Gallenga PE. Treatment of retinal tears and lattice degenerations in fellow eyes in high risk patients suffering retinal detachment: a prospective study. Br J Ophthalmol. Sep 1999. 83:1046-1049. [QxMD MEDLINE Link].
Curran CD, Adams OE, Vagaggini T, Sodhi GS, Prairie ML, Baker MJ, et al. PROPHYLACTIC TREATMENT OF LATTICE DEGENERATION IN FELLOW EYES AFTER REPAIR OF UNCOMPLICATED PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT. Retina. 2024 Jan 1. 44 (1):63-70. [QxMD MEDLINE Link]. [Full Text].
Kristian P, Cholevík D. LASER THERAPY OF RETINAL TEARS. Cesk Slov Oftalmol. 2023 Spring. 79 (3):126-133. [QxMD MEDLINE Link]. [Full Text].
Orlin A, Hewing NJ, Nissen M, Lee S, Kiss S, D'Amico DJ, et al. Pars plana vitrectomy compared with pars plana vitrectomy combined with scleral buckle in the primary management of noncomplex rhegmatogenous retinal detachment. Retina. 2014 Jun. 34(6):1069-75. [QxMD MEDLINE Link].
Wilkinson CP. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. 2014 Sep 5. 9:CD003170. [QxMD MEDLINE Link].

Media Gallery

Example of a lattice lesion containing white crisscrossing wicker lines, which are seen in about 10% of lattice lesions. This lesion is complicated by an extensive retinal tear at the cuff of the lesion.
Another example of wicker lines seen within a lattice lesion. Prophylactic retinopexy has been performed around this lesion.
An example of a flap tear at the edge of a lattice lesion and three adjacent holes. This area of lattice degeneration has been barricaded by laser retinopexy.
A large horseshoe tear at the opposite edge of the lattice lesion pictured above. Laser retinopexy surrounds the tear and lattice lesion.
A peripheral lattice lesion demonstrating the typical snail-track appearance, with overlying vitreal opacities, which may represent glial proliferations or regions of increased vitreoretinal condensation.
An example of a heavily pigmented lattice lesion.
An acute rhegmatogenous retinal detachment that may be associated with lattice degeneration. (Lattice lesion not seen in this image.)
Another example of a peripheral lattice lesion with a snail-track appearance.
Lattice lesion containing small atrophic holes.
Radial perivascular chorioretinal degeneration with retinal tear at the margin. These lesions run along vessels and may be found in Wagner's and Stickler's disease.

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Author

Hemang K Pandya, MD, FACS Vitreoretinal Specialist, Dallas Retina Center; President, American Retina Forum

Hemang K Pandya, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Michigan Society of Eye Physicians & Surgeons, Michigan State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ilya (Eli) M Sluch, MD Fellow in Cornea, Bascom Palmer Eye Institute

Ilya (Eli) M Sluch, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Stanley M Saulny, MD Consulting Staff, Department of Ophthalmology, Ophthalmology Associates of the Valley

Stanley M Saulny, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Writers Association, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

David Sarraf, MD Associate Clinical Professor of Ophthalmology, Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, UCLA Geffen School of Medicine, Greater Los Angeles Veterans Affairs Healthcare System

David Sarraf, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Alex Yuan, MD, PhD EyeSTAR Resident and Postdoctoral Fellow, Department of Ophthalmology, Jules Stein Eye Institute at University of California, Los Angeles

Alex Yuan, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

This review was partly supported by a Research to Prevent Blindness Grant #OP 31 for David Sarraf, MD.