Narrative review outlines risk stratification and selective intervention for peripheral retinal degenerationsNew imaging helps doctors decide when to treat risky eye spots before tears form

Frontiers in Medicine Published May 17, 2026 DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider selective prophylactic laser for symptomatic tears or confirmed tractional instability in peripheral retinal degenerations.

This narrative review examines the management of patients with peripheral retinal degenerations, retinal tears, and rhegmatogenous retinal detachment. The authors synthesize findings from 29 studies to propose a functional stratification of PRD into low-risk atrophic lesions, intermediate entities, and high-risk tractional lesions. They highlight that PVD represents the key biomechanical event linking PRD with retinal tears and retinal detachment, particularly during acute symptomatic stages.

The review emphasizes the utility of wide-field imaging and swept-source optical coherence tomography for visualizing peripheral morphology. These tools enable differentiation between benign lesions, tractionally unstable configurations, and subclinical retinal detachment. The authors suggest that AI-assisted decision support may help standardize risk interpretation by integrating multimodal imaging features with clinical risk modifiers within a human in the loop model.

Current evidence supports selective prophylactic laser photocoagulation in eyes with symptomatic retinal tears, fellow eye retinal detachment, or OCT confirmed tractional instability. Conversely, routine treatment of asymptomatic low-risk PRD is not justified. The authors note that clinical relevance and management of many PRD remain controversial. Practice should be individualized using integrated clinical assessment and multimodal imaging, with intervention targeted to tractional instability and meaningful risk modifiers.

Many people have small changes in their retina that look scary but might not need treatment. This review looked at 29 studies to help doctors decide when to act. It found that not every spot needs fixing. Some are harmless, while others need attention if they pull on the retina.

The review explains that a specific eye event called posterior vitreous detachment often links these spots to tears. New tools like wide-field imaging and advanced scans make it easier to see these differences. This helps separate harmless lesions from those that are pulling on the retina.

Doctors should use selective treatment for eyes with symptoms or confirmed pulling. Routine treatment for low-risk spots is not justified. Artificial intelligence can help standardize how doctors interpret these risks. However, managing these conditions remains controversial. Each case needs individualized assessment using clinical judgment and imaging.

What this means for you:

Doctors should use imaging to target treatment only to eyes with confirmed pulling or symptoms.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

IntroductionPeripheral retinal degenerations (PRD) encompass a broad spectrum of peripheral retinal alterations, ranging from benign atrophic changes to tractional lesions associated with retinal tears (RT) and rhegmatogenous retinal detachment (RRD). Despite increasing detection with modern peripheral imaging, the clinical relevance and management of many PRD remain controversial. This review aims to provide an imaging guided, risk based framework for PRD evaluation and management, emphasizing the role of posterior vitreous detachment (PVD), selective prophylactic intervention, and emerging AI-assisted risk stratification and decision support concepts.MethodsA narrative literature search was conducted in PubMed, Scopus, and Web of Science (January 2000 to September 2025) using predefined terms related to PRD, vitreoretinal traction, RT, RRD, PVD, ultra widefield (UWF) imaging, and peripheral OCT. Of 842 records identified, 29 studies met inclusion criteria and were qualitatively synthesized.ResultsPRD can be functionally stratified into low risk atrophic lesions (paving stone degeneration, WWOP), intermediate entities (degenerative retinoschisis), and high risk tractional lesions (lattice degeneration, snail track degeneration, retinal tufts). PVD represents the key biomechanical event linking PRD with RT and RRD, particularly during acute symptomatic stages. UWF imaging and SS-OCT improve visualization of peripheral morphology and vitreoretinal interface abnormalities, enabling differentiation between benign lesions, tractionally unstable configurations, and subclinical RRD. Current evidence supports selective prophylactic laser photocoagulation in eyes with symptomatic RT, fellow eye RRD, or OCT confirmed tractional instability, while routine treatment of asymptomatic low risk PRD is not justified. AI-assisted decision support may help standardize risk interpretation by integrating multimodal imaging features with clinical risk modifiers within a human in the loop model.ConclusionPRD management should be individualized using integrated clinical assessment and multimodal imaging, with intervention targeted to tractional instability and meaningful risk modifiers.

Narrative review outlines risk stratification and selective intervention for peripheral retinal degenerationsNew imaging helps doctors decide when to treat risky eye spots before tears form

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Narrative review outlines risk stratification and selective intervention for peripheral retinal degenerationsNew imaging helps doctors decide when to treat risky eye spots before tears form

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