White Without Pressure (WWOP)

Retinal white without pressure (WWOP) is a common retinal condition

that is reported to occur in up to 30% of the general population. One
study found WWOP in 2.5% of whites and 23% of blacks. The incidence
of WWOP increases with age; it has been estimated to occur in
approximately 5% of eyes under age 20 years and 66% of eyes over age
70 years. Individuals with increased axial length (high degrees of
nearsightedness) are more likely to develop WWOP.

Retinal WWOP appears as an area of the retina that is translucent white

to gray in color and often is bounded posteriorly by a reddish-brown line.
This condition can mimic the appearance of a shallow retinal detachment.
WWOP may have scalloped posterior borders (suggested to be a sign of
possible progression) and has been noted to be migratory in nature;
sequential fundus examination reveals that the size, shape, and location
of WWOP may change over time. Areas of WWOP frequently are
associated with lattice degeneration and snowflake degeneration. WWOP
may be circumferential and usually occurs bilaterally.
WWOP usually is associated with vitreous degeneration and posterior vitreous detachment (PVD).
Horseshoe retinal tears or linear retinal tears can develop along the posterior border of WWOP, and these
tears are associated with the traction of PVD.

In the management of a patient with WWOP, it is important to consider factors that are contributory to the
development of retinal breaks, such as the presence of lattice degeneration, of scalloped borders (suggesting
progression over time), of shrinkage of the vitreous (the jelly-like fluid filling the eye), or of an elevated
tractional membrane.

Patients with WWOP should be followed at 1- to 2-year intervals, depending on the presence of other
associated risk factors. The patient should be reexamined every 6 months if the posterior borders of the
WWOP are scalloped and there is extensive vitreous degeneration. As patients reach their 40s and 50s, there
is a general increase in the risk of associated retinal breaks and detachment because of increased vitreous
liquefaction and/ or vitreous detachment (PVD). Caution should be exercised in managing patients with high
myopia because of the association between increased axial length and detachment. It is important to inform
patients about the signs and symptoms of retinal detachment and watch carefully for breaks that may
develop at the posterior border of the lesion.

The most important consideration in the management of WWOP is the vitreoretinal traction related to this
condition. Vitreoretinal traction is known to be associated with WWOP and is strongly implicated in the
genesis of retinal tears and subsequent retinal detachments. Patients with this condition should know that it
carries a low risk for complications but that it is important to report symptoms or signs of traction and breaks
immediately.