Asteroid hyalosis is defined by the presence of white, snowball‐like non‐crystalline vitreous opacities that move with the vitreous and appear to be anchored to its matrix. Asteroid hyalosis commonly occurs in the absence of other identifiable ocular abnormalities and is usually an incidental finding. The vitreous opacities are usually invisible to the patient and asymptomatic, but asteroid hyalosis can be a significant obstacle to the examination of the fundus. The prevalence increases dramatically with age. The aetiology is unknown. We systematically reviewed the literature for epidemiological data, qualitatively reviewed available studies, conducted meta‐analyses with demographical stratifications, evaluated temporal changes and estimated the future prevalence using forecasting analysis. Nine eligible studies were identified with data on 104 569 individuals. The overall population prevalence of asteroid hyalosis was 0.75% (95% confidence interval: 0.39–1.21%); however, the prevalence was highly age‐dependent, ranging from 0.27% (95% confidence interval 0.12–0.49%) in individuals aged 0–39 years and gradually increasing to 3.07% (95% confidence interval 1.90–4.50%) in individuals aged ≥80 years. Male gender was an additional risk factor (odds ratio 1.80, 95% confidence interval 1.32–2.45, p = 0.00017). The estimated global prevalence was 10.7 million subjects in year 1950, which is expected to increase to 41.5 million in year 2020 and 91.2 million in year 2100. The prevalence of asteroid hyalosis is relevant because it impacts the utility of diagnostic strategies, especially screening methods for conditions such as diabetic retinopathy.

Aetiological processes of polypoidal choroidal vasculopathy (PCV) remains poorly understood, but several studies indicate that immunity may play a role and report elevated levels of systemic C‐reactive protein (CRP). In this systematic review and meta‐analysis, we summarize available evidence in the field. We searched the databases PubMed/MEDLINE, EMBASE, Web of Science and the Cochrane Central on 19 March 2020. Two independent authors reviewed the studies and extracted data. Two independent authors reviewed the studies, extracted data and evaluated risk of bias within individual studies. Studies were reviewed in the text qualitatively and measures of association were included for quantitative analyses. Results from univariate analyses and multivariate‐adjusted analyses were included for separate meta‐analyses to evaluate whether the association was only due to factors associated with PCV. Four studies (246 patients with PCV and 2861 control individuals) were identified and included for a qualitative and quantitative analysis. Increased CRP was associated with PCV when pooling both univariate measures (OR 3.54, 95% CI: 2.13–5.89, p < 0.0001) and multivariate‐adjusted measures (OR 3.05, 95% CI: 1.56–5.98, p = 0.0011). Sensitivity analyses confirmed robustness of the results. Increased CRP is associated to PCV, even after adjusting for demographics, lifestyle factors and co‐morbidities. Clinical value of CRP in relation to PCV remains unclear, but the association gives much needed insight into the aetiology of a poorly understood disease.

Asteroid hyalosis is a benign degenerative condition of the vitreous that is often asymptomatic. Our purpose with this narrative review is to provide a current overview of asteroid hyalosis from a clinical perspective. We review the epidemiology and risk factors, the clinical diagnosis and differential diagnoses, clinical challenges in eyes with asteroid hyalosis, and the treatment of asteroid hyalosis. Many clinical questions remain unanswered, and the current evidence to guide clinical practice is largely based on anecdotal evidence and clinical experience. More studies on asteroid hyalosis from a clinical perspective are warranted.