Floaters
When we are born, our eyes are filled with a vitreous “gel” that is clear and solid throughout. The vitreous is crystal clear and we see right through the gel without interference. For many reasons, but usually starting by middle age, the vitreous gel starts to contract, shrink and thicken. Because the eye remains the same size, the shrinking gel pulls away and detaches from the back wall of the eye. The inner wall of the eye is lined with the retina. This process of the gel pulling away is called a “vitreous detachment”, and the subsequent disturbed, mobile vitreous, now contains clumps and strands of thicker and thinner gel. All these irregularities and movement in the vitreous make up the many shapes and objects we call floaters. When the gel pulls away and swirls in the eye, it can irritate the retina enough to cause images of light-hence the possibility of flashes along with the floaters. (Other causes of flashing lights are possible, such as migraines, but these should be easily differentiated by your eye doctor).
This breakdown of the vitreous gel is a normal occurrence in nearly all people by age 75. However, it is inflammation, or eye trauma. Sudden floaters, especially those accompanied by flashes, can be very alarming. Hopefully most people would call their ophthalmologist immediately after experiencing these symptoms. As we soon shall see, floaters, especially those accompanied by flashes, can be very alarming. Hopefully, most people would call their ophthalmologist immediately after experiencing these symptoms. As we shall soon see, floaters are an important warning sign- and dangerous if ignored. Even floaters that have been around for years should be carefully examined by an eye doctor.In the worst case scenario, floaters and flashes can be the result of the vitreous pulling on and tearing the retina. This retinal tear can release blood, which contributes to even larger, sometimes hazy floaters. A retinal tear is a serious problem that can lead to a retinal detachment. The detachment can occur immediately or even years after the tear developed. Therefore, it is never “safe” to avoid having your floaters examined, even if they have been around for years. Someone with occasional floaters can be walking around with one or more tears in the retina- a time bomb waiting to go off!
While a true retinal tear or detachment requires surgery, what can or should be done about floaters? Once a thorough eye exam determines there are no retinal problems, then the floaters become simply an annoyance. While the moving spots and dots can be quite upsetting at first, they are rarely debilitating. Most people function quite well with a few floaters in one or both eyes. Usually, new floaters become much less noticeable after a few weeks, but sometimes they remain bothersome for months, even years. Unfortunately, the only definitive treatment to remove floaters is surgery. This is almost never required and can carry more risk than benefit. Simpler and safer treatments using in-office laser or injections of medicines into the eye are currently being evaluated and researched.
The most important take-home message is to schedule an eye exam immediately after you notice floaters! If you’ve already waited a while and never had the floaters checked, you are not out of the woods. It is never too late to find an undiagnosed retinal problem and fix it before it leads to a much worse situation with possible vision loss.
