As Seen in Expressly My Health
But occasionally floaters, especially those associated with a flash of light or a loss of peripheral vision, may indicate a more serious problem. Donald Schwartz, MD, associate clinical professor of ophthalmology at the University of California, Irvine and the University of Southern California's Doheny Eye Institute, explains when you need to worry about floaters.
What are floaters? Floaters are spots or wispy objects that people see in front of their eye, typically when they're looking at a background that doesn't provide much contrast, like a blue sky or a blank wall. People are able to see particles of different sizes or shapes, wispy lines or little dots. When people move their eyes in one direction, they will see these "floaters" move in different directions and then settle down.
Almost everybody at one point in their life will see floaters. Floaters were documented thousands of years ago by the Latins as muscae volitantes, or flying gnats, so it is not a new phenomenon.
What causes floaters? The front part of the eye is comprised of the cornea, which refracts the light coming into the eye. The lens focuses an image on the retina, which is like camera film in the back of the eye. The large space between the lens and the retina is filled with a gel known as the vitreous humor. It's a gel of the same consistency of the white of a raw egg. That gel has debris left over from the formation of the eye. So, if some debris in the vitreous humor floats between the front part of the eye and the retina, it casts a shadow on the retina, and we see this as floaters. At different times the debris moves more in line with a patient's line of sight, which is why floaters come and go.
Do floaters ever go away? While they don't leave the eye, most patients eventually stop noticing floaters. The floaters are simply no longer apparent within the visual axis of the eye, the line of sight. Over time, gravity causes the floaters to sink down below the line of sight as the gel in the eye becomes more liquefied. Most floaters do tend to diminish with time.
Are floaters ever serious? When people look at a blue sky or white clouds, they're apt to see floaters more often. But, if the number of floaters increases dramatically, or they change in nature from being wispy floaters to a multitude of tiny, little dot-like floaters, or they're associated with a flashing light or flashes of light, it may indicate a change from the normal floaters that almost all see to something more significant.
These symptoms might indicate a change in the vitreous humor, the gel of the eye, which is also a normal aging phenomenon. As the vitreous gel changes with age, there is more movement of the particulate matter and debris and, because of that, we see the floaters more frequently.
Along those lines, a flashing light that's associated with an increase in floaters, especially if it's a quick flashing light, usually indicates that the gel is pulling on the retina as it is separating from it. Again, this is normal, called a vitreous separation. As the gel becomes more liquified and pulls away from the retina, we'll see a sort of lightning flash off to the side. This, again, is a normal type of aging change, which usually occurs in patients in their 50s and 60s.
However, if the light changes from a quick flash of light to a persistent light, if there is a significant increase in the number of floaters or if there's missing side vision, like a curtain coming across the vision, it can indicate that the normal process of the vitreous change has possibly caused damage to the retina. This can be a significant finding. It could be a retinal tear. As the gel peels away and tugs on the retina, there is the potential to tear a small hole in the retina. Worst case, the fluid goes through that hole and behind the retina and peels the retina off, then we have a retinal detachment. So, as the process of a vitreous separation is occurring, there is the potential—and the numbers are quite small—of a retinal tear and then a retinal detachment.
Can a retinal tear or detachment be fixed? If the retina is damaged with a tear, there are a number of different techniques that can be used to seal the tear and repair the retina. A retinal tear is a very urgent situation to protect the remaining vision. If the peripheral retina has a small hole or tear, it may be sealed off with a laser, a cryogenic probe, which is a freezing cold probe, or even with an air bubble. These are techniques to close the small hole before it becomes a retinal detachment.
If a detachment has occurred, then surgery needs to be performed to replace the retina to its normal location. That is a more significant surgery.
When should someone see a doctor about floaters? If floaters become worse, they need to be evaluated to make sure the floaters do not indicate the possibility of retinal damage. If a patient sees a sudden change in the nature of their floaters, and particularly if they notice flashing lights or missing vision in their peripheral vision, they should see a doctor.
