Saturday, Feb 1, 2020 by Nisha Gupta, MD

Our topic this month will be floaters.

What are floaters and their symptoms?

Floaters originate in the back of the eye. We are all born with a gel that takes up the space in the back of the eye, called the vitreous. This gel is firm when we are younger but over time, some areas can become more liquid in nature and shrink. Small pieces of the gel can separate from itself as well. These both can lead to symptoms of floaters and can be seen during an exam.

Floaters are seen in a different way to each person. They may be seen as black spots, strings or cobwebs, or like small flies that are not really there. They usually follow the eyes as they move but go away or disappear if looked at directly. Normally, they come and go and are not present on a daily basis. Occasionally, a person may see a flash of light. These are like a camera flash in the peripheral vision. This occurs when the gel pulls on the retina.

What causes floaters?

The most common cause of floaters is age. As one gets older, the gel changes and often leads to floaters. Being very near-sighted can also lead to floaters. Eye surgery, such as cataract surgery, is another potential cause. More serious causes include injury to the eye, inflammation, infection, retinal detachment, and bleeding (as discussed with proliferative diabetic retinopathy).

How are they detected?

A comprehensive exam is completed to look for changes in the vitreous. Doctors are able to see areas where the gel has become more liquified. They can also see if a piece has separated from the rest. This condition is called a posterior vitreous detachment.

posterior vitreous detachment

The arrow in this photo points to a posterior vitreous detachment. Image Source1

Are floaters dangerous?

In general, floaters are not dangerous. They are quite common and affect many people. Typically, they appear only for a few seconds and then are gone. However, it is important to see a doctor if one is experiencing new floaters, an increased number of floaters, new flashing lights, or any change in vision. Sometimes these are indicative of something else happening in the eye, and a dilated exam should be done to check for a more serious cause.

What are the treatments for floaters?

Nothing: Most floaters do not require any treatment. Patients with new symptoms are examined several times and then monitored for new symptoms. Most patients do not need any treatment since the symptoms are not constant and they get better over time. If there is a specific cause of the floaters, such as inflammation or bleeding, there may be specific treatments to target these causes.

Laser: Some doctors may use a laser to break up the floaters. This treatment does not work for all patients. There is a risk of damage to the retina, so it not used very often and is not normally a recommended treatment. More studies are being done to see if this a good treatment.

Surgery: This is reserved for patients with so many floaters that they interfere with the vision. Surgery carries more risks so patients and surgeons will only use this as a treatment if the benefit of removing the floaters is stronger than the risk of having surgery.

Return next month for a discussion on a new topic!

  1. Image courtesy of Optos [return]

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