What are Floaters?
Floaters are the visual sensation of seeing “cobwebs” of “debris” in one’s vision. People sometimes initially believe they are seeing a small, annoying insect flying around near them, but there is no actual insect. When one looks to the right, the “spot” may move to the right, as if it’s “floating” in that direction. When one looks to the left, it may move to the left in a similar manner. Often, the floater will not precisely follow one’s eye movements. It will continue to move and drift after one’s eye stops moving.
Floaters are a very common symptom that many people have. Often, when people look at a bright background such as the sky or a white wall, they will notice their floaters more.
Floaters occur when certain changes occur inside the eye. To understand what they are, one must review the anatomy of the eye.
Imagine the eye is a small round room. Now imagine that the room has wallpaper covering the walls. This wallpaper is called the retina. Then imagine the room is filled with a clear jello-like material. This material is called vitreous. When a person is born, the vitreous is just like freshly made jello. It’s clear and see-through (transparent).
When floaters form, what’s actually happening is that the vitreous (jello) is shrinking. Parts of it become a stringy material which clump up inside the eye. These are floaters. Strands of this stringy vitreous cast a shadow on the retina and one sees the floater symptoms.
What Causes Floaters?
In most cases, floaters occur as part of a natural aging process. They are very common and, if you ask around, you are bound to know someone who has floater symptoms. When one first has floaters, it can be very annoying. Over time, they tend to “settle” at the bottom of the eye and become less bothersome since they are not in the line of site. In most cases, floaters do not go away completely.
In most cases, floaters are an annoyance that people tend to get used to and eventually ignore.
Are Floaters Ever Serious?
Floaters themselves are not serious, but they can sometimes be related to a more serious problem. Because of this, whenever people have new floaters or suddenly more floaters than before, I recommend that they see their eye doctor for a checkup.
To understand how floaters can cause a serious problem, let’s review eye anatomy again. Imagine the eye as a small round room filled with vitreous gel (jello). The room has a wallpaper which lines the inner surface. This wallpaper is called the retina. When the floaters form and the vitreous gel shrinks, it can pull on the wallpaper (retina) and cause part of it to rip. This is called a retinal tear or retinal hole. In some cases, the vitreous pulls a large section of the retina completely off. This is called a retinal detachment. Both of these scenarios are serious and could lead to vision loss. Fortunately, we have treatments to fix these problems.
It’s very difficult for a person to tell the difference between whether they are having regular floaters versus a retinal tear or retinal detachment. When my patients call me and describe their symptoms, I often cannot tell the difference over the phone. I tell them to come in to my office for an eye examination. The eye exam is very important in these situations.
What Causes Flashing Lights?
When the vitreous gel rubs or pulls on the retina (inner wallpaper of the eye), it can turn on small sensors on the retina called photoreceptors. As a result, people see light flashes. A common way people experience this is after getting hit in the head or eyes – one can “see stars.” In the aging process of vitreous gel shrinking, it can pull on the retina and cause both flashing lights and floaters. Sometimes, people notice the flashes and don’t really notice the floaters as much. If you the sudden appearance of flashing lights, you should contact your ophthalmologist immediately. We worry that the retina has been torn.
When people have migraines or eye-related migraines (called ophthalmic migraines), they may experience flashing lights in their vision. This can occur even without a headache.
Who is at risk for floaters?
The most common reason people have floaters is because their eyes are getting older. Sometimes, floaters can be related to recent trauma, contact sports, or physical straining. In addition, floaters can often occur if someone is nearsighted or myopic. Having a history of eye surgery is also a risk factor for having floaters.
How are floaters treated?
For floaters which are simply annoying, no treatment is recommended. They often fade over time or become less bothersome. For most of my patients, I recommend no treatment.
For floaters which are extremely bothersome, some people choose to have in-office laser surgery called “YAG Laser Vitreolysis.” The laser zaps the floater and disintegrates it. Research into this laser surgery is in its early stages. Also, some people elect to have surgery to remove them in the operating room. This surgery is called “Floaters Only Vitrectomy.”
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