Floaters are one of the most common symptoms for which patients seek help from trained eye specialists. Floaters are caused by any opacity in the optical pathway, that becomes visible to the patient, especially in bright light.
Floaters are usually associated with a benign condition called posterior vitreous detachment (PVD). PVD’s can be seen as a normal age-related occurrence, where the jelly-like substance filling the back of the eye (Vitreous) begins to pull loose from its normal attachment to the retina. The jelly-like substance then breaks up into fragments which become visible to the patient as floaters.
A PVD and associated floaters by itself is harmless, but occasionally during the process of detaching from the retina, the Vitreous / Jelly, can cause a small tear or hole in the retina which will require treatment. If this hole is left untreated, it has an almost 50% chance of leading to a retinal detachment, which can lead to permanent visual impairment.
If the hole is diagnosed early, an office-based laser procedure is done where the hole is closed with laser, thus eliminating the development of retinal detachment. It is important to note that other tears or holes can develop in the same eye, or in the other eye, which might also require treatment at a later period.
Flashes (photopsias) are subjective images of light as seen by the patient. Most patients describe a bright flash of light becoming visible in their peripheral visual areas. Photopsias are caused by mechanical stimulation of the retina, such as when the vitreous / jelly pulls loose from the retina during a PVD. Photopsias are often associated with a retinal tear and require a thorough eye examination to exclude any retinal tears or holes.
If you suffer from an acute onset of flashes and floaters, it is necessary to be seen by an ophthalmologist, who would then dilate the affected eye (or both) so as to carefully examine the peripheral retina for any retinal tears or holes.
This examination in the setting of flashes and floaters are especially important in near-sighted (myopic) patients, post-cataract surgery patients and after any eye injury, as these groups of patients are especially at risk to develop a retinal detachment
Chronic floaters are often bothersome to the attentive patient. The treatment of floaters is also controversial. As the floaters are harmless, although irritating, they are usually managed conservatively –i.e. to do nothing about them. Recent treatment options now also include laser fragmentation of the floaters (with a specialized YAG laser). Some retinal surgeons also offer the patients a surgical procedure where the vitreous jelly is removed and replaced by eye fluid, thus removing the bothersome floaters. It is important to note that the surgery is not without risks, and there remains a 5-10% risk of complications which could potentially lead to permanent visual impairment.