The development of spots or "floaters" in one's vision can be a common experience, but it is important to understand why they appear and situations where floaters may represent a threatening situation to your eye.
What is a floater?
A gel-like substance called vitreous fills the majority of the eye's volume. The vitreous is found behind the iris, pupil, and lens. It is composed mostly of water and proteins. The vitreous has a more viscous consistency than water and can be fairly sticky. On the backside of the vitreous lies the retina, which is a thin layer of nerve tissue that lines the inside of the eye.
Over time, the protein fibers in the gel coalesce, causing small floaters or strings in the vision. The vitreous also begins to pull away from the retina. Eventually, as the vitreous actually separates from the back of the eye, a Posterior Vitreous Detachment (PVD) can occur, which your ophthalmologist can see when looking inside your eye. Patients can have very different experiences as the PVD develops. Some people may not notice anything at all, while others can have a prominent jelly-like spot that can move in and out of the central vision as the eye moves. Still others can experience a dense spot or semicircular object that can interfere with reading, computer work, and other daily tasks.
Over time, the vitreous consistency changes and within it, pockets can form that have a more water-like consistency. As a result, the floaters tend to drift off center more and can become less of a nuisance. Your brain will also tend to adapt to them and notice them less. Floaters don't actually dissolve, though, so don't be surprised to see them if you are actively looking for them. Some patients have also reported noticing them more in the morning, as the opacities can sometimes settle over the retina overnight and therefore appear front and center when first waking up.
What about flashing lights?
The retina's job is to sense and convert light into a signal that is then transmitted to the brain for interpretation. However, physical stimulation on the retina can also cause it to send off signals that your brain also misinterprets as light. For example, it is common to talk about seeing "stars" after getting hit in the eye - the impact can compress the eye, which causes the retina to release signals in a nonspecific way.
As the vitreous changes and separates from the retina, there can be some temporary pulling on the retina, which can also manifest as a quick flash of light. These generally occur in the peripheral vision, frequently when moving the eye from one side to another. They can also be subtle at times, only being noticeable when the outside environment is dark. Also, because the cause of this flashing occurs independent from what they eye is actually seeing, they can occur even if the eye is closed.
When is it a problem?
If the retina and vitreous are bound together abnormally tightly, there can be excessive traction on the retina as the vitreous tries to pull away. As a result, the retina can tear. This is a particularly concerning situation -- a retinal tear is at risk of developing into a retinal detachment, which is a potentially blinding condition and frequently requires urgent treatment. Based on a description of the flashes, it is not possible to know whether a flash of light represents mild pulling on the retina that might resolve on its own or a retinal tear and needs urgent treatment. When the retina is torn, there can also be a release of blood or some other cells from the underside of the retina that enter into the vitreous and can look like a burst of very small floaters.
What should we do?
If you develop new floaters or flashes, it is generally a good idea to contact your eye doctor's office and discuss your symptoms. You can reach us at 503-557-2020 or contact one of our 11 locations directly. If there were any concerns, it would be appropriate to go in for a dilated examination to make sure there is no retinal tear or detachment. Often times, despite the symptoms, the exam does not reveal anything that needs treatment, but we still need to be very cautious because the potential vision loss from not finding a tear or detachment early is very serious.
Can we get rid of floaters?
Unfortunately, there is no simple way to remove floaters. Further, there are no effective medical supplements, nor anything we can do that can delay or prevent vitreous changes. The good news is that floaters generally do become less bothersome over time, but that timeframe can be months to years, and some people remain consistently bothered. One method to get rid of floaters is a vitrectomy, which is a surgical procedure in which the vitreous is removed and replaced with a modified saline solution. Because of the invasive nature of this procedure, the risks must be carefully discussed between you and your doctor. Some physicians have discussed using a laser to break down the dense vitreous condensations. This treatment remains controversial, as there are not many studies to verify its safety and effectiveness.
If you have any questions about flashes or floaters or concerns about your eye health, please contact us at 503-557-2020.
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