From the Guidelines
Vision changes and black floaters are most commonly caused by posterior vitreous detachment (PVD), a natural aging process where the gel-like vitreous inside the eye begins to shrink and pull away from the retina, as supported by the study published in Ophthalmology in 2020 1. This process typically causes floaters, which appear as dark spots or squiggly lines in your vision. Other causes of vision changes and black floaters include:
- Retinal tears or detachment
- Eye inflammation
- Bleeding in the eye
- Diabetic retinopathy
- Certain medications like hydroxychloroquine It is essential to seek immediate medical attention if you experience sudden increases in floaters, flashes of light, a curtain-like shadow across your vision, or vision loss, as these may indicate a retinal tear or detachment requiring urgent treatment 1. Most isolated floaters are benign and don't require treatment, though they can be annoying. They typically become less noticeable over time as your brain learns to ignore them. Regular eye examinations are crucial for monitoring eye health, especially if you have risk factors like high myopia (nearsightedness), previous eye surgery, or a history of eye trauma, as emphasized in the study published in Ophthalmology in 2020 1. The American Academy of Ophthalmology recommends a comprehensive eye examination to evaluate the vitreous status, measure visual acuity, and examine the peripheral fundus using scleral depression or a fundus contact or non-contact lens using the slit-lamp biomicroscope 1. In cases where vitreomacular traction (VMT) is present, optical coherence tomography (OCT) may be helpful in assessing the extent of the traction and guiding treatment decisions 1. Overall, while vision changes and black floaters can be caused by various factors, posterior vitreous detachment (PVD) is the most common cause, and regular eye examinations are essential for early detection and treatment of any underlying conditions that may affect vision and quality of life 1.
From the Research
Causes of Vision Changes and Black Floaters
- Vision changes and black floaters can be caused by various factors, including retinal detachment, which can lead to anatomical changes in the retina 2, 3, 4, 5, 6
- Retinal detachment can cause disruption of the inner segment/outer segment (IS/OS) junction, external limiting membrane (ELM) disruption, cystoid macular edema (CME), epiretinal membrane (ERM) formation, and outer retinal corrugation, all of which can affect visual outcome 2
- Outer retinal corrugation has been found to be a predictive factor for poor visual acuity outcome in patients with rhegmatogenous retinal detachment 2, 4
- Fundus autofluorescence and spectral domain optical coherence tomography (SD-OCT) can be used to detect retinal changes and predict visual outcome in patients with retinal detachment 3, 4, 5
- Disruption of the photoreceptor inner segment/outer segment band has been associated with poor visual acuity outcome in patients with retinal detachment 3, 6
Retinal Detachment and Vision Changes
- Retinal detachment can cause vision changes, including blurred vision, double vision, and floaters 2, 3, 4, 5, 6
- The extent of retinal detachment and the presence of macular involvement can affect visual outcome 3, 4, 5, 6
- Surgical repair of retinal detachment can improve visual outcome, but the extent of improvement depends on various factors, including the duration of detachment and the presence of underlying retinal disease 2, 3, 4, 5, 6
Diagnostic Tools for Retinal Detachment
- SD-OCT is a useful tool for detecting retinal changes and predicting visual outcome in patients with retinal detachment 2, 3, 4, 5, 6
- Fundus autofluorescence can be used to detect retinal changes and predict visual outcome in patients with retinal detachment 3, 4, 5
- Multicolor confocal scanning laser ophthalmoscopy can be used to detect and delineate structural retinal abnormalities following retinal detachment surgery 5