From the Guidelines
Floaters in vision are caused by small clumps of gel or cells inside the vitreous humor and most are harmless, but a sudden increase in floaters, especially with flashes of light or peripheral vision loss, requires immediate medical attention as it could indicate a retinal tear or detachment. The presence of floaters can be attributed to the natural aging process, where the vitreous humor partially liquefies, casting shadows on the retina that appear as spots, threads, or cobweb-like shapes drifting across the field of vision 1. As the brain typically adapts to the presence of floaters over time, most cases do not require treatment. However, for mild cases, simply moving the eyes up and down can temporarily shift floaters out of central vision. If floaters are numerous or significantly affect vision, treatments such as vitrectomy (surgical removal of the vitreous humor and replacement with a salt solution) or laser vitreolysis (using lasers to break up floaters) may be considered, although these procedures are generally reserved for severe cases due to potential risks like retinal tears, cataracts, or infection 1. Some key points to consider include:
- The importance of immediate medical attention if there's a sudden increase in floaters, especially when accompanied by flashes of light or peripheral vision loss, as this could indicate a retinal tear or detachment, which is a medical emergency requiring prompt treatment.
- The role of vitrectomy and laser vitreolysis in treating severe cases of floaters, with pars plana vitrectomy showing evidence of greater patient satisfaction compared to Nd:YAG laser for floaters 1.
- The need for a comprehensive eye evaluation to assess the presence of retinal breaks, lattice degeneration, and other conditions that may be associated with floaters, and to guide management decisions 1. In terms of management, the goal is to prevent vision loss and maintain quality of life, with treatment options depending on the underlying cause and severity of the condition 1. Overall, while most floaters are harmless, it's crucial to be aware of the potential risks and to seek medical attention if symptoms worsen or if there are concerns about vision loss.
From the Research
Causes of Floaters in Vision
- Floaters are common ophthalmic issues that may be a sign of benign, age-related changes of the vitreous or more serious retinal detachment 2
- They are often secondary to benign, degenerative changes in the vitreous 3
- Posterior vitreous detachment is a common cause of floaters, which can be confirmed with optical coherence topography (OCT) 4
- Floaters can also be caused by particles or debris in the vitreous gel of the eye, causing shadows and visual changes 5
Treatment Options for Floaters
- Observation is the most common management strategy for floaters 4
- Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis 4
- PPV is considered the most definitive management option for vitreous floaters, but carries inherent risks such as infection, cataract formation, and retinal detachment 4
- Nd:YAG laser vitreolysis is a less invasive alternative with varied success rates 4
Importance of Medical Evaluation
- Patients presenting with flashes and floaters must be referred to an ophthalmologist to rule out sight-threatening conditions 2
- Key examination features include the nature of the flashes and floaters, whether one or both eyes are affected, and changes in visual acuity or visual field 2
- Early surgical intervention and expanded indications are likely to continue as surgical instrumentation and techniques are further developed 6