From the Guidelines
Floaters in the eye are typically harmless and don't require treatment, but a sudden increase in floaters, especially when accompanied by flashes of light or a curtain-like shadow in peripheral vision, can indicate a retinal tear or detachment requiring immediate attention. These small dark spots or string-like shapes that drift across your vision are caused by tiny clumps of gel or cells inside the vitreous, the clear jelly-like substance that fills your eyeball. As we age, the vitreous begins to shrink and become more liquid, causing these clumps to form 1. Most floaters are normal and simply annoying, but it's essential to see an eye doctor promptly if you experience any unusual symptoms.
Causes and Risk Factors
The symptoms of a posterior vitreous detachment (PVD) include light flashes (photopsias) and floaters (myodesopias), and patients with such symptoms are at a higher risk for retinal detachment 1. Between 8% and 22% of patients with acute PVD symptoms have a retinal tear at the time of the initial examination. The stages of a PVD are described in detail, and patients typically report the light flashes characteristic of a PVD as being most noticeable in the dark.
Management and Treatment
For bothersome but non-emergency floaters, maintaining good eye health through regular eye exams, wearing sunglasses outdoors, and taking breaks during screen time can help manage symptoms. In rare cases where floaters significantly impair vision, procedures like vitrectomy (surgical removal of the vitreous) or laser therapy might be considered, though these carry risks and are typically reserved for severe cases 1. Most people eventually adapt to floaters as the brain learns to ignore them over time.
Key Considerations
It's crucial to note that a spontaneous vitreous hemorrhage can be the presenting sign of PVD or may occur during the evolution of the PVD 1. Approximately 80% of patients who presented without detected breaks, and then had breaks occur subsequently, had either pigmented cells or hemorrhage in the vitreous or retina at the initial evaluation, or new symptoms that prompted a return visit to the ophthalmologist. Therefore, prompt medical attention is necessary if you experience any unusual symptoms, such as a sudden increase in floaters, flashes of light, or a curtain-like shadow in your peripheral vision.
From the Research
Causes and Effects of Floaters in the Eye
- Floaters are a common cause for presentation to ophthalmologists and may significantly affect visual function 2.
- They are often secondary to benign, degenerative changes in the vitreous 3.
- In most cases, floaters are not a sign of a serious underlying condition, but they can be debilitating for some patients 4.
Treatment Options for Floaters
- Treatment options are available for patients with symptomatic floaters, including vitrectomy and YAG vitreolysis 2, 4.
- Vitrectomy is a surgical procedure that involves the removal of the vitreous gel and any blood or debris that may be causing the floaters 5, 6.
- YAG vitreolysis is a laser procedure that uses a YAG laser to break up the floaters and make them less noticeable 2.
Risks and Complications of Treatment
- Vitrectomy carries risks, including iatrogenic retinal breaks, retinal detachment, and cataract formation 2, 5, 6.
- The risk of retinal detachment after vitrectomy is around 5.5% 5.
- Cataract formation is a common complication of vitrectomy, occurring in around 50% of phakic cases 6.
- YAG vitreolysis is a relatively new procedure, and its long-term efficacy and risks are still unclear 2.
Patient Satisfaction and Outcomes
- Most patients who undergo vitrectomy for floaters are satisfied with the results, with around 88% of patients reporting improvement in their symptoms 5.
- However, some patients may experience persistent or recurrent floaters after treatment 5.
- The visual acuity of patients who undergo vitrectomy for floaters may not change significantly after the procedure 5, 6.