Floaters & Flashes
Eye floaters are deposits or condensation in the vitreous (often referred to as vitreous humor, vitreous fluid, or vitreous gel), which fills the posterior part of the eye. People use the term eye floaters to describe seeing spots within their vision that move or “float” when they look around. Eye floaters may be present in only one eye or both eyes.
The structures in the front of the eye (the cornea and lens) focus rays of light onto the retina, the light-sensitive tissue lining the inside of the eye. The light coming from images around us focused onto the retina allows one to see. The light going to the retina passes through the vitreous humor, which is a jellylike material that occupies the back two-thirds of the eye. At birth and during childhood years, the vitreous gel is usually apparent and transparent. Later in life, strands, deposits, or liquid pockets very commonly develop within the vitreous gel. These changes in density cast a small shadow onto the retina’s surface, and the patient may perceive these shadows as eye floaters. They are usually light black to gray in color. As the eye moves from side to side or up and down, these strands, deposits, or pockets also shift in position within the eye, making the shadows move and appear to float or undulate.
People describe eye floaters as black spots or specks in the vision, spots in the eyes, straight and curved lines, cobwebs, strings, or “O” or “C”-shaped blobs. Some people see a single floater, while others may think they see hundreds. The lines may be squiggly, thick, or thin, and they sometimes appear to be branched. Most people appear as various shades of gray and are darker in color than the background. The density of different eye floaters will vary within an individual eye. An eye floater may be more noticeable under certain lighting conditions and be more apparent when looking at a bright sky. Floaters are rarely seen in situations with reduced illumination.
Like fingerprints, no two people have identical patterns of eye floaters. If a person has eye floaters in both eyes, the eye floaters’ pattern within each eye will be different. In any eye that has eye floaters, that pattern of eye floaters may also change over time.
Eye floaters always appear darker than the background and cannot be seen in darkness or with the eyes closed. This is unlike seeing flashes of light, which people often notice in the dark and with the eyes closed.
Causes of Eye Floater
Any eye condition in which the clarity of the vitreous humor is altered can produce the symptom of eye floaters. As one gets older, changes typically begin within the vitreous humor. The vitreous gel naturally undergoes some liquefaction, resulting in small pockets of more liquid vitreous lying within the firmer gel. This is called vitreous syneresis. The boundary between each liquid pocket and the gel may be noticeable to the individual as one or more eye floaters. It is also normal for the collagen fibers within the vitreous to become thickened and denser with age, resulting in eye floaters. Any person who is over the age of 50 will have these changes within their eyes. However, the degree of eye floaters produced by these typical changes will vary from person to person.
As the vitreous naturally ages, the gelatinous structure also begins to shrink within the space that it occupies. This shrinkage often leads to the back surface of the vitreous moving forward within that space. The vitreous is usually attached to the eye’s innermost tissue, the retina, at its posterior aspect at the optic nerve’s edges. As the vitreous shrinks, this attachment to the optic nerve may release. This former attachment now floats within the eye, causing one or more eye floaters that can sometimes seem very large and circular in shape. The vitreous back surface, now floating within the eye, will also cast shadows onto the retina, producing eye floaters. This shrinkage and pulling away from the vitreous back is called a posterior vitreous detachment (PVD) or posterior vitreous separation. It is very different from a retinal detachment. About 50% of 65-year-olds will have a PVD in one or both eyes. A person developing a PVD in one eye is likely to develop a PVD in the other eye within 18 months.
In addition to vitreous syneresis and posterior vitreous detachments, both of which are regular occurrences that cause eye floaters with aging, there are many abnormalities in the eyes that may also cause the symptoms of eye floaters. Any cellular material within the vitreous may cause eye floaters. Red blood cells resulting from hemorrhage and white blood cells as a result of inflammation are common types of cellular material causing eye floaters. Bleeding into the vitreous may result from injury, diabetic retinopathy, a retinal tear through a blood vessel, or eye surgery. Inflammation in the vitreous may be caused by noninfectious uveitis, injury, penetrating or blunt injury to the eye, severe eye infection, or eye surgery.
Eye floaters are extremely common in adults and are a leading symptom that causes people to see an ophthalmologist. Almost everyone has eye floaters by age 70, although some people are much more aware of them than others. It is unusual for children under 16 years of age to notice eye floaters unassociated with eye disease.
Diseases associated with Eye Floater
Abnormal eye floaters are associated with the retinopathy of diabetes, retinal tears, retinal detachment, and large degrees of nearsightedness. They occur more commonly in people who have had an injury to the eyes, surgery to remove cataracts, or YAG laser surgery after cataract surgery. Tuberculosis, sarcoidosis, syphilis, toxoplasmosis, and acute retinal necrosis of the eye are other inflammatory diseases associated with eye floaters. An unusual ocular condition called asteroid hyalinosis is also a cause of eye floaters. Primary or secondary tumors in the eye, including lymphoma and leukemia, are associated with eye floaters, but these are extremely rare.
Risk factors for developing Eye Floater
Increasing age is a significant risk factor for the development of symptoms of floaters. Being nearsighted (myopic) is a risk factor for eye floaters occurring earlier in life. The process of vitreous syneresis is accelerated in highly myopic eyes, and posterior vitreous detachments occur at a younger age in significantly nearsighted people. Diabetes is a risk factor for the development of eye floaters that arise due to diabetic retinopathy. Eye injury is an additional risk factor.
Eye floaters can be annoying and maybe anxiety-provoking, but by themselves, they are not dangerous. Normal aging changes within the eye cause the majority of eye floaters. However, a person developing the sudden appearance of eye floaters should be checked by an ophthalmologist to ensure that there is no associated eye abnormality or systemic disease that requires treatment. Sudden onset of many eye floaters or the beginning of eye floaters associated with flashing lights could signify a retinal tear that requires treatment to prevent retinal detachment. A curtain or cloud in the vision or a loss of side vision could be a symptom of associated retinal detachment.
Treating Eye Floater
If you develop floaters, you should be examined promptly by a health professional trained in diagnosing and treating eye disease. These include ophthalmologists and optometrists.
An ophthalmologist is a medical doctor (MD) who is specialized in eye and vision care. Most ophthalmologists in the United States are board-certified by the American Board of Ophthalmology after taking rigorous written and oral tests. They can deliver total eye care, including performing a complete eye examination, prescribing eyeglasses and contact lenses, diagnosing and treating eye diseases, and performing surgery on the eyes and the area around the eye.
An optometrist is a doctor of optometry, an OD. To become an optometrist, one must complete a pre-professional undergraduate college education followed by four years of professional education in a college of optometry. Optometrists are licensed by the individual states to practice optometry, just as physicians are licensed to practice medicine. Optometrists can perform an eye examination and can determine the presence of vision-related problems. They can also prescribe eyeglasses and contact lenses. Depending on the state in which they practice, optometrists also may be allowed to treat eye diseases and prescribe eyedrops for various conditions. Still, they are not trained or licensed to perform surgery in an operating room.
The eye care professional must dilate pupils with eye drops and examine the entire eye, including the vitreous and the retina, when evaluating a patient with a complaint of eye floaters.
There are no safe and proven methods to cure eye floaters caused by vitreous syneresis or posterior vitreous detachment. Most will fade over time and become less annoying or noticeable. Learning relaxation techniques may hasten the neurologic adaptation to persistent eye floaters.
Diagnosing Eye Floater
When a patient goes to the ophthalmologist with the symptom of eye floaters, the doctor will first ask the patient questions. The ophthalmologist will check the patient’s central and peripheral vision, look at the front of the eyes with a slit lamp, and then place drops in the eyes to dilate the pupils. After the pupils are dilated, the retina and vitreous will be examined with bright lights from an ophthalmoscope mounted on the doctor’s head. The ophthalmologist will be able to see the eye floaters themselves and will be able to tell the patient whether any associated abnormalities require further tests or treatments.
Most eye floaters decrease in size, density, and darkness with time. Some of this is due to the floater’s actual absorption through the natural processes within the eye. Eye floaters may also shift in position within the eye, resulting in less of a shadow effect. Also, the human brain tends to adapt to and often becomes used to the presence of eye floaters, ignoring them like how a person only notices the feeling of shoes on their feet when they think about it. Eye floaters eventually tend to become less bothersome, both through a reduction in density and size and the above-described neuro-adaptation process. Anxiety about the symptom of floaters can make the floaters more noticeable.