Floaters and vitreous detachment

 

Hyperopia

Definition

What are floaters?

Floaters are little “cobwebs” or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.

Most people have floaters and learn to ignore them; they are usually not noticed until they become numerous or more prominent. Floaters can become apparent when looking at something bright, such as white paper or a blue sky.

Source : National Eye Institute 

 

What is vitreous detachment?

Most of the eye’s interior is filled with vitreous, a gel-like substance that helps the eye maintain a round shape. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, the eye’s light-sensitive tissue. As we age, the vitreous slowly shrinks, and these fine fibers pull on the retinal surface. Usually the fibers break, allowing the vitreous to separate and shrink from the retina. This is a vitreous detachment.

 

In most cases, a vitreous detachment, also known as a posterior vitreous detachment, is not sight-threatening and requires no treatment.

Source : National Eye Institute

 

Organ

The vitreous makes up about 80% of ocular volume. It consists mostly of water (99%), the remainder being hyaluronic acid and collagen fibrils. These fibrils connect the vitreous to the retina. Some areas (at the disc, the fovea and around the periphery anteriorly) are more adherent than others. The concentration of hyaluronic acid decreases with age and the vitreous liquefies (synchysis) and reduces in volume, causing it to fall away from the retina and cause a vitreous detachment. In doing so, it may pull on the retina (particularly if one of the more adherent areas has become detached) and a retinal tear may result. If fluid seeps under a retinal tear, a retinal detachment ensues.

Source : Patient

 

Symptoms

Floaters are little “cobwebs” or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.

Source : National Eye Institute

What are the symptoms of vitreous detachment?

As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina that you may notice as floaters, which appear as little “cobwebs” or specks that seem to float about in your field of vision. If you try to look at these shadows they appear to quickly dart out of the way.

One symptom of a vitreous detachment is a small but sudden increase in the number of new floaters. This increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.

Source : National Eye Institute

 

Frequency

Floaters are more likely to develop as we age and are more common in people who are very nearsighted, have diabetes, or who have had a cataract operation.

Source : National Eye Institute 

A vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80. People who are nearsighted are also at increased risk. Those who have a vitreous detachment in one eye are likely to have one in the other, although it may not happen until years later.

Source : National Eye Institute

 

Causes

As mentioned above, posterior vitreous detachments (PVDs) are common causes of vitreous floaters. Far less commonly, these symptoms can be associated with retinal tears or detachments that may be linked to PVDs.

What leads to vitreous detachments in the first place?

As the eye develops, the vitreous gel fills the inside of the back of the eye and presses against the retina and attaches to the surface of the retina. Over time, the vitreous becomes more liquefied in the center. This sometimes means that the central, more watery vitreous cannot support the weight of the heavier, more peripheral vitreous gel. The peripheral vitreous gel then collapses into the central, liquefied vitreous, detaching from the retina (like Jell-O separating from the inside of a gelatin mold or bowl).

Eye floaters resulting from a posterior vitreous detachment are then concentrated in the more liquid vitreous found in the interior center of the eye.

It's estimated that more than half of all people will have a posterior vitreous detachment by age 80. Thankfully, most of these PVDs do not lead to a torn or detached retina.

Light flashes during this process mean that traction is being applied to your retina while the PVD takes place. Once the vitreous finally detaches and pressure on the retina is eased, the light flashes should gradually subside.

Source : All About Vision 

 

Evolution

Retinal tear with or without detachment. This complicates about 10% of cases on presentation and a further 2-5% of patients in the weeks that follow. Occasionally, vitreous detachments can be associated with a vitreous haemorrhage if the part that has become detached happened to overlie a blood vessel.

Source : Patient

 

Prevention

It is recommended to drink enough to prevent dehydration of the vitreous.

 

Diagnosis

The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a macular hole or detached retina, early treatment can help prevent loss of vision.

Source : National Eye Institue 

  

Treatment

Most eye floaters and spots are harmless and merely annoying. Many will fade over time and become less bothersome. In most cases, no eye floaters treatment is required.

However, large persistent floaters can be very bothersome to some people, causing them to seek a way to get rid of eye floaters and spots drifting in their field of view.

In the past, the only treatment for eye floaters was an invasive surgical procedure called a vitrectomy. In this procedure, some or all of the vitreous is removed from the eye (along with the eye floaters within it) and is replaced with a sterile clear fluid.

But the risks of a vitrectomy usually outweigh the benefits for eye floater treatment. These risks include surgically induced retinal detachment and serious eye infections. On rare occasions, vitrectomy surgery can cause new or even more floaters. For these reasons, most eye surgeons do not recommend vitrectomy to treat eye floaters and spots.

 

Laser Treatment for Floaters

Recently, a laser procedure called laser vitreolysis has been introduced that is a much safer alternative to vitrectomy for eye floater treatment. In this in-office procedure, a laser beam is projected into the eye through the pupil and is focused on large floaters, which breaks them apart and/or frequently vaporizes them so they disappear or become much less bothersome.

To determine if you can benefit from laser vitreolysis to get rid of eye floaters, your eye doctor will consider several factors, including your age, how quickly your symptoms started, what your floaters look like and where they are located. If you haven't established an eye doctor, click here to find one near you.

The floaters in patients younger than age 45 tend to be located too close to the retina and can't be safely treated with laser vitreolysis. Patients with sizable eye floaters located farther away from the retina are better suited to the procedure.

The ophthalmologist who performs laser vitreolysis also will evaluate the shape and borders of your eye floaters. Those with "soft" borders often can be treated successfully. Likewise, sizable floaters that appear suddenly as a result of a posterior vitreous detachment often can be successfully treated with the laser procedure.

Source : All About Vision 

 

 

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