Clear vision is easy to take for granted in our high-paced, screen-facing world. You wake up one day and notice tiny black spots in your line of sight. These optical spots, called floaters, are a common part of aging that are often harmless; however, they can sometimes indicate a more serious eye condition. This blog will help you decipher why you may have these black dots in your eye and when you should see a qualified ophthalmologist.
What Are Vitreous Floaters?
The substance in the eye, known as the vitreous humor, is a clear, gel-like substance that fills the center of the eye between the lens and retina. This thick fluid plays two key roles in eye health: 1. it provides nutrients to your eye and 2. It helps the eye keep its shape. The vitreous humor is responsible for about 80% of the eye’s volume.
While thicker than water, vitreous humor still lets light in, so the retina can communicate with your brain. Water makes up the majority of the vitreous humor (98% to 99%), but it also contains other substances, such as salt, sugars, proteins and collagen.
Typically, this gel-like substance remains thick, but it can slowly liquify and lose its consistency as you age. When this occurs, clumps of protein move around in the eye, causing a shadow on the retina.
These shadows can appear in the central or peripheral vision as the following small black or gray objects:
- Specks
- Dots
- Circles
- Rods
- Crescents
- Hooks
- Threads
- Cobwebs
These shapes, also called vitreous floaters, you may notice more when looking at a blank wall or a bright object. Floaters follow your eye movement, meaning if you look to the left you will see proteins drift in front of the macula (the center of the retina) and vice-versa to the right.
Although floaters are not painful, they can become an annoyance to your vision. Over time, your eyes can adjust to these floaters and they become less noticeable.
Age remains the most common factor of floaters. The risk is also higher if you are nearsighted, have diabetes, or have had cataract surgery.
Types of Eye Floaters
There are three main types of vitreous floaters you may experience:
- Fibrous strand floaters: This type of floater occurs when protein fibers clump together and appear as multiple dots or cobwebs. Fibrous stand floaters are common in younger people, and they do not typically impact vision.
- Diffuse floaters: This type of floater appears as small clouds. It is most common in older adults as a natural part of aging.
- Weiss Ring floaters: This type of floater gets its name from the large, ring-shaped fibers that form. This is usually a result of the vitreous pulling away from the retina.
When Should I See My Eye Doctor?
Contact your eye doctor if you notice any severe symptoms associated with vitreous floaters. At minimum, an ophthalmologist can check for any serious issues, such as a retinal tear or retinal detachment. During this visit, they will perform a dilated eye exam. This test helps your ophthalmologist examine the peripheral retina to rule out tears, bleeding, or eye inflammation.
If you experience a sudden increase or change in the size, shape, or amount of floaters, you should promptly visit your eye doctor.
Posterior Vitreous Detachment
As you age, there is an increased likelihood of developing a posterior vitreous detachment in which the once-firm gel vitreous turns to a more loose-like liquid and shrinks, causing it to pull away and separate from the retina.
A posterior vitreous detachment typically does not cause any vision problems, as this process is slow and can take weeks. However, the liquified vitreous can sometimes pull too hard on the retina and cause a tear. Failing to address a retinal tear in a timely manner can result in a retinal detachment, which is considered a severe eye emergency.
Retinal Detachment
When the vitreous liquid pulls away and causes the retina to tear, fluid can build up underneath the retina and push it away from the eye to cause a detachment.
While retinal detachments are rare (occuring in only 1 out of 10,000 cases) you should be aware of the symptoms.
Contact a doctor immediately if you have floaters plus flashes (streaks of lighting in your vision), a loss of side vision and/or the appearance of a dark curtain across your vision. Pain and extreme blurry vision may also accompany these symptoms of a retinal detachment.
Do Eye Floaters Go Away?
The proteins that cause floaters, unfortunately, do not go away, but you may not notice them over time. This is because your brain can adjust to the shadows and ignore them, and the floaters can also settle toward the bottom of your eye.
So, while they may never truly resolve, your vision may not be as fully impacted.
How to Get Rid of Eye Floaters?
Usually, floaters caused by aging do not require treatment – even if they are an occasional nuisance. Any eye surgery is a surgery, always carrying an amount of risk. Therefore, your eye doctor most likely will not recommend intervention if the floaters are harmless.
In the event you have particles or debris that produce cloudy vision and impact your day-to-day life, speak with your eye doctor about surgical treatments for vitreous floaters. Generally, surgery is reserved for serious cases of eye floaters associated with a retinal tear or detachment. The benefits tend to outweigh any risks. However, some people report having problems reading or driving a car. These cases may benefit from surgery.
Vitrectomy to Treat Floaters
As noted, and while rare, floaters can be the result of a retinal tear or retinal detachment. If the retina pulls away from the back of the eye, surgery becomes necessary to replace the vitreous and reposition the retina.
A vitrectomy is a type of eye surgery that treats eye conditions related to the vitreous or retina. To treat floaters, an eye surgeon can use a vitrectomy to remove a portion, or all, of the vitreous and replace it with saline, a gas bubble, or silicone oil. Depending on the specific issues, your eye doctor may also reposition the retina against the back of the eye.
The body absorbs gas bubbles over time and replaces it with fluid. Silicone oil will need to be removed once the eye heals.
A retina specialist will discuss the pros and cons of a vitrectomy. Complications can include retinal tear, retinal detachment, development of cataracts, glaucoma, hypotony, macular edema, optic neuropathy, vitreous hemorrhage, and endophthalmitis.
Laser Treatment
For milder to moderate cases of eye floaters that impact your vision, your eye doctor may offer the option of laser treatment to break up the floaters and make them less noticeable. This procedure, known as a laser vitreolysis, or laser floater removal (LFR), uses a nano-pulsed, ophthalmic YAG laser to break down proteins that drift in your eye.
Laser treatment can take several sessions to reduce the size of the initial floaters. Plus, as with any eye procedure, there are risks including glaucoma, retinal tear, or retinal detachment. Laser treatment can also inadvertently pass over the lens or the retina, leading to further eye damage. Some ophthalmologists may wait several months to see if the floaters resolve on their own before treatment.
