If you’re seeing little floating spots, specks, squiggles, or cobwebs that no one else can see, you’re not the only one. In fact, you’re in good company because most of these floaters are a product of aging and there is no person on earth who is a stranger to aging.
What are these floaters?
A floater is a particle or opacity drifting around the inside of your eyeball; specifically, in the rear space of the eye known as the vitreous cavity. When you’re young and spritely, the vitreous is structured as a solid sort of gel, and is anchored to certain points around the retina lining the inside of this cavity. However, as you get older, the vitreous begins to liquify and lose its organized gel structure, shrinking and pulling away from its points of adhesion around the retina. This is called a posterior vitreous detachment (PVD).
It’s during this age-related process that you are likely become aware that little shadows are inhabiting the inside of your eyeballs. These visible specks, spots, and squiggles are caused by clumps of gel floating around pockets of liquified vitreous, or can be from a little tuft of retinal tissue that’s been pulled off as the vitreous detached away from these points of retinal adhesion.
A PVD is the most common cause of floaters. However, there may be other, more serious, causes of the perception of floaters in the eye. Floaters can also be from:
- Bleeding inside the eye, such as from diabetic retinopathy or trauma to the eye, face, or head
- Cells produced by inflammation inside the eye, known as uveitis
- A retinal tear or retinal detachment, resulting in a release of pigment cells and/or blood droplets that are seen as floaters
Because of the potential for floaters to signal a rather serious problem with the eye, if you ever experience a sudden increase in the number of floaters, perhaps accompanied by flashes of light, and/or a change to your vision such as a dark shadow obscuring part or all of your visual field – see an eye doctor immediately.
Do floaters go away by themselves?
Yes and no. The floaters don’t dissolve away, but most people find they become less aware of them over time. As the name suggests, floaters float, which means they can move from the center of your vision, where you’re most conscious of them, to your peripheral sight, where they can be happily ignored. There may be situations where they are more apparent, such as:
- When looking up at a clear sky
- When looking at a blank white wall
- When reading from a screen or a book
- When someone points them out to you, such as while reading this blog
- After cataract surgery
Occasionally, there may be a floater or cloud of floaters which is very large, very central, and refuses to go away. Some studies have found that floaters have the potential to be associated with lower quality of life, can interfere with routine tasks such as driving or reading, and cause noticeable vision impairment.
Management of Floaters Which are Very Large, Very Central, and Refuse to Go Away
If the “put up with it and forget about it” approach is simply not working for your floaters, there are two procedures that your ophthalmologist (eye specialist) may consider.
Vitrectomy
To put it bluntly, a vitrectomy is a surgical procedure that sucks out the vitreous and all those pesky floaters within it. This outpatient procedure is usually performed under a local or topical anesthetic. General anesthesia may be an option in certain circumstances.
Tiny incisions are made within the wall of the eye to allow a suction tool to access the vitreous cavity and suction out the vitreous. A bubble of air, silicone gas or oil is used to replace it.
Your eye may feel swollen and red for a few weeks post-operation, and during this time you’ll need to follow some instructions, such as using medicated eyedrops and avoiding certain activities.
As with any surgical procedure, vitrectomy comes with risks, including:
- Inducing a cataract
- Causing a retinal tear or detachment
- Causing swelling and distortion of the macula (part of the retina)
Vitreolysis
Laser vitreolysis is an alternative to vitrectomy but is only suitable for certain types of floaters. Using a specific type of laser (known as YAG laser), a series of nanosecond heat pulses are used to zap those floaters into oblivion.
You may be suitable for laser vitreolysis if the floaters are:
- Causing significant disruption to your life
- Not improving despite at least two months having passed
- At least 2mm away from the lens in the front half of the eye and the retina at the back of the eye
Floaters that are due to bleeding, inflammation, or retinal tears/detachments aren’t suitable for vitreolysis and will resolve once the underlying condition has been properly treated.
In the vast majority of cases, floaters are harmless and your brain will learn to ignore them. However, remember in those instances outlined above, they can occasionally herald an eye emergency, so all new floaters should be checked out with your eye doctor or optometrist.