Alamo Optometry Blog

September 7, 2014

Flashes and Floaters

Filed under: Common Eye Concerns and Questions — gkblog @ 5:38 pm

(As appeared in Alamo Today, August 2014)

Thankfully in my field of practice there are very few ocular emergencies.  However, one of them is sudden onset of flashers and floaters.  This can be a potentially serious eye condition that warrants immediate attention, so I will discuss some of the causes and symptoms and what to do if you experience any of the effects.

When patients call the office complaining of sudden onset of flashes and floaters, the most common diagnosis is a posterior vitreous detachment or PVD.  Most patients will notice in their field of vision squiggly lines, small dots, a “spider-web” appearance, or any combination of these.  Most of the time the cause of floaters is idiopathic, meaning it just happens; other causes include trauma and age.  The vitreous gel, which fills the posterior 2/3 of the eye, is made of tightly-packed translucent collagen fibers.  Over time, the fibers that make up the gel liquefy and condense, causing it to move forward and pull away from the retina.  Since there is now an area of fibers that are situated in front of the retina, as light enters the eye it goes through this area and casts a shadow onto the retina; this is what the patient perceives as floaters.  This situation alone is completely benign and might cause slightly decreased vision but will have no long term effects on the eye.  However, as the gel pulls away from the retina there are tractional forces that develop and can pull a part of the retina away causing a retinal hole and/or detachment.   This is what needs immediate surgical intervention by a retina specialist.

If the retina is detached from the back of the eye, it is not receiving any oxygen and will die like any other tissue or organ in the body.  Generally speaking, the prognosis for visual recovery is directly related to how quickly the diagnosis and treatment is initiated and the location of the detachment.  This is why it is absolutely imperative that if you notice a sudden onset of floaters, flashes of light, decrease in vision, a veil or curtain coming over your vision, or any combination of these that you have your eyes dilated as soon as possible.  If you have any of these symptoms, we will always squeeze you in for a same day appointment.  If the diagnosis is a PVD, there is no treatment.  We will discuss some precautions and some things to watch for and do a repeat dilation in 4 weeks.  Most studies have shown that if a retinal complication is going to occur, it is going to happen within the first 4 weeks, most likely sooner.  If there is a retinal hole and/or detachment a prompt referral to a retinal specialist is ordered.  Many treatments now can be done in office; however, outpatient surgery is sometimes indicated.  The retinal surgeon will discuss your options with you and recommend the procedure and treatment plan with the greatest likelihood of success.

Patients will invariably ask if there is anything that can be done to remove the floaters, and unfortunately the answer is no.  The only way to clean out the floaters is to do a procedure called a vitrectomy, which involves going into the eye and removing all of the vitreous and replacing it with clear fluid.  However, the risk of retinal complications is relatively high with this procedure.  Therefore, retinal surgeons will not do surgery for a benign condition, albeit an annoying one, to risk loss of vision.  Thankfully, your brain learns to “tune out” the floaters over time so they are not as noticeable.  They never actually go away or disappear; your brain just learns to suppress them.  If you actively look for them, are out in the sun, or around a lot of light or glare it is relatively easy to find them.

If you have had a recent episode of floaters with or without flashes of light, please have your retina evaluated as soon as possible.  I would rather you come in for an office visit and the diagnosis is floaters versus waiting for the symptoms to go away and having possible decreased vision from a retinal complication.

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