Flashes & Floaters

Most of the eye’s interior is filled with vitreous, a gel-like substance that is very thick when we are young. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, which lines the inside of the eye. As we age, the vitreous slowly liquefies and begins to pull away from the retina as the gel collapses upon itself. Separation of the vitreous from the retina can happen rather suddenly. When the separation occurs, the fibers inside the vitreous can become dense and visible. These fibers appear as “floaters”, often described as black spots or cobwebs floating in one’s field of vision. These floaters may also be accompanied by “flashes” of light (lightning streaks) in one’s peripheral, or side, vision. These flashes are caused by a pulling effect or traction that the vitreous has on the retina (the light sensitive part of the eye) as it separates from the retina. This mechanical pulling stimulates the retinal nerve cell to send an electrical signal to the brain. The brain interprets this signal as light, even though no light is there.

This entire process is called a vitreous detachment or separation. In most cases, a vitreous detachment is not sight-threatening and requires no treatment. 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. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.

Although a vitreous detachment does not threaten sight, once in a while some of the vitreous fibers pull so hard on the retina that they tear the retina leading to a retinal detachment. This is a sight-threatening condition and should be treated immediately. If left untreated, a detached retina can lead to permanent vision loss in the affected eye. Those who experience a sudden increase in floaters or flashes of light should have an eye care professional examine their eyes as soon as possible. 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 retinal tear or detachment, early treatment can help prevent loss of vision.

Treatment:
Most of the time, floaters will seems to dissipate after several weeks time. However, a small percentage of people will experience annoying floaters that are always in their visual axis. These floaters may possibly be treated with a laser procedure called YAG vitreolysis or a vitrectomy.

YAG vitreolysis surgery is an office based procedure used to break apart floaters into small pieces as well as break the adhesions in the vitreous. The purpose is to make the floater small enough that it is not recognized, and /or move the floater away from the central visual axis so that it is not noticed any longer. This procedure can take from 10 to 30 minutes to perform and it can take several procedures to be effective. This is covered by most insurance plans and is often the first treatment attempted for floaters as it is the least invasive, minimal risk procedure with 80 % success rate for the right candidate.

Vitrectomy surgery is another way to eliminate floaters. This is often a second line treatment for floaters as it is a more invasive procedure that is performed by a vitreo-retinal specialist in an operating room. In this procedure, a small vitrectomy handpiece is inserted into the eye. This handpiece is essentially a small vaccum that cuts and sucks up the vitreous. Although highly successful, this procedure does come with more risk, such as infection, bleeding within the eye, and retinal detachment and longer healing time.