Vitreous Floaters

The eye is filled with a gel called the vitreous. It is located behind your lens (like the lens of a camera) and occupies the whole space, which extends back to the retina (the seeing part of the eye). Like jelly, this gel is transparent and homogeneous and unless there is some defect in it, does not stop the passage of light. With age (and this is very variable from person to person) this gel becomes less homogeneous, and can cause visible shadows or floaters under specific conditions.

Symptoms

Floaters are vague shadows of spots, webs that move inside the eye with the movement of the eye. They usually start moving just after the eye moves, and continue in the same direction for a short while after the eye stops moving. These shadows are not completely dark, but allow light to get through them. Some people describe them as a haze or a blurred moving zone. They are much more visible when there is a lot of light entering the eye or when you are looking at a very bright uniform background such as the sky or a white wall.

What is their cause? Is it serious?

Floaters are quite common. If they are few in number and do not change much over time, they are not worrisome as they occur in many people. They are part of aging and they are mainly the result of the condensation of the vitreous gel, or its separation from the retinal surface. We only get worried when there are a large number of spots that appear in the eye all at once or when they are associated with flashes of light in the dark (see retinal tear and retinal detachment).

For most patients, they are only visible when there is a lot of light present. With time, but this can take several months or years, the problem becomes less visible and bothers the vision less. For some people though, floaters are visible in regular light, when looking at a computer screen or reading reports and correspondence. For these patients, floaters are a major hindrance on their quality of life and their ability to work. It is in these cases that we sometimes intervene.

What can be done?

As with any therapy, we first need to determine the severity of the problem and make sure that there is not other cause explaining the symptoms you have. For this, a complete eye exam will be done in which we will test your vision, examine the front part and the inside part of the eye to make sure there is nothing else going on with your eyes.

If we find no other cause for the symptoms, we will try to determine how much these vitreous floaters bother you by testing the effect of stray light in your eye. This gives us an objective measure of the effect of scattered light in the eye often in the absence of visible floaters. We will also obtain an OCT of the retinal surface and will attempt to look at the structure of the vitreous just above the retina, as this is where most bothersome floaters are located. These exams help us to understand what is bothering you and to decide if an intervention is appropriate.

If the findings and symptoms are significant enough that an intervention is necessary, there are currently two approaches that can be considered: one surgical and another one pharmacological. Once removed, floaters do not come back. However, for the vast majority of patients, just waiting and doing nothing is the best course of action.

• In the surgical approach, a modification of the pars plana vitrectomy (commonly used in many vitreoretinal procedures) can be used to remove bothersome floaters. The modification of this technique intends to minimize the risk of developing a cataract or a retinal tear post-surgery. Your treating EyeMD will explain all risks and benefits of surgery to you.
• In the pharmacologic approach, something is injected into the eye to facilitate the collapse of the gel and the disappearance of the floaters. Some people use a gas bubble; others have started to use enzymes. With this approach, the floaters often increases before they start to decrease in number. Moreover, it is less definitive than surgery but as a procedure, it takes less time.

Research on floaters

We are currently trying to better understand vitreous floaters by documenting what the patient experience. In addition, we are also constantly adapting the treatment procedures to minimize the risks for the patient.

If you are interested in participating or getting a copy of our scientific publications on the subject, do not hesitate to contact us.