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Floaters:

What are floaters?

Floaters are due to opacities in the vitreous jelly of the eye, which cast shadows on the retina, the light sensitive membrane at the back of the eye. They can take many forms, from small dots, circles and lines to large clouds and cobwebs which obscure the vision. Most of us will have noticed floaters in our vision at some time, as small mobile cobwebs visible against a bright uniform background. These are known as "physiological floaters" and are normal. However sometimes patients develop a sudden onset of new floaters: these patients should have an eye examination.

How do floaters form?

There are several causes: Posterior Vitreous Detachment (PVD) is the commonest cause of floaters. The vitreous separates from the retina and then floats around in the cavity of the eye, casting shadows onto the retina. Other causes include degenerative change in the vitreous (vitreous syneresis), longstanding vitreous haemorrhage, previous intraocular inflammation.

Do the floaters go away?

Patients usually find that their symptoms of PVD settle down after 3 months or so. The brain tends to adapt to the floaters and eventually is able to ignore them, so they then only become a problem in very bright light. Occasionally patients do have long term problems from their floaters, however fortunately this is uncommon.

Should I be worried by floaters?

Anyone that has a sudden onset of floaters, or has significant floaters affecting their vision should have an eye examination. Floaters may be associated with or due to underlying eye disease. The majority of floaters are due to a posterior vitreous detachment, which may be associated with the formation of retinal tears. Retinal tears should be treated to prevent development of a retinal detachment. If the floaters are due to vitreous haemorrhage, then the cause of the haemorrhage should be identified, such as new vessels in diabetic retinopathy, or a retinal tear.

Can floaters be removed?

In the vast majority of patients treatment is not indicated. Symptoms of floaters tend to settle down with time. However in a small minority of patients the symptoms remain very troublesome, and in such cases treatment can be considered. There are 2 different treatments:

YAG laser vitreolysis:

The vitreous opacities are disrupted and blown apart by laser focussed into the back of the eye. In theory this treatment sounds great, but it tends not to completely remove floaters, and one large floater may be disrupted into several smaller ones. Repeated treatments may be required. There are risks of retinal detachment, and direct damage to the retina by the laser. There are concerns about the safety of this technique and so it is not in common use by ophthalmologists in the UK.

Vitrectomy:

Floaters can be removed by vitrectomy. The vitreous and floaters are removed. This is very successful at removing the floaters but it is an intraocular operation and, as with any eye operation, small risks do exist. These include infection, development of cataract, retinal detachment and even, very rarely, loss of vision.

 
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