Floaters in the Eye

Floaters in the eye are small dark spots that are seen in your field of vision. Patients’ often notice them when looking at something bright such as a computer screen or a white wall. They tend to move around in the eye and you often will not be able to focus on them.

Floaters can come in many different shapes and sizes. Patients’ often report seeing them as black or grey dots, squiggly lines, threadlike strands, cobwebs or ring like objects. Majority of the time eye floaters cause no more than just annoyance to the patient’s field of vision. The presence of floaters are common and usually not dangerous.

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What causes them?

floaterEye floaters typically appear when tiny pieces of the eye’s gel-like liquid called vitreous breaks loose from the back portion of the eye. These loose pieces float within the eye casting a shadow on the retina causing the phenomenon known as floaters.

Floaters in the eye are more prevalent with age. The vitreous behind the eye begins to liquefy with age causing an increase of floaters in the eye. Although rare, some eye disorders and disease can also cause eye floaters.

When are eye floaters and flashes a medical emergency?

Detecting a new eye floater from time to time is not any cause for concern. However, if you noticed a sudden shower of multiple floaters accompanied by flashes of light, you need to seek medical attention from your eye doctor immediately.

The sudden appearance of these symptoms could mean a vitreous or retinal detachment. This happens when the vitreous begins to pull away from the retina which may eventually cause a small tear or hole in it.

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The procedure (Vitreolysis)

Until recently, there was no safe and easy way to treat floaters in the eye. A surgical procedure known as vitrectomy was the only option of treating floaters in the eye. Traditionally, this procedure is reserved for patients with retinal detachment and serious eye infections. It involved replacing the eye’s natural fluid with a sterile clear fluid getting rid of the eye floaters altogether. But the risks usually outweigh the benefits and for these reasons, most eye doctors will not recommend vitrectomy to treat eye floaters.

Since the introduction of the vitreolysis procedure; the removal of floaters in the eye has become relatively quickly and safe to perform. This non-invasive and pain-free procedure uses laser light pulses to evaporate the floaters in the eye. The vaporised floater is turned into gas which gets absorbed in the eye.

This pain-free procedure can be performed in the clinic and under local anaesthetic eye drops. The procedure takes between 30–60 minutes and occasionally, more than one visit is required.

Frequently asked questions

About vitreolysis
Also known as floater laser removal, laser vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. It is performed in your ophthalmologist’s office and typically takes 20–60 minutes per treatment session. On average, patients will require two treatment sessions to achieve a satisfactory result. The goal of vitreolysis is to achieve a “functional improvement”. That is, to allow you to return to “normal” day-to-day activities without the hindrance of floaters.

How does vitreolysis work?
Vitreolysis involves the application of nanosecond pulses of low-energy laser light to evaporate the vitreous opacities and to sever the vitreous strands. During this process, the laser energy evaporates the collagen and hyaluronin molecules to form a gas. The end result is that the floater is removed and/or reduced to a size that no longer impedes vision.

What happens during the procedure?
Vitreolysis is performed as an outpatient procedure; you do not have to stay overnight in a hospital. Immediately prior to treatment, your ophthalmologist will administer eye drops to prepare the eye and to provide mild anaesthesia. A contact lens will then be placed on your eye, with the laser light delivered through a specially designed microscope.

During treatment, you will likely observe small, dark specks/shadows; signalling that the floaters are being evaporated into small gas bubbles. These gas bubbles quickly dissolve and are reabsorbed into the vitreous humour. Once the treatment is complete, your ophthalmologist may treat your eyes with anti-inflammatory drops. It is important to note that most patients will need to undergo two treatment sessions, sometimes three, in order to achieve a satisfactory result. As there is minimal inflammation post-treatment, these sessions can be performed on consecutive days.

What to expect after treatment?
You may observe small, dark specks in your lower field of vision immediately following treatment, but these small gas bubbles will quickly dissolve and will not impede vision. It is also important to note that some patients may experience mild discomfort, redness or temporarily blurred vision directly following treatment.

How long before I can go back to my routine lifestyle?
Normal activities can usually be resumed immediately or after the dilation drops wears off within three hours.

Complications and side effects
Reported side effects and complications associated with vitreolysis are rare. Side effects may include cataract and intraocular pressure (IOP) spike.

Who will benefit from vitreolysis?
While some floaters can be effectively treated, several floater types are difficult to treat and/or less likely to regress than others. To that end, it is necessary to first undergo an ophthalmic examination in order to determine your eligibility for vitreolysis treatment. Generally-speaking, if you suffer from persistent moving shadows, vitreous strands and opacities in your vision commonly known as eye floaters and it is impacting your functionality or enjoyment if life, you are a good candidate for vitreolysis.

A number of factors, such as age, onset of symptoms and floater characteristics, will also determine whether vitreolysis is your best treatment option.

  • Age In most cases, younger patients (<45 years) suffer from microscopic floaters located close to the retina (1–2mm) and are not considered to be good candidates for vitreolysis treatment.
  • Onset of Symptoms If your floater symptoms came on very quickly then they may be associated with a posterior vitreous detachment (PVD), the characteristics of which can be effectively treated with vitreolysis.
  • Floater Characteristics Large floaters with a soft border, situated away from the retina, are ideally suited to treatment with vitreolysis.