What are floaters?
Floaters are small pieces of debris in the vitreous cavity (the jelly like substance within your eyes) of your eye. They are often described as either as small dark shapes that float across your vision and can look like spots, threads, squiggly lines, or even little cobwebs. Floaters move as your eyes move — so when you try to look at them directly, they seem to move away. When your eyes stop moving, floaters keep drifting across your vision.
You may notice floaters more when you look at something bright, like white paper or a blue sky.
Are floaters serious?
Most people have floaters that come and go, and they often don’t need treatment. In the majority of cases, they are benign and are harmless apart from the visual disturbances they cause. But sometimes floaters can be a sign of a more serious eye condition. This includes a posterior vitreous detachment that can be complicated with a retinal tear or more seriously a retinal detachment. So if you notice new floaters that appear suddenly and don’t go away, it’s important to have your eyes checked by an ophthalmologist urgently.
Is there any treatment for floaters?
Flashes and floaters rarely lead to any serious complications, so you generally don’t need any treatment for them. If they are troublesome, the effect of floaters might be minimised by wearing dark glasses. This will help especially in bright sunlight or when looking at a brightly lit surface. In many cases, floaters get less noticeable with time as your brain adjusts to the jelly change.
However, in a small group of patients, the floaters can get very troublesome and significantly affect their lifestyle. In these cases, surgical treatment by way of pars plana vitrectomy can be offered. In this procedure, the vitreous jelly is removed with keyhole surgery in the eye with small incisions (up to 0.5mm) that do not require a suture. Surgery offers an excellent outcome in a vast majority of patients with studies showing symptoms to have settled in over 99% of patients. However, appropriate counselling and suitability assessment is important and hence recommended.
Laser treatment has been offered for treating floaters by a few surgeons in the UK. It is relatively easy to perform but it is not always successful since it works by disrupting large floaters into smaller pieces. It has shown to only improve symptoms in approximately 66% of patients (compared to 99% opting for vitrectomy). The laser can also cause some damage to the lens and the retina. Due to its limited efficacy and associated risks, Mr. Jasani does not recommend this treatment for floaters.
Are there risks with surgery?
As is the case with any surgical intervention, vitrectomy for floaters do carry some risk. The most common risk of surgery is the development of or worsening of a pre-existing cataract and therefore surgery for floaters can be occasionally be combined with cataract surgery in such cases. There is also a small risk of a retinal detachment (less than 1 in 100) which would require further surgery. The most serious risk is of an infection or bleed inside the eye (less than 1 in 1000) which can result in loss of vision. Fortunately this is rare but it is best to discuss all risks and benefits of surgery on an individual basis prior to any decision being made with regards to treating floaters.