Posterior Vitreous Detachment: Everything You Should Know About Flashes and Floaters

“Oh squiggly line in my eye fluid, I see you there lurking on the periphery of my vision. But when I try to look at you, you scurry away. Are you shy squiggly line? Why only when I ignore you, do you return to the center of my eye? Oh squiggly line, it’s alright, you are forgiven.” – Quote from Stewie in Family Guy

Floaters and flashes are a common problem the majority of the population will suffer at some point in their lives. In my 15 years as an ophthalmic technician, five of those years were spent with a retinal specialist. I learned quite a bit about flashing lights, floaters, vitreous detachments, and retinal detachments among other retinal diseases. I have also suffered from floaters since I was a teenager. I have, what is termed, vitreous syneresis. First, let me start by defining what the vitreous is and how floaters occur.

The vitreous is a gel-like fluid in the back of the eye, behind the iris and lens. It gives the eye its rigidity and keeps the retina pressed against the back wall of the eye. The vitreous is attached to the retina in two places: the optic nerve, and the ora seratta but may stick to the retina in other places as well.

The vitreous gets its consistency from being 99% water. The other components are vitrosin (a type of collagen), phagocytes, hyalocytes of Balazs and hyaluronic acid. Phagocytes are white blood cells (part of the immune system) that clean the vitreous of any foreign debris, and the hyalocytes of Balazs recycle the hyaluronic acid. There are no blood vessels feeding the vitreous. All blood vessels in the back of the eye are contained within the retina

As we age, the vitreous liquefies and loses its gelatinous consistency due to the break down of the vitrosin (collagen) and the hyaluronic acid. When the collagen breaks down, it sometimes forms chunks in the shape of strings, worms, blobs, cobwebs and other shapes that float in the watery vitreous. These “floaters” can be annoying, obstruct the vision, and are most noticeable against a white or solid background like the sky. They are sometimes accompanied by flashes of light, resembling a camera flash, in the periphery of the vision. This is caused by the vitreous collapsing and tugging at the retina, which causes the nerves to fire, registering a flash of light in the brain. This collapse is called a posterior vitreous detachment. Occasionally, the vitreous can pull too hard on the retina and cause it to rip, leading to a retinal tear. These tears, if not treated, will allow fluid to build up underneath the retina (the typical immune response to injury) and create a retinal detachment. Flashing lights and floaters do not necessarily mean you have a retinal detachment. If you have these symptoms, you should see your ophthalmologist as soon as possible. The ophthalmologist will be able to catch a retinal tear before you can see it in your vision.

There are two treatments currently available for floaters. The first is a vitrectomy. This procedure is done on patients who have a retinal detachment, or large floaters that completely obstruct a portion, or all, of their vision when it floats into view. The vitreous is removed and the vitreous cavity is filled with silicon oil. In the case of retinal detachment, a gas bubble is placed in the eye.

This surgery is not recommended for minor or annoying floaters. There is a long recovery time. Vision may not improve for three to six months after surgery. The procedure is quite invasive as well, carrying a large risk for infections such as endophthalmitis, a nasty infection that can cause permanent vision loss in less than 24 hours.

Laser treatment is available. There is only one surgeon in the USA that has the experience to treat floaters with laser. He is the one who developed the technique, Dr. John Karickhoff. He is located in Virginia and his experiments with using a YAG (Yttrium, Aluminium and Garnet) laser to vaporize the floaters. The technique takes about 20 minutes and two treatments are usually needed

The most important thing to remember is if you have just one or two floaters and flashes occasionally, there is really no reason to worry. If you notice a sudden increase in floaters, your one or two floaters turn into considerably more, and you notice the flashes have become more frequent, you should see your ophthalmologist right away. Surgery should be a last resort. I’ve had floaters since I was 16 years old, and I have quite a few of them. After awhile, you get used to them. I rarely notice mine anymore unless I’m looking at green grass or the sky. If they really become intrusive and block your vision, consider the laser surgery. It’s less invasive and less likely to cause vision problems.

My next hub will discuss retinal detachments and the various surgical treatments available, along with how to find the right retinal specialist for you.

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