Dr Simon ChenCataract & Retina SurgeonFloaters are small shadows cast on the retina by strands and clumps in the vitreous, the clear gel that fills the eye. Most are harmless and many become less noticeable with time; laser or floater surgery is considered when persistent floaters interfere with everyday life. New flashes, a sudden increase in floaters or a shadow need urgent assessment.
Floaters are small shadows cast on the retina by strands and clumps in the vitreous, the clear gel that fills the eye.
They look like dots, threads, cobwebs or rings that drift across vision, most obvious against a bright sky or a white wall, and they move when the eye moves. Almost everyone has some. With age the gel liquefies and shrinks, and at some point it separates from the retina: a posterior vitreous detachment, or PVD. That separation often brings a burst of new floaters, sometimes a large ring-shaped one, and occasionally flashes of light.
A PVD is a normal event and in most eyes it is harmless. The concern is that, as it separates, the gel occasionally tears the retina, and a tear can lead to a retinal detachment. That is why new floaters, particularly with flashes, need a prompt retinal examination even though most turn out to be benign.
Light enters the eye through the pupil. As it passes clumps and strands in the gel, each one casts a shadow on the retina, and that shadow is what you see.
Further explanation: What is a Weiss ring floater?.
Further explanation: How does the vitreous change with age?.
Further explanation: Can eye floaters affect your quality of life?.
Floaters come in many shapes. Some have sharp edges and others are poorly defined. They move within the eye.
Grey dots, fine threads, worm-like strands and cobweb shapes drift across a bright view. They move with the eye and can dart away when you try to look directly at them.
Most floaters are the gel casting shadows. Over weeks and months the brain often learns to ignore them and they settle lower in the eye, out of the line of sight, even though they have not gone away.
New flashes, a sudden increase in floaters, a shadow or curtain, or sudden loss of vision need urgent assessment. Call the clinic; if it is closed or you cannot be assessed promptly, attend your nearest emergency department.
The right approach depends on the floaters themselves, the health of your eye and how much your symptoms affect you. Observation, laser and surgery each have a place.
The aim is to confirm that the retina is intact, then to understand how much the floaters are affecting you.
After dilating drops, the whole retina is examined out to its edge, sometimes with gentle pressure on the eyelid to see the far periphery. If a tear is found it can usually be sealed with laser in the clinic on the day. An OCT scan (optical coherence tomography, a light-based scan of the retina) checks the macula and shows the state of the gel.
If the retina is healthy, Dr Chen talks through how the floaters are affecting your reading, driving and work, and whether observation or treatment makes sense for you.
YAG laser vitreolysis can be an effective treatment for selected floaters. It uses focused laser pulses to break down vitreous opacities and reduce the shadows they cast in your vision.
Dr Chen generally finds it most effective when there is one, or a small number of, isolated floaters that can be clearly seen in the middle of the vitreous cavity, safely away from the eye’s lens and retina.
Suitability requires an individual clinical examination and assessment by a retinal specialist. Type and position of your floaters, your symptoms and the health of the rest of your eye are considered before recommending treatment.
Focused laser treatment. The cone represents laser light converging on a selected floater. The coloured light is illustrative. About laser treatment.
Laser is performed through a contact lens placed on the eye after numbing drops. More than one session may be needed, and treatment may reduce symptoms without removing every floater. Potential risks include raised eye pressure, damage to the lens or retina, and retinal tears or detachment.
Dr Chen regularly performs vitrectomy for people whose floaters continue to interfere with everyday life. The decision starts with understanding your symptoms: what you see, how long it has been present and how it affects reading, driving, work or other activities that matter to you.
Through small openings in the white of the eye, the vitreous gel and its floaters are removed. This is usually day surgery.
Vitrectomy for floaters. A probe removes vitreous gel containing floaters; a separate light pipe illuminates the view. About vitrectomy.
Dr Chen performs floater surgery with the Alcon UNITY Vitreoretinal Cataract System (VCS), a state-of-the-art vitrectomy platform, through three tiny self-sealing openings of 25 or 27 gauge, usually without stitches. Its vitreous cutter works at up to 30,000 cuts per minute, so each cut takes a smaller bite of gel. This is designed to reduce pulling on the retina as the gel is removed, which matters in floater surgery, where the aim is to clear the floaters while leaving a healthy retina undisturbed.
The system controls pressure inside the eye throughout the operation, and ZEISS RESIGHT wide-angle viewing lets Dr Chen examine the far edge of the retina before finishing, to find and treat any weak areas.
About the technology in Dr Chen’s practiceVitrectomy can substantially reduce the disturbance caused by floaters, but it is an operation inside the eye. Risks include retinal tears or detachment, infection, bleeding, raised eye pressure and, rarely, loss of vision. Cataract can develop or progress afterwards if you still have your natural lens. Some floaters or visual symptoms may remain.
Before deciding, Dr Chen will explain the likely benefit for your symptoms, the risks for your eye and whether cataract surgery should be considered at the same time or separately.
Combined cataract and retinal surgery
Published in mivision · October 2018
Read an article about floaters written by Dr Simon Chen with Dr Chris Hodge, covering assessment and treatment in more detail.
Usually not. The exception is a sudden change: a shower of new floaters, flashes or a shadow, which can mean a retinal tear and needs urgent assessment.
Vitrectomy is a well-established operation, and it carries risks, including retinal tear or detachment and infection; a cataract commonly follows in eyes with their natural lens. Those risks are weighed against how much the floaters affect you, and discussed openly.
Do not drive if floaters or other visual symptoms interfere with safe vision. Discuss this with your eye clinician; an assessment considers your visual function and the standards for your licence.
No drop, tablet or diet has been shown to clear floaters. Be cautious of products that claim otherwise.
Yes. Dr Chen offers YAG laser vitreolysis for selected floaters. Whether it suits your eye depends on their size, number, visibility and distance from the lens and retina. Read about laser treatment and suitability
A letter chart is only part of assessing vision. Moving shadows may interrupt reading or work even when individual letters remain clear. Describe the tasks affected, how long symptoms have lasted and whether they are improving; these details help guide a proportionate treatment decision.
It is a ring-shaped condensation that may become visible when the vitreous separates from its attachment around the optic nerve. A ring does not by itself establish that laser is suitable: its position, the rest of the vitreous and the retina need examination.
No. YAG vitreolysis targets selected opacities in the vitreous gel. YAG capsulotomy makes an opening in a cloudy capsule behind an artificial lens. Laser used to seal a retinal tear has a different purpose again.
Longer articles by Dr Chen go into these questions in more detail, including what the research shows.
The article “Does the vitreous grow back after vitrectomy surgery?” explains what takes the place of the removed gel after surgery.
Appointments and enquiries are made through Vision Eye Institute Chatswood.
Level 3, 270 Victoria Avenue, Chatswood NSW 2067For a sudden change in vision, follow the urgent advice above.
Optometrists, GPs and ophthalmologists can refer through Oculo or with the PDF referral form.
Vision Eye Institute confirms your appointment after you submit your request. The request form is not for emergencies. A referral is not strictly essential to request an appointment, but you need a valid one to claim a Medicare rebate for your consultation.
