Dr Simon ChenCataract & Retina SurgeonFloaters are dots, threads or cobweb-like shapes that drift across your vision. Dr Simon Chen assesses their cause and discusses treatment when persistent symptoms interfere with everyday life.
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.
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 months the brain learns to ignore them and they settle lower in the eye, out of the line of sight, even though they have not gone away.
For new flashes, floaters, a shadow or sudden vision loss, follow the urgent advice below. Urgent assessment advice
Slide each picture to compare typical vision with the change described. Illustrations are indicative, not a diagnostic test or a prediction of vision after treatment.
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; you do not need to try laser before discussing surgery.
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.
Long-standing, stable floaters that have not changed are a different matter and can be discussed at a routine appointment. It is the change that matters.
Retinal tears and 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. Dr Chen will discuss the anaesthesia, recovery and follow-up appropriate for your eye.
Vitrectomy 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 →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. Dr Chen considers the type and position of the floaters, your symptoms and the health of the rest of your eye before recommending 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 will explain the benefits, limitations and alternatives for your particular eye.
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.
Bring these, and anything else on your mind. Write the answers down, or bring someone who can.
They often become less noticeable over months, as they settle out of the line of sight and the brain learns to ignore them. They seldom disappear completely on their own.
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 →
Arrange an assessment with Dr Simon Chen through Vision Eye Institute. For a sudden change in vision, follow the urgent advice above.
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