THOSE NAGGING FLOATERS!
We have all seen them, those little spots or specks that seem to float freely in our vision from time to time. You might impress your friends with muscae volitantes, although the medical community will simply use the term FLOATER. To most people they are an occasional annoyance, but to some folks they can be downright exasperating. Floaters are usually made up of a protein substance that exists in the eye even prior to birth. At the time of birth these proteinaceous, collagen fibers disintegrate but leave remnants that will "float" across your line of sight. If these fragments are positioned near the back of the eye close to the retina, you will see them as spots or specks or even cobwebs that seem suspended in your vision. It is difficult to look directly at a floater because as you turn your eye the floater darts past your vision to a new location. Floaters are always more visible if you are looking against a light, bright background such as the sky, a blank wall or page in a book.
Floaters are noticed more often by nearsighted people and they are more apt to show up as we get older. A nearsighted eye is typically one that is slightly elongated (stretched) and this stretching can result in the release of more visible fibrils. The vitreous (jelly-like fluid in the eye) is relatively thick in a young person but as we age the vitreous becomes more fluid and the likelihood of seeing more floaters is increased.
The vast majority of people that complain about floaters have, in fact, a very benign, normal condition that requires no treatment. However, do not ignore them entirely. A sudden awareness of several floaters or an increase in the floater count accompanied by flashes of light can mean something more serious. Nearly everyone will eventually have a posterior vitreous detachment or PVD, that results from the pulling-away of the vitreous body from the retina. The resultant traction on the retina will cause you to see flashes of light or lightning streaks that may occur over several days, followed by an increase in the floater count. This will normally occur in those of us over the age of 45. It is estimated that half the population over 50 has already had a PVD. The PVD itself is not serious, but on occasion it will cause a small tear in the retina. Over time and without treatment this tear may produce a retinal detachment. Only a small percentage of PVD's will result in a retinal tear, but because of the threat of retinal detachment, it will be important for you to see your eye doctor so he/she can rule out any tears or breaks in the retinal tissue.
Ironically, if you have already had a complete vitreous detachment in both eyes (and you may have without even knowing it) and there were no tears in the retina, your chances of ever having a retinal detachment are slim. There is no longer a threat of pulling on the retina from the vitreous because it has harmlessly fallen forward. You may, however, have to fight off a few large floaters due to the repositioning of the vitreous base and these may linger for months to years before they settle out of your view.
Progress is being made on vitrectomies, which are actually "vitreous transplants", in order to "clear out" many different opacities found in the eye that are serious enough to truly affect vision. A few aggravating floaters DO NOT make you a candidate for vitrectomy. This is a serious operation and reserved for patients with serious vision trouble, especially blood in the vitreous, but the success of vitrectomies is quite promising.