Floaters in Your Vision: What You Need to Know and When to be Concerned

We have all looked up at the clear blue sky and noticed small "floaters" or squiggly lines moving across our field of vision from time to time. They can resemble strands of hair, cobwebs, or dots. Though they may appear as if located in front of our eyes, they in fact originate inside of our eyes; and represent a normal structure known as the vitreous.

The vitreous is a clear, gel-like substance that fills the eye's largest cavity. While mostly composed of water; small amounts of collagen, a structural protein; and hyaluronic acid, a naturally occurring structural polysaccharide, coincidentally best known as the key ingredient in most cosmetic fillers; help give the vitreous its shape.

A young person's vitreous has a thick consistency and firmly adheres to the retina, the neurosensory tissue that lines the back wall of the eye and sends images from the visual world to the brain for processing. It is perfectly normal for small cavities within the vitreous present themselves as floaters, even at a young age.

In the absence of trauma, a person's floaters can remain relatively stable for several decades. But as the years pass and the eye ages into the fifth or sixth decade, the vitreous contracts and liquefies, eventually to the point that it separates itself from the retinal surface. At this time, one will often notice a sudden change or increase in floaters or black specks in one eye. These new floaters may be accompanied by intermittent flashing lights in the same eye, representing ongoing traction of the vitreous against the retina while certain areas remain in the process of separating.

This is the critical time to see your eye care provider for an urgent dilated eye exam. In 10 to 15% of patients with new symptoms from this vitreous separation, known as a posterior *vitreous* detachment; the traction can cause a hole or tear in the peripheral retina.

If detected early with a dilated exam, a retinal hole can be treated with a quick in-office laser procedure without further consequence. However, if left untreated; a retinal hole can result in a *retinal* detachment, which can result in vision loss and requires urgent surgical repair.

In summary, most floaters are harmless and represent normal cavities within the gel-like structure of a person's eye. But any sudden change or increase in floaters in one eye, especially if accompanied by flashing lights, warrants scheduling an urgent dilated exam with your eye care provider so that any vision-threatening conditions can be identified and treated.

Shawn Kavoussi M.D. is a board-certified ophthalmologist at the Berkeley Eye Center in Houston, TX; specializing in diseases and surgery of the retina and vitreous. To schedule an appointment, you can reach our office at 713-526-1600.