Floaters are very common but disconcerting, often leading to severe visual disturbances for the patient. Patients will describe the symptoms as a floating image in their central vision that often looks like a “hair, insect or comma.” The symptoms can present very acutely, or sometimes more slowly and progressively over time.
The cause of floaters are changes in the vitreous gel of the eye. The eye consists of two compartments separated by the lens of the eye. In front of the lens is a small cavity filled with fluid called the aqueous fluid. Behind the lens is a larger cavity filled with the vitreous gel. The gel is contained within a capsule, much like a balloon filled with gel. This gel initially consists of a solid clear gel that forms the bulk of the eye, but sineretic changes occur as we get older. The gel gradually becomes more fluid filled forming small pockets or cavities of fluid within the gel, and the solid particles in the gel congregate together to form particles in the gel. These particles move with eye movements, but due to the fact that they are suspended in a gel, they move slower than the movement of the eye. The sineretic changes also causes a decrease in the volume of the vitreous gel, causing a detachment of the gel from the retina. This can occur very acutely, causing a sudden haziness floating in front of the persons’ central vision.
It is very important to note that these symptoms are in no way dangerous or detrimental to a persons’ vision. The floaters are however very symptomatic and irritating, causing a disturbance in the central fine vision, especially so with reading. It is however very important to examine the eye due to the fact that the gel detaching from the retina can cause damage to the retina leading to a retinal detachment and the risk of permanent vision loss. The people with an especially high risk are nearsighted individuals. Also individuals with a previous history of retinal problems as well as a family history of retinal problems are at high risk of developing retinal holes and detachments. If these damages to the retina are recognized early, argon laser treatment can be performed that closes the retinal tear or hole and preventing further damage to the retina as well as a retinal detachment. Vitreous floaters are more difficult to treat. There is some comfort in the fact that these floaters will mostly improve spontaneously over time as they settle and move away from the central vision. In some instances the floaters can be treated with a YAG laser that breaks it into smaller pieces and accelerating its move out of the central vision, and therefore improving the irritating hazy floater obscuring an individuals’ central vision.