Are you seeing little ‘cobwebs’ or specks?

These little objects that float about in your field in vision are called ‘floaters’. They move with your eye and are most noticeable when you are looking at a blue sky or a white background like a wall or piece of paper.

Why is it important to have floaters checked out?

A floater is a symptom, not a diagnosis. What this means is that a floater is just what you see, it does not tell us what the cause is. It is like having a fever and you feel hot but we do not know what the cause is. To get you better and to prevent it from getting into a serious condition, we need to know the cause to advise the appropriate treatment.

What is the commonest cause of floaters?

Posterior vitreous detachment (PVD) is the most common reason. In Singapore, where myopia is common , patients have floaters earlier on in life and not just linked to age. The vitreous (gel-like fluid that fills the inner part of the eye) has proteins which can clump together and develop into string-like structures or cobwebs or any other shapes and these cast shadows on the retina. At the same time, the vitreous collapses and starts to detach itself from the retina.  That explains why along with floaters, you may also notice flashes of light as the vitreous is pulling on the light-sensitive retina. The pulling action stimulates the retina, causing your brain to interpret it as a light signal.

Will I lose my vision?

Floaters due to PVD are generally harmless and they eventually settle at the bottom of the eye and drift out of the line of vision. Most people learned to live with floaters or ignore them. If you have a sudden onset of floaters, you must see an eye doctor the soonest you can it could be due to other reasons other than a PVD. Floaters can also be made up of:

• Red blood cells, which is caused by a retinal tear or detachment. This is a medical emergency as it can lead to blindness if not detected and treated promptly.

• White blood cells that may suggest inflammation in the eye (uveitis), infection or cancer.

It is therefore very important to find out what the floaters are due to as we need to rule out sight- or even life-threatening diseases.

If you are already seeing floaters, watch out for sudden increase in number of floaters, appearance of flashes or in severe cases, presence of a ‘curtain’ blocking your peripheral vision as they may imply the onset of a retinal problem. Regular eye examination at an interval recommended by your eye doctor should be followed strictly. You are at higher risk of these conditions if you are short-sighted. Patients who are short-sighted should have a yearly eye examination to screen for retinal problems.

How does the eye doctor see the floater?

Eye drops will be instilled into your eye to dilate the pupil so that your vitreous and retina can be more thoroughly visualised through a slit-lamp biomicroscope. An indirect ophthalmoscope and an ultrasound of the retina may also be done to confirm the diagnosis. All these assessments are painless and can be performed on the same day in the clinic. Also a special camera is used to look in detail the peripheral retina.

How are floaters treated?

In most cases, floaters are part of the natural ageing process and are simply an annoyance. They can be distracting at first, but eventually tend to “settle” at the bottom of the eye, becoming less bothersome but they physically do not go away completely. More often then not you adapt to the floaters and see them less over time unless you look out specifically for them.

The treatment methods for floaters differ depending on the associated conditions diagnosed by your eye doctor. If they are found to be due to blood and a retinal tear is detected, the condition can be treated by laser retinopexy to seal the tear. The laser forms a barricade scar tissues around a retinal tear and prevents it from developing into a retinal detachment. It is a very safe procedure and not a surgery. There are no incisions and not uncomfortable.

If a retinal detachment has already developed, then surgery is required to reattach the retina. This also means that if a patient sees floaters and gets an eye check by an eye doctor earlier, treatment can be advocated early with good results and the retinal tear may not have developed into a detachment. Therefore, do not always assume that floaters will go away so do not ignore them.

Furthermore, when the floaters are found to be due to white blood cells, then more detailed assessments will be carried out to determine if they are due to infection or cancer. This is done taking a sample of the vitreous and sending it for cytology to find out the type of cells. After which further work-up is warranted to determine the source and extent of the problem.

Can the floaters be removed?

Floaters can be removed through a surgical procedure called vitrectomy. In this procedure, the vitreous is removed along with its floating debris.

If you experience sudden onset or increase in floaters, flashes of light or a loss of peripheral vision you should consult an eye care professional as soon as possible