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Flashes and Floaters and Shadows, Oh My!

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It’s Monday night. You’re watching the ball game, when suddenly you see spots in your vision. You blink several times, but the specks don’t go away. In fact, you start noticing new sparks of light and a shadow in your field of vision. Should you contact your eye care specialist?

It’s Monday night. You’re watching the ball game, when suddenly you see spots in your vision. You blink several times, but the specks don’t go away. In fact, you start noticing new sparks of light and a shadow in your field of vision. Should you contact your eye care specialist? 

Yes. 

These symptoms can be signs of a serious condition that requires prompt attention.

What are floaters?

Floaters have been described as spots, circles, or cobwebs that appear in your field of vision. They are small collections of fibers or cells inside your vitreous – the gel-like substance that fills the back cavity of the eye. What you are seeing is the shadow that this clump of cells casts on the retina – the layer of nerve cells lining the back of the eye. The floaters may be more symptomatic when you look at a white wall or blue sky. You may even notice that the floaters drift in and out of your line of sight when you move your eyes from side to side.

What causes floaters?
The most common cause of floaters is age-related changes to the vitreous, the gel that accounts for nearly 80 percent of the volume of the eye and helps maintain the round shape of the eye. Over time the collagen fibers in the vitreous degrade, making it more liquid. This leads to the vitreous separating from the back of the eye, also known as posterior vitreous detachment. The clump of stringy vitreous fibers can block light in your line of sight, casting shadows that you may see as floaters. These are frequently accompanied by flashes of light that look like lightning streaks in your field of vision. 

These flashes occur when the vitreous gel is pulling on the retina. Most of the time, these flashes and floaters will subside within a couple months, and the vitreous separates without any additional problems. However, if the vitreous is very sticky and tugs on the retina, it can cause a retinal tear or detachment. Retinal tears can usually be treated in the office by your retina specialist to prevent retinal detachment. Fluid behind the retina can cause permanent vision loss if left untreated. 

Other common causes of floaters that your eye care provider will evaluate for include inflammation in the back of the eye, bleeding in the eye (usually from diabetes mellitus, high blood pressure, blocked blood vessels, or trauma), medications, or floaters related to prior  eye surgery. 

It’s important to be aware of the increased risk factors of developing floaters which include being over 50 years of age, nearsightedness, past eye trauma, prior cataract surgery, eye inflammation, and vitreous separation in the other eye. 

When should I see an eye doctor?

  • Flashes and floaters are common as people age. However, you should contact your eye doctor if you notice:
  • An increased number or sudden onset of new floaters
  • Flashing lights (lightning streaks) in your field of vision 
  • Shadow or darkness in your peripheral or side of vision
  • Curtain or veil covering part your vision

These painless symptoms can be signs of retinal tears or a detached retina, both of which are serious conditions that require prompt attention and treatment.  

What should I expect when I see my eye doctor?

Your doctor will ask you about your symptoms, specifically which eye is being affected, when it began, and if you have had any recent medical changes. A dilated eye exam will be performed, and depending on the findings, additional testing or imaging may be done.

Dr. Jaya B. Kumar is a retina specialist at Florida Retina Institute. She received her doctorate of medicine from Saint Louis University, completed her ophthalmology residency at Duke University, and completed a fellowship in vitreoretinal surgery and diseases at Cleveland Clinic Foundation. For more information, visit FloridaRetinaInstitute.com.

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