Floaters Are Common as We Age but May Signal a More Serious Eye Problem

LEXINGTON, Ky. (Feb. 6, 2017) — Have you ever noticed the sudden appearance of a black dot in your field of vision that moves around when you move your eyes? It could also look like a cob web. You try blinking but it just won’t go away. They can be quite bothersome especially if you’re trying to read or do other close work.

What are floaters?

A floater may appear as a dark gray or black spot, circle, spider web, or squiggly line that drifts in the vision as the eye moves.  Floaters are most noticeable in bright sunlight or when looking at a white background.  What we see as a floater is actually a shadow cast by a small condensation of vitreous gel inside the eye. 

Does everyone have them?

No, but they are very common, and are more likely to occur with age.  The vitreous gel liquefies with age, causing condensations within the gel, which become the floaters that we see.  Eventually the vitreous gel separates free from the retina forming a posterior vitreous detachment (PVD).  This happens to most people at some point during their lives.  A new central floater often appears when the PVD occurs, and intermittent light flashes may be present.  The risk of a retinal tear is highest during the month after a PVD occurs because gel that is stuck to the retinal surface may cause a tear as it separates.

When should I be concerned?

You should seek immediate evaluation by an ophthalmologist if you see a new floater(s), the floaters are accompanied by flashing lights, or part of your vision becomes dark.  Floaters that appear red could indicate bleeding inside the eye, which is another indication for urgent evaluation.

Why is it important to seek urgent evaluation by an ophthalmologist?

Symptoms like flashing lights, multiple new floaters, decreased vision, or bleeding inside the eye can be the first sign of a retinal tear or retinal detachment which can lead to permanent vision loss.  Early treatment offers the best chance for preservation and/or recovery of vision.  A retinal tear can often be treated with an in-office laser procedure to prevent retinal detachment and loss of vision.

Other important causes of floaters include diabetes, injury to the eye, inflammation (uveitis), and infection.

Will my floaters go away?

Over time, the brain learns to “tune out” the floaters in the eye.  This process usually takes months.  The floaters themselves may also settle to the bottom of the eye and move out of center vision.  Occasionally floaters can impair vision enough that a surgical procedure, vitrectomy, is indicated to remove the vitreous gel.  Most people find that floaters become much less noticeable over time and surgery is not needed.  Laser treatment of floaters to break them up into small particles has significant risk and has not yet gained wide acceptance.  Eye drops and diet modification have not been shown to decrease floaters.  For floaters that are annoying, after being evaluated by an ophthalmologist, most patients find that “time is the best medicine.”

Clare Fraser, MD, PhD, is an assistant professor at the University of Kentucky Department of Ophthalmology and Visual Sciences.