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From the patient’s point of view, floaters are objects that drift around in the field of vision. They may look like blobs, little worms or cobwebs that move with the eye’s movement. They seem impossible to focus on and are most visible when looking against a bright plain background such as a blue sky or a blank computer screen. Floaters are in fact particles suspended inside the vitreous body – the gel-like structure that fills the space between the lens and the retina. What we see, however, are not the floaters themselves, but the shadows they cast on the retina. The closer they are to the retina, the larger and clearer they appear in the field of vision.
Commonly, floaters develop as part of normal aging. With age, the gel-like vitreous body undergoes syneresis – a process in which water is separated from solid components, creating pockets of fluid that are perceived by the patient as blobs or little worms. The major structural protein of the vitreous – collagen fibrils – become denatured, clump together and can be seen as floating strings or cobwebs. The fluid pockets may collapse, causing the vitreous to shrink and pull away from the retina. This pulling exerts mechanical stimulations on the retina, producing “flashes of light” or photopsias in peripheral vision. Eventually, the vitreous is separated from the retina. This is known as posterior vitreous detachment or PVD. PVD is very common but is generally benign and does not require treatment. The floaters may be a nuisance to vision, but in most people, the brain will eventually learn to ignore them. Complications may happen, however, in a small number of cases. As the vitreous detaches, it may pull the retina with it, resulting in a retinal tear. Fluid from the vitreous may then sip through the tear and cause the retina to separate from the underlying tissue. This is known as retinal detachment and is a sight-threatening condition. Worrying signs to watch out for include:
- A sudden increase in number of new floaters, especially tiny ones as these may represent pigments or blood cells released from the damaged retina or blood vessels.
- A shade or curtain of vision – a sign of loss of vision from the detached part of the retina.
People with high degree of myopia are at higher risks of having PVD. The longer shape of the eyeball in myopia increases the likelihood of PVD and also the risk of retinal complications. This is because the retina is stretched over a larger surface and becomes thinner and more vulnerable to tears.
Other risk factors for PVD include intraocular inflammation, trauma, previous eye surgery, diabetes and family history.