Seeing Spots?

They appear in your line of sight suddenly, strange specks or dots, even cobweb-y strands that won’t go away when you blink or rub your eyes. For some people, the experience is disconcerting, alarming.

Relax — it doesn’t mean you’re growing blind or have some microscopic spider weaving its lair under your eyelid.

There’s a perfectly good explanation for those spots in your vision that move when your eyes move but also appear to drift away when you zero in on them.

Eye floaters, says Dr. Luis Haddock, an ophthalmologist and retina specialist at Bascom Palmer Eye Institute, part of the University of Miami Health System, are a common complaint among the 50-plus crowd and one more annoyance that can be blamed on growing older.

“As you age,” he says, “the gel-like substance inside your eyes becomes more liquid and more stringy. It sags and clumps and begins to detach, blocking the light passing through the eye.”

That jelly-ish substance is called vitreous and it fills about 80% of the eye, helping it maintain its round shape. When it shrinks and sags, pulling away from the eyeball, it casts shadows on your retina, resulting in the spots that can be confounding the first time a patient notices them.

These spots are most noticeable “when you look at a plain lighted background or on a bright sunny day,” Dr. Haddock says.

It’s not only age that can cause floaters, of course. Younger patients with severe nearsightedness can have issues with earlier liquefying and sagging vitreous. Also, other illnesses may cause floaters, including diabetes, infections and uveitis, or inflammation of the eye. In those situations, the underlying causes of the disease are treated.

However, most floaters are usually harmless and don’t require treatment.

“They go away on their own after a while,” Dr. Haddock says. “They settle out of the line of vision.”

In some rare cases, eye floaters may multiply and grow denser, impairing vision and affecting visual quality and the patient’s quality of life. For such instances, Dr. Haddock may recommend a vitrectomy, a surgery that removes the vitreous along with the floaters from the eye and then replaces the vitreous with a salty solution that helps maintain the shape of the eye. The procedure, however, comes with certain risks and complications, Dr. Haddock adds, and most surgeons are reluctant to recommend it unless the floaters seriously interfere with vision.

Laser treatment that vaporizes floaters can be used, too, but Dr. Haddock does not favor this therapy and the risks are not well known at this time.

Though usually benign, floaters can signal more serious issues, including eye inflammation, eye trauma, hemorrhaging and retinal tear or detachment.

It’s important for a person with floaters to monitor the situation. 

“If you’re suddenly having more or new floaters, if you’re seeing flashes of light like lightning in the eye or have loss of peripheral vision, that’s when it’s time to go see a doctor,” Dr. Haddock says. “Those are symptoms that may suggest a bigger problem.”

A retinal tear happens when the weight of the vitreous tugs at the retina until it breaks. This can lead to a retinal detachment, or the lifting or pulling of the light-processing tissue from the back wall of the eye. If left untreated, a detachment can cause permanent loss of vision, so Dr. Haddock emphasizes the urgency of seeing an eye doctor in the case of light flashes and sudden changes in floater density. “Early treatment is essential.”

If the doctor determines a retina is torn, he can repair the tear by laser or freezing to seal it.

In the case of a small retinal detachment, a doctor might also choose to inject a gas bubble into the vitreous, which causes the gel-like substance to close back up. If, there is progression to a retinal detachment, surgical retinal detachment repair is warranted.

But a retinal issue, Haddock repeats reassuringly, is “the most serious event” of a floaters case but also rare. Most of the time, floaters are simply one more reminder that our eyes — like our graying hair, creaking joints, and fading hearing — have fallen victim to the calendar’s relentless march.

 Ana Veciana-Suarez, Guest Columnist

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: Ana Veciana Suarez, Bascom Palmer Eye Institute, Dr. Luis Haddock, floaters, retina