Am I Imagining Worms Floating in my Vision? All You Need About Eye Floaters
LSC Editorial Team
October 7, 2024
What are Eye Floaters?
Many people aged 50 to 60 and older may occasionally notice unusual shapes drifting in their vision. These shapes can vary widely in size and form, often resembling small spots, dust particles, flies, mosquitoes, tangled threads, filaments, blobs, worms, strands of hair, cobwebs, or even rings.
This is completely normal and a natural part of aging. You’re not imagining things—these visual disturbances, known as eye floaters, are real and are caused by actual changes within your eyes, constantly drifting in your field of vision.
Causes of Eye Floaters
People who are significantly short-sighted are more likely to develop vitreous degeneration at an earlier age, which can lead to the appearance of floaters as early as their 30s or 40s.
This risk is linked to the natural length of the eyeball—the more severe the short-sightedness, the longer the eyeball, and the sooner vitreous degeneration tends to occur. Undergoing laser vision correction (e.g. ZEISS SMILE®, LASIK, or PRK), does not lower the risk of early vitreous floaters for individuals who were previously highly short-sighted as these procedures alter only the front part of the eye (i.e. the cornea).
The retina is a layer of light-sensitive cells that lines the back of the eye, similar to the film in a camera. When these nerve cells are stimulated by light, they send signals to the brain, allowing you to perceive what you’re seeing. Between the lens and the retina lies the vitreous gel, a gel-like substance that fills this space and is also tightly attached to the retina.
Floaters develop as the collagen in the vitreous gel begins to deteriorate with age, typically starting around 50 to 60 years old. This process is medically referred to as “vitreous degeneration.” At birth, the vitreous gel is quite firm, but as we age, it softens, with parts of it becoming more liquid-like. The collagen within the vitreous changes, thickening and forming clumps, resembling debris floating in fluid.
When you move your eyes, these clumps shift around and catch the light, similar to how snowflakes in a snow globe swirl when the globe is shaken. The movement of these clumps casts small shadows on the retina, creating the visual effect we recognize as “floaters.”
Are There Other Medical Causes of Eye Floaters?
Whilst vitreous degeneration is the most common cause, there are sometimes less common but still important causes. These include:
A vitreous hemorrhage occurs when bleeding happens within the vitreous cavity, causing blood cells, rather than collagen debris, to disperse in the gel. This is most commonly a result of advanced diabetic eye disease but can also be caused by other conditions that affect the blood vessels in the retina.
Uveitis refers to an inflammatory eye disease. The inflammatory cells that float in the vitreous gel contribute to the perception of floaters. There are various subtypes of uveitis, so it’s crucial to have a thorough evaluation by your ophthalmologist to ensure you receive the right advice, monitoring, and treatment.
What Do Eye Floaters Look Like?
Floaters come in various forms, shapes, and sizes:
They may appear as small black dots drifting across your field of vision, fading in and out of view. They can also take on hair-like shapes, resembling worms, strings, ropes, or even tiny insect-like figures. Each individual experiences floaters differently.
Floaters may appear and disappear in your vision:
Floaters can sometimes be difficult to notice, becoming visible only when your eye moves, and then seeming to slow down as your gaze stabilizes. However, they may reappear when you shift your focus. As a result, these symptoms are typically transient.
Floaters are often more noticeable against light or uniform backgrounds:For instance, they are more easily seen on computer screens, clear skies, or while gazing out to sea. This means that people in certain professions, such as those who spend a lot of time working on computers, may notice them more frequently. In Singapore, where there is abundant daylight, floaters are commonly perceived.
Are Eye Floaters Harmful and Do They Signal Any Problem with the Eye?
Floaters themselves do not harm your eye health; they are a normal part of the aging process in the eye. In most cases, they are not associated with other eye problems. Initially, floaters can be somewhat annoying, as they may disrupt your vision. For example, when reading a newspaper or using a computer, a clump of floaters may drift into your line of sight and temporarily obscure your view.
However, in a small number of cases, floaters can occur alongside retinal tears or holes. Therefore, if you notice any floaters, it’s important to have a retinal examination, which can be scheduled on a non-urgent basis.
Although vitreous gel degeneration is a gradual process that can take months or years, the final stage involves the back layer of the vitreous gel peeling away and separating from the retina, known as posterior vitreous detachment. This condition is significantly different from standard vitreous degeneration because, at this stage, the risk of a retinal tear increases due to the tugging effect of the separating gel on the retina.
When posterior vitreous detachment occurs, floaters may appear suddenly, or there may be a rapid increase in their number. A key distinguishing feature of this situation is the presence of numerous floaters (often described as a “shower of floaters”) accompanied by persistent flashing lights. The abundance of floaters can be so pronounced that it resembles a dense fog or a room filled with smoke.
It’s important to recognize that this is a medical emergency. You should see an eye doctor for a retinal examination as soon as possible.
A retinal tear resulting from posterior vitreous detachment can be treated with laser therapy during a relatively simple outpatient procedure. However, if a retinal tear goes untreated, even for just a few hours, it can rapidly progress to a retinal detachment, which will then necessitate retinal reattachment surgery.
Having a posterior vitreous detachment does not always indicate the presence of a retinal tear, as the gel can separate from the retina without causing any damage. However, it is crucial to have an eye examination to confirm this.
There are however a minority of cases in which retinal tears and retinal holes can co-exist with floaters, and thus, a retinal examination at some point is important so long you have any floaters. This can be conducted on a non-urgent basis.
Although the vitreous gel degeneration is a slow process that can take months or years, the final stage of this process is that the back layer of the vitreous gel peels away and separates from the retina, a process which we call a posterior vitreous detachment. A posterior vitreous detachment is very different from plain vitreous degeneration because when it happens, the risk of a retinal tear is much higher, due to the tugging effect of the separating gel from the retina at this point in time.
When this happens, floaters develop all of a sudden, or the individual experiences a very rapid increase in the number of floaters. The important feature that differentiates this from pure vitreous degeneration is that there are numerous floaters (i.e. a “shower of floaters”), and this is always accompanied by persisting flashing lights. The extent of floaters can be so significant that it appears as a dense fog, or as if you are in a room full of smoke.
You need to be aware that this is a medical emergency, and it is absolutely essential that you see an eye doctor for an examination of your retina as soon as possible.
A retinal tear caused by a posterior vitreous detachment can be treated with laser in a fairly straightforward clinic procedure. However, if a retinal tear in this situation is left untreated, for even more than a few hours, it can quickly progress to a retinal detachment, for which retinal reattachment surgery is then required.
Now, having a posterior vitreous detachment does not always mean that a retinal tear is present, as the gel may peel away from the retina without causing a tear, but an eye examination is still absolutely essential to make sure that this is the case!
Will Eye Floaters Go Away?
Floaters are typically visible only for a brief period before the brain filters them out. This doesn’t mean that the floaters have physically disappeared—they are still present. However, over time, the brain learns to recognize floaters as insignificant, causing them to fade from perception. They may become noticeable again in certain situations, such as in bright lighting or against a light, uniform background. As a result, most individuals experience less annoyance from floaters over time.
Additionally, in cases of posterior vitreous detachments, we perceive floaters less frequently as the vitreous gel fully separates from the retina. This separation allows the gel to move further away from the retina, reducing the light-scattering effect and the shadows cast on the retina.
Do Eye Floaters Need to Be Treated?
Since most vitreous floaters are transient, individuals typically come to understand that any symptoms are temporary and eventually learn to manage their perception of them. As a result, most patients with floaters do not experience symptoms severe enough to require treatment.
However, if floaters significantly affect visual quality to the point of disrupting a patient’s quality of life or hindering their job performance, treatment may be considered. Some individuals may find floaters particularly bothersome because the debris is located closer to the retina, casting more distinct shadows.
Additionally, floaters can contribute to a degree of psychological stress, especially for those in vision- dependent jobs. This includes office workers who frequently use computers, drivers, musicians, and individuals in high-risk occupations, such as site engineers.
However, when floaters cause a significant visual quality issue to the extent that they interfere with a patient’s quality of life or prevent them from performing their job effectively, treatment can be considered.
Eye Floaters Treatment Options
Many suggestions exist for managing vitreous floaters, including relaxation techniques like yoga and meditation. While these methods may help alleviate the psychological effects of floaters, physical reduction or removal can only be achieved through medical treatment.
The available medical treatment options include:
YAG Laser Vitreolysis
The YAG laser vitreolysis procedure utilizes a disruptive laser directed at larger floater particles, delivering sufficient energy to break them into smaller pieces. Often, these fragments become dispersed, and patients may continue to experience symptoms after the procedure.While some patients may notice an improvement in their symptoms, the overall outcomes can be unpredictable, and multiple treatment sessions may be necessary. Additionally, the substantial energy introduced into the eye in a relatively unregulated manner can potentially lead to retinal damage.
Vitrectomy Surgery
The surgical treatment for floaters is known as vitrectomy (sometimes informally referred to as “floaterectomy”). Although vitrectomy is a commonly performed surgical procedure, it is typically conducted for other reasons, such as reattaching a detached retina or removing membranes from the retina, rather than specifically for floaters. This procedure involves micro-incisions and is performed under local anesthesia. It is an outpatient surgery that usually lasts less than one hour. During the procedure, the retinal surgeon completely removes the vitreous gel along with all the floater debris. The effectiveness of this procedure in eliminating floaters is well established, and patients can expect to have complete eradication of floaters afterward.
The primary consideration in determining whether a patient should undergo vitrectomy is the small but significant risk of visual complications, estimated at 3-5%. These complications cannot be corrected with glasses and include retinal detachments caused by retinal tears during the procedure. Retinal detachments are sight-threatening and necessitate surgical intervention to reattach the
retina.
For patients who have not yet had cataract surgery, undergoing vitrectomy may also accelerate the development of cataracts, meaning they should be prepared for the possibility of needing cataract surgery in the near future.
While floaters are a common symptom, it is crucial to have a thorough eye examination by an ophthalmologist to rule out retinal tears or other serious eye conditions that may require treatment.
A comprehensive assessment of your floaters and retinal health by a retinal specialist is essential for understanding your risks and obtaining sound medical advice regarding treatment options.
If you notice new or sudden increases in your floaters or experience persistent flashing lights, it is important to seek an eye examination as soon as possible. Please call us to schedule an urgent appointment during office hours.
If you have stable floaters and are concerned about them, or if you wish to have a comprehensive eye assessment to understand your risks and discuss potential treatments, please contact us to schedule an appointment with our retinal specialist.
Floaters, whilst a common symptom, require a thorough eye examination by an ophthalmologist to ensure that you do not have retinal tears or other more sinister eye conditions, as some of these can be treated.
A comprehensive assessment of your floaters and retinal status by a retinal specialist is important to know your risks, and to obtain honest and medically-sound advice for treatment, if any.
If you have developed new and recent floaters, or a sudden increase in your usual number of floaters, or are experiencing persisting flashing lights, you will need an eye examination as quickly as possible. Call us to schedule an urgent appointment during office hours.
If you have been having stable eye floaters for some time and are concerned, and would like to have a comprehensive eye assessment, understand your risks and discuss if any treatment is necessary, contact us to schedule an appointment with our retinal specialist.
