Floaters & Posterior Vitreous Detachment

The vitreous is a collagen based matrix in the middle of the eye that is necessary for appropriate eye development. As you become older, just like how wrinkles form in the skin due to aging, the vitreous also begins contracting and condensing with age. This condensation is what becomes known as floaters. As the vitreous contracts and pulls on the retina, this traction generates brief flashes of light called photopsias. Eventually, the vitreous interface with the retina (known as the hyaloid) will separate from the retinal surface. When this event occurs, it is called a posterior vitreous detachment (PVD) and the patient sees a large symptomatic floater that has an ovoid/web-like configuration. This process happens to everyone eventually as they get older just like cataracts occur in everyone as they get older.

 

Occasionally, when vitreous separation occurs, it may result in a vitreous hemorrhage or bleed in the eye due to the traction along the blood vessels on the retina. In approximately 10% of the population, the vitreous interface is very adherent to the retina and during this separation process, the traction creates a retinal tear.

 

A retinal tear is a serious eye condition that left untreated, may result in a retinal detachment where the retina peels off the back of the eye like wallpaper peeling off and loses its nutrient supply, leading to blindness. Once the retina is detached, the retina begins degenerating due to the lack of nutrition and must be surgically re-attached in order to restore vision. It is therefore very important to see your retina specialist when you have symptoms of flashes of light or floaters to get appropriate evaluation to make sure there is no retinal tears or retinal detachment in your eye.

Once you have a PVD, these floaters are present for the rest of your life. You are seeing the vitreous gel now in front of the retina which is why it is visible. This is a benign condition, albeit, a nuisance initially. For many patients, the floaters become less noticeable and less bothersome over the next 3-6 months. In the rare instance that the floaters remain symptomatic and bothersome, outpatient surgical intervention can be performed to remove the floater by removing the vitreous gel inside the eye.