How to

Treat floaters

Miss Louisa Wickham, chief surgeon at Moorfields Private Eye Hospital

Floaters

What are floaters? Floaters occur when collagen condenses in the vitreous jelly that sits at the back of your eye. When you’re born, this jelly is very firm, but as you get older it becomes more liquid. The collagen begins to change in nature, becoming thicker and forming into clumps, which then begin to move around. It’s a bit like when you shake a snow globe and the little snowflakes move around—as your eye moves, these clumps of collagen are agitated, and as they move around they catch the light and disturb your vision.

What does someone with floaters actually see? You might see little black dots moving across your eye—I’ve heard floaters described as being like little flies. Other people might see them as a big clump. They might notice, for example, that when they’re reading, a large floater will gradually drift into their central vision, causing them problems. They can seem worse in certain lighting conditions, so if your job requires you to look at lots of white screens, for example, you might notice floaters more commonly. The same is true if you live in a very sunny country. There is also evidence to suggest that people who are either very short-sighted or long-sighted tend to notice floaters more than those who aren’t. The symptoms are usually transient, so floaters are not always experienced in the same way or in the same place. And if you went to an optician for an eye test, it would often come back as normal, because although the quality of vision is affected, your ability to see letters on a chart is likely to be entirely normal. How common are floaters? Very common. Around 75% of patients will say that they’ve had them at some point. Certainly, floaters become much more prevalent with age. They can also get much worse quite suddenly. For example, vitreous detachment—where the vitreous jelly changes its position in the eye—is a common condition among patients in their fifties and sixties, and this can suddenly cause the appearance of floaters to increase considerably in a short period of time before settling back down again.

Can they become a serious problem? Floaters can be very annoying and can significantly affect your quality of life, but in the vast majority of cases they don’t indicate any disease of the eye. But if there’s a sudden increase in the number of floaters—as happens with vitreous detachment—then that could be indicative of a wider issue that needs to be checked out by an optician or ophthalmologist.

Are there treatments available? In the vast majority of cases, floaters will only be visible for a while before settling down. That’s not because the floaters have gone away—they don’t get broken down or absorbed in some way—but because your perception of them changes. After a while, the brain understands that the floaters are insignificant and will begin to fade them from your vision, except in particular lighting conditions where they might become visible again. Where floaters are causing a significant issue with a patient’s quality of life or preventing them from doing their job effectively, there are treatments available.

What are these treatments? The one that I would strongly discourage patients from pursuing is the YAG Floater Lysis laser treatment, which targets and disperses floaters. Very often, the floaters are dispersed into smaller ones, making those patients more symptomatic than they were beforehand. Also, you’re introducing a lot of energy into the eye in a fairly unregulated fashion, and this can cause retinal injuries. To my mind, this treatment is neither regulated nor controlled enough to deal with the issue.

The second treatment is called a vitrectomy. This keyhole surgery is a very effective and controlled way of removing the floaters, but it is not entirely risk-free. There’s around a 3-5% risk of complications that could cause permanent visual reduction not correctible with glasses.

What should we do if floaters become a problem? In the first instance, you should see your optician, so they can check whether there’s anything untoward going on. Once you know your eyes are healthy, the floaters will often settle down. But if they don’t, then your next course of action would be going to see your GP and asking them to refer you to a consultant for an expert opinion.

Moorfields Private Eye Hospital 8 Upper Wimpole Street London W1G 6LH 0800 328 3421 moorfields-private.co.uk