Floaters, also called “flying flies” in Latin, are a very frequent symptom that leads patients to worry and prompts them to go for an eye examination.
Floaters can be divided, from an anatomopathological point of view, into benign floaters, which are these small flies, small cobwebs, floating opacities within the visual field that the patient sees are because of the normal imperfection of the vitreous gel. The eye is a sphere inside which there is a gel that fills it and this gel is called the “vitreous”: although it is almost perfect and being made up of 99% water, it can have imperfections, even the most perfect vitreous of a healthy subject has some small moving body. These imperfections can be perceived by the patient especially when looking at the sky, in conditions of great brightness, or looking at a white surface.
These small floaters are absolutely benign and do not cause any kind of problem; they can increase in the course of life and even degenerate, that is, the vitreous body at a certain point, as we go along in the years, tends to dehydrate and therefore to collapse on itself. The vitreous tends to detach from the retina in the back, then on the central retina, the one used to see (which is called macula) and on the optic nerve.
The vitreous, depending on how it detaches from the retinal surface, the time it takes to detach and whether it is a very acute event or slowed down over time, can cause symptoms but also damage, that is, a vitreous detached acutely can cause haemorrhages on the retinal surface and can cause ruptures on the vitreous base, therefore on the front of the eye. The patient presents to the ophthalmologist with acute symptoms, which are having important floaters, not all are seen but decidedly more important because they can partially obscure the field of view. This patient must be carefully examined by the ophthalmologist, so as to be able to understand what are the relationships of the vitreous with the retina, so if a retinal rupture has formed, the patient must be stopped immediately and treated with the Argon laser, the retina and the patient himself must be placed in position for a few days, so that he cannot move and the laser can take effect and glue the retina.
If there are no alterations of the retina (such as tears or peripheral holes), the surface of the central retina and the macula must be analyzed (correctly and not simply with ophthalmoscopy) with the use of OCT, in order to understand what the intimate relationships are of the retinal surface with the vitreous. OCT allows us to understand if the vitreous is detached on the head of the optic nerve, on the fovea (that is on the central area of the retina) or if it is detached on the macula and which of these three modalities is in place.
It has happened more or less to everyone. We are looking at the sea, the blue sky on a particularly bright day, on the sheet that we are writing on or more simply, the white screen of the computer and suddenly, we notice the presence of so many small dark corpuscles, filaments, and spotters floating on our visual field.
Commonly referred to as “flying flies”, these moving bodies are scientifically defined as, by their “floating” nature, “eye floaters”. Although they are not per se dangerous to the sight, eye floaters should not be neglected as they may spell a more serious eye disease (such as retinal detachment) or simply cause discomfort in carrying out daily activities, first and foremost, reading.
Causes Of Eye Floaters
To describe the causes of eye floaters, it is necessary to briefly dwell on the anatomy of the eye. The vitreous body, a clear and gelatinous substance that fills the space between the crystalline lens and the retina, therefore retains the spherical shape of the eyeball, makes up about two-thirds of the volume of the eye. The vitreous gel consists of 99% water and the remaining 1% of collagen fibers, sugars, vitreous cells (hyalocytes), proteins, hyaluronic acid, electrolytes, etc., which constitute the scaffold. The deterioration of the microstructure of the vitreous body begins with the fluidization of the gelatinous component: the collagen fibers begin to fragment and form filaments of different shapes that sometimes intertwine. They may project a shadow on the retina and are perceived as opacity, the eye floaters. Vitreous degeneration is a natural phenomenon primarily due to aging, which is why after 40 or 50 years of age it is easy to detect the problem more frequently. Other causes of the defect are due to myopia, which, if rather high (i.e. above 5 diopters), may cause accelerated degeneration processes even in younger years, between ages of 20 and 30. Finally, eye floaters may be caused by head trauma, prolonged use of specific drugs, dehydration or metabolic disorders that favor the degenerative process of the vitreous body.
How To Eliminate Eye Floaters
A thorough eye examination can ward off the danger that eye floaters may manifest, more serious eye diseases. The fact that there are currently no specific medications to treat floaters, two routes can be followed for treatment: laser surgery or vitrectomy. The choice of one or the other treatment is to be evaluated together with the treating physician based on the characteristics of the defect.
The Treatment With Yag Laser
The treatment of floaters with Yag Laser is the preferred treatment when the defects are sufficiently distant from the retina and the crystalline lens. The intervention is simple, not painful, and lasts from 10 to 30 minutes after which the patient can resume normal work or sports activities. Through the laser, the eye floaters can be eliminated in three ways: vaporization, delocalisation, and thinning.
– Vaporization is the laser striking the fibrils directly transforming them (moving bodies) into gases.
– Delocalisation is done by cutting the upper area of the thin filaments that hold them together. They all scatter below and no longer interfere with the field of vision.
– Thinning is preferred when floaters are multiple, fibrous, and harder to vaporize. In the case of having a hundred of moving bodies that have been highlighted, since overheating the vitreous body should be avoided, the solution is to strain them.
It should be emphasized that it may often be more than just a treatment to get the best result and that the purpose of the procedure with Yag Laser is to eliminate opacities in the vitreous, not to remove them from the body. If the patient’s vitreous is permanently damaged, blurred or streaked, the laser can not change it.
Vitrectomy is an advanced ophthalmic microsurgery technique that removes the vitreous of the eye, partially or totally. Used for the treatment of various ocular pathologies that are developed when the vitreous body is irremediably damaged and is no longer transparent, the operation consists of cutting and suctioning of the vitreous humor by inserting microspheres into the eyeball. These microspheres are of extremely small diameter (0.4 mm) so as to minimize complications during and after surgery and provide a faster recovery of the patient.
The surgery is performed under local or general anesthesia and its duration may obviously vary depending on the severity of the problem. Generally, the operation lasts about 20 minutes, while postoperative recovery, except for any complications, is approximately 24 hours. Afterward, the patient has to follow some special arrangements, among of which is the use of particular collars, to follow certain postures for sleep, and avoid the certain effortful activities.
It is therefore appropriate to carefully evaluate the pros and cons of each treatment of choice with your ophthalmologist to reach the safest resolution to the problem.
The vitreous floaters, technically called “floaters” but more commonly known as “flying flies”, are the result of the chemical-physical variation of the vitreous body, a gelatinous and transparent substance that fills the eye.
A thorough eye examination is very important to identify, document, and choose any therapeutic strategies to treat the disorder.
What is the vitreous body for?
The vitreous body offers the eye mechanical and nutritional support, as well as providing, thanks to its transparency, an optical function.
How are flying flies formed?
Over the years, particularly after 45 and 50 years of age, the chemical-physical composition of the vitreous body undergoes some variations: this determines a certain inhomogeneity, which results in the formation of clusters of collagen fibers and / or cells. These clusters remain suspended in the vitreous body, floating in its structure.
The chemical-physical transformations that the vitreous body undergoes can give rise to its contraction, therefore to its detachment from the retina behind.
This phenomenon, known as “posterior vitreous detachment”, is a common occurrence in people over the age of 45 and generally occurs without causing any problems; however, in some cases, the vitreous body can maintain a certain adhesion with the retina, exerting on it a traction force known as “vitreoretinal traction”, which can be followed by the development of retinal tears, small hemorrhages inside the vitreous and the development of numerous floaters.
These events are often accompanied by the perception of light flashes, linked to the fact that the retina is able to transform mechanical impulses (therefore also tractions) into light impulses; the sudden appearance of floaters, especially if accompanied by light flashes, requires immediate specialist evaluation, as a possible symptom of retinal breaks, which in turn could create the conditions for a retinal detachment.
How are vitreous floaters perceived?
In the presence of light, the vitreous floaters cast their shadow on the retina and this is ultimately perceived as a movable body in the visual field, which seems to move together with the eye’s movements. The shapes of the movable bodies can be different: dots, circles, lines, clouds or cobwebs; they are all usually noticed when looking at a light background, such as a clear sky, a sheet of paper, or a light wall.
Are vitreous floaters harmful?
The floaters that are formed due to the natural transformation of the vitreous body are not as harmful or dangerous for the health of the eye, however, they are often the reason that allows to reveal otherwise asymptomatic retinal degenerations and therefore a visit is always recommended. Usually, they do not interfere with vision, therefore in these cases, it is not necessary to intervene in any way, unless peripheral retinal degenerations are diagnosed as an accessory finding, which may require prophylactic laser treatment for retinal detachment. Other times, when they are of considerable size, they can interfere with the performance of normal daily activities, significantly altering vision.
How and when should we intervene?
Today there are no surgical treatments for vitreous floaters with standards of efficacy and safety comparable to other surgeries, such as, for example, cataract surgery. Despite this, laser vitreolysis and minimally invasive vitrectomy are proposed.
Through small pulses emitted by a YAG laser, the mobile bodies are vaporized and reduced in size. This treatment is performed without surgically penetrating the eyeball. In order to carry out the treatment, the floaters must be at least 2 mm away from the retina and the lens and there must be no simultaneous active inflammatory states of these structures.
The treatment is carried out on an outpatient basis; the possible complications induced by laser vitreolysis are increased ocular pressure, cataracts, and retinal detachment.
Minimally invasive vitrectomy
Vitrectomy refers to the surgical removal of the vitreous body, which can be performed with especially thin-gauge surgical instruments. The instrument used, called vitrectome, is an aspirator equipped with a very high-frequency guillotine cutting system (up to 10 thousand cuts per minute), in order not to create tractions on the retina, through which the mobile vitreous body is cut and removed.
The most common complications induced by minimally invasive vitrectomy are retinal rupture, retinal detachment, increased ocular pressure, and cataracts.
For any other details, consult your ophthalmologist who will illustrate, according to your specific case, the most appropriate therapeutic conduct, making you aware of the advantages, risks, and benefits.