Laser Floater Treatment (LFT)
What are Floaters?
Floaters appear as gray or black specks, lines, or cobwebs in your vision. As your eyes move, the floaters can move too. They do not follow your eye movements precisely, as they usually drift when the eyes stop moving. Floaters are caused by clumps or bits of material suspended in the vitreous gel that fills the back of the eye. When you are younger, the vitreous is a solid gel and the floaters are not mobile and that is why it’s easy for your brain to disregard them. However, as you enter middle age, the gel in your eye begins to liquify and these deposits are able to move around. As light enters your eyes, the floaters cast shadows on the retina. It is the shadow of the floater inside your eye that you see. Floaters may have a variety of causes, some serious, and some not so serious (continue reading below).
What are Flashes?
Flashes are sensations of light, when no light is really there. They may appear as many tiny bright lights (like sparklers) or like flashes of lightening. Flashes may occur when the vitreous gel pulls on or tears the retina. These flashes usually last for only a second or so, but typically occur repeatedly. They may be more obvious with eye movement, or in a dark room. Some people with migraine headaches may experience a different type of flash. These are usually shimmering, jagged lights that are present constantly for a period of fifteen minutes or longer. They typically appear in the center of your field of vision and progress slowly towards the edge of the visual field. A headache that is commonly throbbing, and on one side of the head, may follow the disappearance of the flashes (but a headache does NOT need to occur for one to be diagnosed with migraines).
Are Floaters and Flashes Serious?
Many people have floaters. Floaters that you have had for years, and that show little change, are usually not serious. It is the sudden onset of a new floater that may be serious. The onset of flashes may also be serious. Anyone with flashes or the sudden onset of a new floater(s) should be examined promptly by an ophthalmologist. The ophthalmologist will perform a dilated exam (looking at the vitreous and retina with specialized equipment after giving drops to dilate the pupils).
What is the Vitreous?
We’ve mentioned the word vitreous multiple times already. What is the vitreous? The vitreous is a jello-like substance that fills most of the space inside the back compartment of the eye. As we age, the vitreous liquefies. This is more likely to occur, and occurs much earlier, in eyes that are nearsighted (myopia). It can also occurs after injuries to the eye or inflammation in the eye.
This vitreous gel is composed of 99% water, and the other 1% consists of special substances known as collagen and hyaluronic acid, which endow the vitreous with its gel-like consistency.
The vitreous has many functions, which include:
- To help maintain the shape of the eye
- To act as a shock absorber
- To allow transmission of light from the external environment to the retina (located immediately behind the vitreous)
- To help keep the retina in contact with the back wall of the eye
Normally, the back surface of the vitreous is in direct contact with the retina and the blood vessels which supply the retina. However, in most eyes the vitreous becomes more liquid and at some point will pull away or separate from the retina and collapse into the central hollow part of the eye. This is called posterior vitreous detachment (PVD) and is a normal aging process.
What is the Retina?
The retina is a thin sheet of light sensitive, nerve tissue that lines the inside of the eye. It is the tissue that turns light into an electrical signal to send to the brain. It is often compared to the film in a camera.
What will my Doctor Look for if I have Flashes and Floaters?
Your doctor will look inside the eye for evidence of disease, liquefaction or detachment of the vitreous, and tears or detachment of the retina. The sudden onset of floaters or flashes is often due to a separation of the vitreous gel from the retina. When this occurs, it tears the retina in only about 10% of cases. This can sometimes happen in a delayed fashion, so you may need to be examined again in 1-2 months.
3 Possible Symptoms of Posterior Vitreous Detachment?
- Floaters. A person typically sees anywhere from a few to hundreds of dark spots or objects “floating” in the field of vision. These floaters may represent bleeding inside the eye, or torn retinal tissue, but they usually represent particles that have been in the vitreous all along. With normal aging, the vitreous becomes more liquid and the particles can float and be seen. When they were fixed in space in the more solid gel, the brain did not notice them. Floaters have also been described as “spots and dots,” “a cloud of smoke,” or a “swarm of bees.”
- Lightning flashes. Lightning flashes are generated by the vitreous tugging on the retina during eye movement. When a posterior vitreous detachment occurs, there may initially be residual areas where the vitreous remains attached to the retina, causing these light flashes. Patients have described these flashes as “a sparkle or twinkle,” “a disco light,” or “fireflies.”
- Decreased vision. Decreased vision is not usually present, although vision can decrease secondary to bleeding inside the eye or retinal detachment.
If retinal detachment develops early on, central vision may be normal but some patients begin to note a “curtain, veil, or fog” that may progressively obscure the peripheral vision, followed by loss of central vision.
Will I Have a Posterior Vitreous Detachment (PVD)?
Most people will have a posterior vitreous detachment by 70 years of age and many will develop this change sooner. It is important to note that the eyes are healthy without associated eye disease. If you have PVD in one eye, it is common to develop it in the other eye over the next year or two.
Following is a list of events that may lead to a posterior vitreous detachment:
- A history of cataract surgery
- Inflammation inside the eye
- Injury to the eye (such as blunt trauma, accident, or falls)
- Bleeding inside the eye
Are Posterior Vitreous Detachments Dangerous?
The majority of people who develop a posterior vitreous detachment are not in danger of further eye complications. The only residual symptom may be the persistence of a few floaters.
In 7%-15% of those who have a posterior vitreous detachment associated with floaters, flashes, or decreased vision, there may be an associated retinal tear. A retinal tear can lead to a retinal detachment. Unfortunately, the symptoms of a vitreous detachment without an associated retinal tear are the same as those with a tear. The presence of a tear cannot be determined by symptoms. An ophthalmologist will need to dilate your eye to look for a tear or detachment.
When is it Important to be Examined?
If a retinal tear does occur during a posterior vitreous detachment, it usually happens when one begins to experience the initial symptoms of the PVD. Therefore, it is important to be examined shortly after these symptoms begin. In a small percentage of patients, the tear may occur many weeks after the onset symptoms or after the symptoms have stopped. For this reason, your physician may request that you return for a repeat examination four to six weeks later.
How is Posterior Vitreous Detachment Treated?
If the posterior vitreous detachment occurred without associated retinal tears, treatment is not required. The vitreous will continue to age and liquefy and floaters will usually become less and less noticeable. With time, most people’s symptoms will completely disappear.
If a retinal tear has occurred, treating the retinal tear with laser is usually recommended. Surgery will be indicated if the tear has progressed to a retinal detachment.
What can be Done about my Floaters and Flashes?
Floaters tend to last longer than flashes. In most cases, they diminish gradually over weeks or months. Often they do not go away completely. A study that included over 300 patients concluded that floaters had the same negative impact on quality of life as age-related macular degeneration.
If your activities of daily living are hindered by bothersome floaters, we may be able eliminate your floaters in a non-invasive manner in the office with a laser. The risks of laser treatment are significantly less than the risks of vitrectomy. In some cases, laser may not completely eliminate debilitating floaters and a vitrectomy may still be required.
We can evaluate your floaters to determine if they are good candidates for laser treatment. Retinal tears and retinal detachment must first be eliminated as possibilities.
Laser Floater Treatment is a minimally-invasive procedure that can significantly improve one’s life and is an excellent for choice for multiple reasons, including:
- Avoid more invasive surgery
- Takes about 20 minutes for a treatment
- Performed in the office with anesthetic eye drops
- Less expensive than vitrectomy
- Effective in 92% of cases
- Modern laser for floater removal does not break big floaters into smaller floaters–it actually vaporizes the solid floaters into a gas