What Are Eye Floaters?

Floaters are a result of changes in the vitreous body, which is the colloidal gel that occupies most of the hollow sphere

of the eye. Aside from maintaining good nutrition, taking anti-oxidant vitamins, and following a healthy lifestyle, ophthalmologists have no specific answer on how to prevent them.

demonstration of pre-macula bursa vitreous eye floater from Scott Geller MD on Vimeo.

The vitreous gel is 99% water and 1% solid elements. Of the solid portion, there are collagen filaments and hyaluronic acid molecules. The ability of hyaluronic acid molecules to retain water molecules is an important factor in maintaining the gel consistency of vitreous. With age, there is a depolymerization of hyaluronic acid, causing these molecules to release their water and form lacunae, i.e. pockets of liquefied vitreous. The collagen filaments aggregate to form larger fibrils, causing the further collapse of the vitreous gel structure. This process is known as vitreous degeneration and syneresis. The collagen fibrils may “float” within the liquid vitreous pockets, giving the patient a sensation of floaters.

The same process that causes floaters may cause flashes of light. When the vitreous pulls on the retina–to which it is attached–the photoreceptors are mechanically stimulated. The retinal cells are incapable of perceiving pain, pressure, or temperature. The only stimulus that the retina responds to is light. So when the retinal photoreceptors experience mechanical stimulation because of the vitreous pull, they send a signal to the brain in the form of disorganized light, which is perceived by the brain as a flash.

What Is a Vitreous Detachment?

With the accumulation of enough lacunae (liquefied vitreous pockets), the vitreous framework collapses, and the vitreous completely separates from the retina. This process is called posterior vitreous detachment. Tissue may tear from an area adjacent to or from the optic nerve head due to an acute posterior vitreous detachment. This tissue (called Weiss ring) is usually visible as a large floater.

Posterior vitreous detachment occurs in less than 10% of people under 50 years of age, but in more than 60% of people who are over 70 years of age. It is more common for people who are nearsighted, who have had an eye injury, have undergone cataract eye surgery, or have had inflammation inside the eye. Eye floater treatment cannot put the vitreous gel back to the retina, whether laser floater removal or vitrectomy.

If You Are under 35 Years of Age, Please Read This

Many patients under 35 (especially post LASIK) have floaters that are often untreatable by laser, usually because they are extremely close to the retina in a potential space called the pre-macular bursa. And these patients have been told by their ophthalmologist that they could see the floater, and that the floater was “x millimeters from the retina.”

The unfortunate fact is that these floaters are impossible to see with the usual examination methods. The only way of examining the vitreous is with a Goldmann Examination Lens to check for floaters in the pre-macular bursa. These floaters are particularly annoying since they are usually trapped in the central 20 degrees of the visual field, and appear quite large due to their proximity to the retina. But their actual size is often no more than 100 microns (0.1 mm).

Even if your ophthalmologist tells you he can “see the floater,” if a Goldmann Lens was not used (it is physically placed on the surface [cornea] of the eyeball), then the doctor is usually wrong in patients under 35. We know this from our experience with hundreds of patients who have had the same story.

Before you go in for an exam, ask if your ophthalmologist is willing to examine the vitreous with a Goldmann Lens. Have your doctor call Dr. Geller prior to the exam to explain exactly what to look for. Many ophthalmologists have never seen or paid attention to this type of micro (but large to the patient) floater. We urge you to take this step, as many patients have come from all over the world, only to be disappointed after a proper evaluation by Dr. Geller.