Many people approach me with a complaint of different visual field disturbances which they describe as black dots, curly lines, floaters, or flies and the like that are seen in their visual field.
These disturbances usually come and go, and may change shape or location. They often move around and hence are noted in different locations of the visual field. What is unique about them is that when you look at these dots or lines, you get the feeling that the shapes are “running off” to the side and the harder one tries to pursue them with one’s gaze, the farther and the faster they will escape to the periphery. Occasionally these disturbances may be right in front of you, and for other individuals they may be somewhat to the side.
These complaints, for the most part, represent small particles or condensations that float in the gel of the eye (this gel is called the vitreous humor). This implies that these floaters are real particles floating within the eye, ‘happily’ moving around in the liquid which fills the eye, which is really more jelly-like than liquid. If an ophthalmologist will look into the eye there is a high likelihood that he/she will succeed in observing these floaters within the eye, assuming that they are not too small.
It is crucial to explain that these are real phenomena, real particles residing inside your eye, and not a figure of your imagination.
What are these floaters and where do they come from?
My answer is that over the years the eye accumulates secretions, peels, and debris from various materials that are liable with time to consolidate and create small semi-opaque particles.
It is helpful to remember that when skin is shed after one tans, the pieces that fall off the skin detach, fall on the floor and are no longer a part of our body. On the other hand, any shed material or debris produced inside the eye accumulate in the eye when shed off, with nowhere to go but remain inside the eye, and as the years go by these particles may accumulate within the eye.
Another reason for floaters is condensation of the gel within the eye. This situation is a little bit like the formation of a film on top of a glass of milk, or crystals within fluid. Likewise, in the eye, condensations (crowding together) of the fibers that form the vitreous gel may eventually form dense opaque particles.
It is important to note that at a certain point in life, usually around the ages of 40-60, the eye undergoes a process that is known as a posterior vitreous detachment (or PVD). This process of vitreous detachment is connected to the gel in the eye slowly contracting and eventually detaching from the wall of the eye. This is associated with an increase in floaters or dots that are seen in the visual field.
Many people ask me: What can be done to make my floaters disappear?
My answer is: simply ignore them, learn to live with them and know that with time the floaters generally settle in more peripheral areas of the visual field and also go out of focus and in this way they are less noticeable on a daily basis.
I completely identify with a person who has a floater stuck right in the center of his visual field and every time he tries to read he feels that the floater is traveling across the page, bothering him and confusing the reading process and affecting his ability to concentrate. When such a person comes to me I reassure him that it is very rare that the “fly” or dirt will stay in this location forever. With time, chances are that the floater will move to a different location: right, left, up or down and thus will have drifted away from the center of the visual field.
Many people ask the question: Why isn’t there a way to remove these annoying floaters from within the eye?
My answer is: As long as the floaters are innocuous and floating in the eye, there is no treatment, medication or surgery that exists or that is justified to go into the eye and remove them. This can be compared to trying to kill a mosquito with a hammer. The damage that is liable to be caused from treating the floaters is not justified given the problem and may even cause worse problems or complaints. Therefore, my answer is: As bothersome as they are, one should simply learn to live with them, ignore them, and know that with time they will, in all likelihood, stop bothering or at least be less and less of a bother. Of note is that even when the floaters have seemingly disappeared, if one looks very well, one will usually be able to find them around the periphery of the visual field. This is because they never actually leave the eye or disappear.
You may have noticed that in this section I did not speak of patients but of people, why?
It is because we as ophthalmologists do not relate to people with floaters as ill, unlike people who suffer from cataracts or glaucoma. Rather, they are healthy people who because of a high awareness of their vision and a particularly curious nature, notice and are aware of the floaters in the eye to the point that they bother them in daily activities. Of note, people with floaters are usually of the strict personality that for instance, would find it hard to observe a framed picture on a wall tilted to one side, and would find it irresistible but to go and align the picture. You should realize that an identical floater would trouble different people to different degrees, and it is partly a personality issue how much discomfort and agony you suffer from this particle floating in front of your eyes.
I hope that this explanation will reassure most people who have such floaters, floaters that manifest as blotches, spots, or curly lines in the visual field.
However, it is clear to me that a small percentage of people with particularly stubborn floaters or extremely high awareness of them will not easily and calmly accept this explanation. I am sorry to disappoint them as well but there is no simple, quick, and safe approach to make floaters disappear without causing damage to or endangering the eye.
Having said all that, it is reassuring to learn that while people with new floaters often complain about them bitterly, when you return to these same individuals some 6-12 months later, you almost always hear that they’ve adapted, learned to ignore it, or the floater just drifted away from the center of their vision.