Eye Floaters and Spots in Vision: When Should You Be Concerned?
"I see black spots floating in front of my eye."
"Sometimes it feels as if I am seeing flies."
"Especially when I look at a white surface, I see things that look like cobwebs."
These are complaints we hear quite often during eye examinations. Although patients describe them in different ways, they are usually talking about the same condition: eye floaters.
Small moving dots, threads, shadows or cobweb-like shapes in the field of vision do not always indicate a serious eye disease. They become quite common with age.
However, there is an important point: newly appearing floaters can sometimes be the first sign of a serious retinal problem.
For this reason, when the floaters started, whether they were present before, and whether any other symptoms accompany them are important.
What are the objects we see floating in front of the eye?
Inside the eye, the space between the lens and the retina is filled with a transparent gel-like structure called the vitreous.
As we age, the structure of the vitreous begins to change. The gel can become more liquid, and some of its fibers can clump together into denser structures.
We perceive the shadows cast by these structures on the retina as moving dots or threads in front of our eyes.
In other words, there is not actually a fly moving in front of the eye. What we see are shadows created by changes within the vitreous.
These images may be more noticeable when looking at a white wall, a bright sky or a bright computer screen.
Why can floaters look like cobwebs?
Floaters do not look the same in everyone.
Some people see small black dots. Others describe thin threads, cobwebs or smoke-like shapes.
This is related to the shape of the condensations inside the vitreous and their distance from the retina.
When you move your eyes from side to side, you may notice that these shapes move too. When you try to look directly at them, they may seem to move away.
This is a typical characteristic of eye floaters.
What is the most common cause of eye floaters?
Natural changes in the vitreous become more common particularly after the age of 40 and become more noticeable with advancing age.
Another common cause is a condition called posterior vitreous detachment.
Over time, the vitreous can separate from the surface of the retina. During this process, a person may suddenly notice one or more new floaters for the first time. Flashes of light may also occur.
Posterior vitreous detachment often develops without causing a serious problem. However, as the vitreous separates, it may pull on the retina in certain areas. If this traction causes a retinal tear, the situation becomes more serious.
This is why newly appearing floaters should not simply be dismissed as an age-related change.
Can floaters be a sign of a retinal tear?
Yes.
The sudden appearance of floaters that were not present before is important when assessing the possibility of a retinal tear.
A retinal tear may cause no pain. The only complaint may be new black spots or flashes of light.
For this reason, it is not correct to assume that a floater is unimportant simply because there is no pain.
When a retinal tear is detected early, laser treatment around the tear may be used in suitable patients to help prevent progression to retinal detachment.
How can retinal detachment present?
Retinal detachment is the separation of the retina from its normal position at the back of the eye. It is a serious condition for vision and requires prompt assessment.
Patients may describe it as: "A black curtain is coming from the side of my vision," "A dark area has appeared in front of my eye," "A shadow has started from one side," or "I suddenly began seeing many black spots."
Flashes of light or reduced vision may accompany these symptoms.
Especially when sudden, numerous floaters are accompanied by flashes or a curtain/shadow in the visual field, it is important not to wait.
In this situation, a retinal examination by an ophthalmologist on the same day is important.
Does every floater mean retinal disease?
No.
This distinction is important.
A few small floaters that have been present for a long time, have not increased in number and do not affect visual quality are often not related to a serious problem.
Over time, the brain may also adapt to these images, so the patient may notice them less even if they do not disappear completely.
The main point to watch for is a new change that is different from the floaters you are used to.
For example, seeing one or two small dots for years is different from suddenly seeing dozens of black dots today.
Who should be especially cautious?
Floaters can occur in anyone, but some people may have a higher risk of retinal problems.
New floaters should be evaluated more carefully in people with high myopia, those who have previously had a retinal tear or retinal detachment, people who have experienced eye trauma, and after some eye surgeries.
A family history of retinal detachment may also be considered during the doctor's assessment.
What examination is performed for new floaters?
For newly appearing floaters, the most important examination is a detailed retinal examination after the pupil has been dilated.
During this examination, the back of the eye, including the peripheral retina, is carefully assessed.
When necessary, OCT or ocular ultrasonography may also be used.
Ultrasonography can provide important information when the retina cannot be fully visualized directly, for example because of bleeding inside the eye.
The purpose is not only to identify why the floater is present, but more importantly to determine whether a retinal tear or retinal detachment is present.
Is there a treatment for eye floaters?
Treatment depends on the cause.
If the retinal examination does not show a problem and the floaters are related to age-related vitreous changes, treatment is usually not required.
Over time, these images may become less noticeable.
In some patients, however, floaters can be prominent enough to seriously affect daily life, particularly while reading, using a computer or working in a bright environment.
Different treatment options may be considered depending on the characteristics of the floaters.
Can floaters be treated with laser?
In selected patients, a procedure called laser vitreolysis may be considered.
The aim is to use laser energy to fragment certain vitreous opacities or reduce their visual effect.
Laser is not suitable for every floater. Factors such as the floater's location, size, structure and proximity to the retina need to be evaluated.
Therefore, the answer to whether a floater can be completely removed with laser is not the same for every patient.
Is surgery needed for floaters?
Very rarely, if floaters significantly reduce a person's quality of life, a surgical procedure called vitrectomy may be considered.
In vitrectomy, the vitreous inside the eye is removed.
However, this is an eye operation and has its own risks. It is therefore not recommended for every patient whose only complaint is floaters.
The decision requires weighing how much the symptoms affect daily life against the potential benefits and risks of surgery.
What is done if a retinal tear is found?
If a retinal tear is detected during the examination, laser treatment may be applied depending on the characteristics of the tear.
The purpose here is not to eliminate the floater, but to help prevent the retinal tear from progressing to retinal detachment.
This is why distinguishing a simple vitreous floater from a retinal tear is very important.
What should I do if I suddenly notice floaters?
The first step is to consider whether this is something you have experienced before or a new change.
If you notice a floater for the first time today, or if there has been a clear increase in existing floaters, an eye examination is recommended.
Do not wait if these three findings occur together:
New floaters + flashes of light + a curtain or shadow in the visual field.
These symptoms should be evaluated for a retinal tear or retinal detachment.
Many important eye conditions do not have to cause pain. Retinal emergencies may also be painless, so the absence of pain should not be used as a reason to wait.
Conclusion
Seeing floaters, black spots or cobweb-like shapes is a common complaint. In many cases, it is related to age-related changes in the vitreous and does not require treatment.
However, newly appearing floaters should be assessed for the possibility of a retinal tear.
If you suddenly begin seeing many black spots, notice flashes of light, or develop a curtain or shadow in part of your vision, do not simply wait and monitor it.
Early diagnosis in retinal disease is important for preserving vision.
If you have newly appearing floaters, particularly with flashes or a change in the visual field, it is appropriate to consult an ophthalmologist for a retinal examination.