Dr. Cha:
Gosh! These floaters! Voice exercises, muah, muah.
Dr. King:
Muahhhh. Me-mae-ma-mae-me. The rain in spain falls mainly on the plain. See I told you I was gonna be a theatre major until my parents threatened me.
Dr. King:
Hi there. Welcome to Days of Our Eyes, Dr. King here.
Dr. Cha:
Dr. Cha.
Dr. King:
Today we’re gonna be talking about floaters. What are they? What causes ’em? We all know ’em. We’ve all seen ’em. We’re all annoyed by them. Keep on watching them. We’ll give you the scoop. So what are floaters? Let’s think about basic eye anatomy again. Okay. We have the front of the eye, the cornea, the lens right behind that. This open space is filled with a clear gel called the vitreous, and then the back is the retina. That’s the nerve layer that lines the inside of the eye. The vitreous is mostly water, but it also has a collagen framework, and that’s just a, a small percentage of the total of the vitreous. But collagen will shrink with time and as it shrinks, it’ll pull and it’ll start to break apart. And we’ll get little bits floating around in this fluid inside the eye. And that’s what we call floaters. So they’re literally floating around in the center of the eye.
Speaker:
What causes floaters?
Dr. King:
You wanna take that?
Dr. Cha:
Sure. Yeah. Floaters. You know, when I explain it to my patients it is literally like, almost like a jello consistency, right? Like it’s gelatinous. So I mean, I’ve experienced it myself growing up. When you have old jello sitting in the fridge, it gets real watery over time. And that’s what actually happens to the vitreous gel or the jello in our eye. It loses its, you know, kind of structural, you know, framework, the structural integrity. And as Dr. King was saying, it pulls away those solid pieces, then float in the liquid pieces, and that’s what you see kind of flying through your vision. He’s kind of chunks of jello swimming in the water into the eye. And that’s what we traditionally see as floaters.
Dr. King:
Right.
Dr. Cha:
But you know, sometimes a floater is not just a floater, right?
Dr. King:
Yeah. So the question arises, when should I be concerned? You know, there’s regular floaters and then floaters can be a sign of something more serious, and that’s what we kind of wanna tease out today. So we’ve just established that certain floaters, those random things floating around kind of like, look, look like little gnats or something like that. Those are a natural process that we all go through. I noticed them as a kid. Some people don’t notice ’em till adulthood. But then you have cases where you can get a sudden onset of a whole bunch of floaters before you had random ones floating around. All of a sudden there’s a hundred of ’em just coming across. Now that’s something new and different and you should be a little concerned.
Dr. Cha:
Yeah. Anytime there’s anything new with your vision, always get seen. You know, don’t put it off, you know, don’t think it’ll be fine, especially if it’s not getting better. Let us see it, because at least we can give you the peace of mind of what’s going on. And if it is something serious, we can get you expedited or get you to the right person quickly. If you need that kind of help.
Dr. King:
Right. So if you see a sudden increase of floaters. If there’s all of a sudden, like a curtain coming across your vision, anything that decreases the quality of your vision blur, curtain across, kind of a gray spot or a missing area. You’re looking at something and you can see part of it. Part of it, it’s not there. That’s a sign of something more serious that might not just be the vitreous, the retina could be involved that needs attention. So you definitely wanna get that taken care of. If there’s flashes of light associated with your new floaters, definitely want to get that checked out.
Dr. Cha:
Probably the flashes of lights, what concerns us the most always, we have a previous episode about ocular migraines. Check it out. When we talk about these serious floaters with these flashes, it’s usually, you know unlike a migraine where it kind of just kind of grows and you can’t really see past it, you get the headache afterwards these, these flashes of light are kind of momentary and they kind of might be exacerbated or they get worse when you move around your head or your eyes. Sometimes, you know, you can get a pretty serious floater or you know, excuse me, more noticeable floater or a large one with what’s called a posterior vitreous detachment. Posterior back, you know, kind of the rear part vitreous that jello consistency and detachment. We talked about how it kind of pulls on itself. Sometimes a large chunk of it pulls off and then you see this large floater that kind of gets in the way and you talked about, you know, it might be big enough and might be at the right spot where it does degrade the vision enough to where you’re concerned and yeah, let us check it out to make sure that is what it is. And that is like what Dr. King will say. It can come with time, most, most everyone will get it eventually. And you want us to at least take a look at it initially to make sure that is the only thing that’s going on.
Dr. King:
Right. Like everyone in our office is trained. Anybody who picks up that phone, if you call describing those kinds of things, we’re gonna get you in and check it out usually that day if possible. We’d rather check it out and it be a normal floater versus letting it go for a few days. And then we have a situation that’s worsening, it’s worth getting checked out if something’s new or changing. We all have floaters, but when we, when we have changes in them, the symptoms are so similar to a retinal detachment versus a posterior detach vitreous detachment. The symptoms are extremely similar. We can’t tell over the phone even you’re telling us everything you see, we need to look.
Speaker:
What does the treatment look like? Is it like drops? Is there a procedure?
Dr. Cha:
Great question.
Dr. King:
Well, first is the assessment, you know, so first thing is diagnosis. We’re gonna check your vision, we’re gonna check your peripheral vision, we’re gonna dilate your eyes and we’re gonna look back there if we can see that there’s floaters in the vitreous, but the retina’s intact. Now we know we don’t have an emergency situation, we don’t have a retinal tear or detachment. Most of the time floaters will settle down on their own. Like we said, they’re moving around in this vitreous gel. And when we move our eyes, that gel swishes around, I think of it as like clothes in a washing machine. You know, you move your eye this way, you move your eye up and down, it swirled ’em around, but eventually they work their way down out of the way. So at first we’ll just give ’em a little time for mother nature to take its course and try to clear it out of there.
If we follow you a little bit and it’s not getting better or it’s really interfering with vision, then the two most common treatments are laser Vitreolysis and what’s called a vitrectomy. The first is laser Vitreolysis, where we use a laser to go in and this one works for bigger chunky floaters. You know, if you’ve got one that just, one that wants to hang there and be in the way, you can take a laser and aim at it and kind of break it into smaller pieces. And the idea is they’ll float down outta the way. So we’re really not removing it at that point. It’s just breaking into smaller pieces to get it outta the way. The more common is the vitrectomy. Do you wanna?
Dr. Cha:
Yeah. The breaking down the word vit there’s the vitreous in there, the gel part and ectomy means we remove it. So the culprit of floaters is this, you know, jello like, kind of like the, the water in the snow globe, so to speak. And if there’s no water in the snow globe, then there won’t be floaters to get in the way of your vision. But usually we, we really reserve this for, this is a very serious surgery. We had to pretty much open your eye and then vacuum out the 90% of the mass of the eye.
Dr. King:
There are some improved techniques these days that has made this much safer than it was. When I first started practicing, I did not like sending patients for vitrectomies cuz there was a much higher risk involved. These days, the techniques have improved to where I will send somebody if they’re very bothered by it, vitrectomies are done by a retina specialist. And with the improved techniques, they can be extremely helpful for folks.
But that’s not a decision we make quickly. That’s something we kind of work into. We’re gonna give it a few months and see how your eyes do before we go jumping to a surgery. It’s just, you don’t just jump because, oh, this annoys me. Let’s see if it’s impactful but the, the newer techniques we have some very happy patients after vitrectomy, but you’re at that point you’re literally removing the offending vitreous. We’re getting rid of the problem and it’s replaced with a clear, clear fluid and then your eye can take over and regenerate from there. So that’s the best way or the only way to completely get rid of floaters.
Dr. Cha:
Yeah. There are no home remedies for that.
Dr. King:
No. A drop won’t get it. This is all happening inside the eye. So, you know, and we talk about collagen. Patients often ask me, can I take a collagen supplement? Nah. Because there’s a barrier there that’s not gonna get in and rebuild collagen in the vitreous. That’s, that’s not going to really have much of an effect.
Dr. Cha:
It’s kind of a closed system the eye. Yeah. Windex is not gonna help
Dr. King:
No, no. Windex.
Speaker:
So the first myth is that floaters are caused by stress.
Dr. Cha:
Hmm. I remember that question. I mean, it might be the reason you notice the floaters.
Dr. King:
Yeah. In stressful situations, often, you know, we’re, we’re kind of, you know, we’re doing some different movements. We can stir ’em up. We tend to neglect ourselves a little bit when we’re stressed and dehydration. Think about this, the vitreous is 99% water. Basically we get a little dehydrated. Guess what? It’s gonna condense itself a little. Just a little bit, makes a huge difference in the eye. All of a sudden those floaters become more noticeable. One of the things I do tell my patients who have a lot of floaters is be sure and stay hydrated. Try and create a little more fluid in that, in that area to help out. So maybe stress if it’s leading to some other things, but stress directly causing floaters. No.
Dr. Cha:
Busted.
Dr. King:
Busted.
Speaker:
You should rush to the emergency room as soon as you experience floaters?
Dr. King:
Rush to the emergency room because you have floaters? No, what are they gonna do? Most emergency rooms aren’t really equipped for dilating the eyes. There are a few. First, see if you can get ahold of your doctor. Your eye doctor. That would be my recommendation before going to an emergency room. If you have a sudden loss of vision, that’s a different story. Now go. But just floaters would you, would you I mean, that’s my opinion. You may differ.
Dr. Cha:
I mean I base off history. Right. If it, if you’re just sitting there and then oh, I notice these floaters. Yeah. You know don’t freak out about it. Let us know and we’ll let you know, you know how soon we need to see you. Well let’s say, you know, I think about the, you know, the, the high schooler or a college kid that’s like playing soccer and then he, they get hit with the ball in their head and they see all these new floaters. Right. That’s something that not an emergency room mind you, but you know that. I think you’re right. Let let us at least get an idea of what’s going on before going to the emergency room. Because yeah. Even if you do do go to the emergency room, what are the chances that ophthalmology is involved? What are the chances that even they even have an ophthalmology department to kind of consult you?
Dr. King:
That’s what we run into when our patients have gone there thinking that’s where they need to go.
Dr. Cha:
Right. But also don’t don’t call the office and say, oh, I need an eye exam because we’ll assume glasses contacts and I’ll see you in a month.
Dr. King:
Right. When you call and say, I’m experiencing something different, I’ve got these floaters, or I have this stuff in front of my eyes, that is immediately gonna get our, our team’s attention and whoever’s on that phone is gonna sit, ask you some questions. They’ll probably put you on hold,
Dr. Cha:
And yeah, like, you know, what was I gonna say?
Dr. King:
I don’t know, I’m glad it wasn’t me.
Dr. Cha:
Get seen… I forgot it. That’s so going on one of the little
Speaker:
Myth#3: Floaters are normal with age?
Dr. King:
Floaters are normal with age?
Dr. Cha:
Sometimes.
Dr. King:
Right. Yeah. The little wispy guy. Yeah. Yeah. They are pretty normal with age because that, that vitreous is more liquid. The good news is they tend to move more. So they’ll be there, but then they’ll move on out of the way. I just name mine, they’re my friends now, Fred, Norm
Dr. Cha:
Wow. I mean, I, I remember a patient, like they said they would have cereal or like a cup of milk every morning and they would see it every morning a floater. Cause like a white background when they look into their mug.
Dr. King:
Yeah. You’ll see ’em more when you’re looking at a solid background versus a pattern, they’ll blend into the pattern. But if you look at a solid white wall, that’s why on a sunny day, you know, people are driving this big blue sky. They’re like, I’m driving down the road. My, my floaters are driving me crazy. Yeah. It’s like, look at some trees.
Dr. Cha:
Watch the road too.
Dr. King:
Watch the road. Stop looking at the sky.
Speakers:
Seeing floaters means you’re going blind?
Dr. King:
Seeing floaters means you’re going blind. Let’s do bust. Just bust. I just don’t even just bust. Yeah.
Dr. King:
So that’s our story on floaters today. We hope you enjoyed it and we hope you found the information helpful. If you did, click subscribe. If you have any questions, leave a question in the comment box. In the meantime, I’m Dr. King.
Dr. Cha:
Dr. Cha
Dr. King:
See you next time.