What Do Flashes and Floaters In My Vision Mean?

Hey are you seeing strange lights or things floating in your vision. Well as Billy Joel would say  “you might be crazy” OR you might just be having a vitreous detachment.  I am Dr. Michael Nelson and today we are talking all about flashes and floaters.  Good Optometry Morning.

What are flashes and floaters

I’m here in my exam room today because this is where I talk to a few patients everyday about flashes and floaters.   Today you are going to learn 3 things.

1. What are flashes and floaters?
2. What do these symptoms mean?
3. And what you need to do about them?

So First I’m going to describe what I mean by the symptoms flashes and floaters and what they look like.

Flashes are exactly that…a bright momentary flash of light in your vision that you can’t associate with a known light source.  They are often off to the side but can be anywhere.  Flashes are not typically normal.

Floaters are semitransparent particles…that can look like lint, dust or ameba that float around in your vision.  They will often slosh around in the direction you move your eye.   They are more apparent against a bright uniform background like the sky, snow or computer screen.  A lot of people have floaters and those that don’t see them can often trained to see their floaters.  Now while floaters are a normal phenomenon, changes in floaters are what we are concerned about.

There is a list of things that your eye doctor is going to rule out when you have these symptoms but today I am focusing two conditions that you should be concerned about:  posterior vitreous detachment and retinal detachment. But before we go further let’s review a little bit of grade 9 eye anatomy.

Here is a model  of an eye ball.   I want you to think about the eye like an SLR camera and I will point a few structures, You have the cornea, the iris, the lens and the retina.   The thing that did not come with this model is a structure called the vitreous…so I made one

When you think about the vitreous, I want you think of it as a clear water balloon filled with clear jelly.  Then I want you to imagine that that you take some crazy glue and glue that water balloon to the walls of the retina.     That is the normal anatomy of the eye.

As a normal aging change of the eye people will develop a vitreous detachment.  This is when those areas where that water balloon is glued to the retina release and then the vitreous water balloon becomes free floating and sloshes around inside of the eye.  This process is normal, and a rule of thumb is that the changes of it happening in any given year are equal to your age.

When this vitreous detachment happens, you will often get symptoms.

1. You will often get more floaters.  These can be clumps of the jelly or areas where the vitreous used to be attached to the retina.  These are less transparent, and they will cast a shadow on the retina and you will perceive it as a floater.   When we look in or take a photo we can physically see these particles floating around.
2. The second symptom is flashes. A flash occurs when the vitreous is trying to separate from the retina but hasn’t done so yet. And it tugs on the retina.  And every tug will stimulate retinal cells and cause a flash of light.  Kind of like this area here.

You will note that I said that a vitreous detachment is normal, so what is the concern.   The concern is that 90% of the time when you develop symptoms they will occur just as I described it, but 1 in 10 patients they will develop a retinal tear.  And this is not good.

A retinal tear can develop when the vitreous is so tightly adhered to the retina that it doesn’t’ release cleanly, rather is tears a part of the retina.   Fluid can then get under the retina and develop into something really bad a retinal detachment. IF you have a retinal tear or detachment, we need to get you to a retinal specialist urgently to repair this.

The key point here that symptoms of a vitreous detachment and retinal detachment are the same.  Flashes of light and/or floaters.  The only way to know if is for an eye doctor to dilating your pupils and take a look inside your eye to see if there is a tear.   So if you have symptoms of flashes and floaters it is important to have an eye doctor look at this right away, don’t wait to see if the symptoms improve.

Another key point is that the process of a vitreous detachment will often take a few months to occur.  I will see the patient when it first starts and most of the time I don’t find a tear and so we have this exact conversation.  The key point is that at that point they likely have a partial vitreous detachment which means some vitreous may have detached but other areas are still attached, and they may separate. OR develop a tear later on.   So if symptoms worsen or change, even if it is the next day they should call me to take another look.

Here is a pro tip for optometrists and optometry students out there.   If you want a great synopsis check out the American Academy of Ophthalmology’s PVD, retinal breaks and lattice degeneration preferred practice pattern.  It is a great resource

So in summary if you have symptoms of flashes and/or floater call your eye doctor right away, don’t wait to see if the symptoms will go away.  And secondly if you have been told you have a vitreous detachment and symptoms change or if it happens in other eye call your eye doctor because the only way to know if there is a tear or not is for them to look.

Thanks again for listenenign  If you liked this video hit the like button. If you want to be the first to hear more like this hit the subscribe button and please leave a comment or question and most importantly have a Great Optometry Day!