Flashes and Floater Symptoms Webinar

Attached is the transcript from Dr. Nelson’s Flashes and Floaters webinar.

I want to welcome you to our patient webinar on Flashes and floaters.

I am Michael Nelson an Optometrist at Waverley Eye Care Centre in Winnipeg.

It’s always good to set out our goals so here are my goals for the next 15 minutes.

1. Learn what flashes and floaters are.
2. Learn what the symptoms could mean.
3. Learn what you should do about these symptoms.

I hear and talk about these symptoms everyday but I sometimes forget others do not.   For that reason, I think it is good 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.  Floaters are normal and often people will have them.   Changes in floaters are what we are concerned about.

What is the differential diagnosis: When a patient tells us they have symptoms of flashes or floaters here is a list of conditions that we are going to try to rule out.     But today I am focusing on two of these vitreous detachment and retinal detachment.

Before we go further let’s review a little bit of grade 9 eye anatomy.    Here is a picture of an eye ball.   I want you to think about the eye like an old 35mm camera and I will point a few structures, You have the cornea, the iris, the lens and the retina.   I want to specifically point out the blue area on this slide which fills up the middle part of the eye…this is called the vitreous.

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 look inside and 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.

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.