Floaters and degenerative vitreous
What floaters are, when they need attention, and whether treatment is appropriate.
What are floaters?
Floaters are shapes that drift across your vision — small black dots, squiggly lines, or large cobweb shapes — caused by debris floating in the vitreous gel inside the eye. Short-sighted people tend to get them younger, and they increase with age. They are most noticeable against bright backgrounds such as white walls or computer screens.
What causes them?
The vitreous gel is made mainly of water with a collagen meshwork. With age, this meshwork breaks down: liquid pools form and the solid parts clump into strands that cast shadows on the retina. In about 70% of people, by age 70, the liquefied gel collapses and peels away from the retina — a posterior vitreous detachment. This often causes a sudden new cobweb-like floater and flashing lights.
When do floaters need urgent attention?
In the vast majority of cases floaters are harmless. However, during a posterior vitreous detachment the vitreous can tear the retina, which may lead to retinal detachment. A marked shower of new floaters with flashing lights, or a curtain or shadow in peripheral vision, requires urgent examination by an eye doctor.
Treatment options
Since floaters are usually harmless, treatment is generally not recommended. Most people find they become less noticeable over time as the brain adjusts.
For people with very severe floaters that significantly affect quality of life, vitrectomy surgery can remove the vitreous gel and with it the floaters. Modern small-gauge vitrectomy has lower complication rates than older techniques, but no surgery is without risk.
A floater-only vitrectomy (FOV or core vitrectomy) removes only the central gel containing the floaters, leaving the vitreous attached to the retina. This reduces surgical risk but does not prevent future floaters when the remaining gel eventually separates. A complete vitrectomy removes as much gel as possible, reducing the risk of future floaters but carrying a higher risk of retinal tears during surgery and earlier cataract development.