Flashes and Floaters

May 15, 2013

Occasionally we can notice a squiggly line, a black dot, or a few minor flashes of light. When these occur, it can be very concerning and annoying. Often, floaters are a normal part of vision, especially as we age and in patients with high myopia. Though floaters and flashes can be a benign annoyance, they can signify conditions of grave concern, including uncontrolled hypertension and retinal detachments or tears. Because it is difficult for a patient to ascertain if a floater or flash of light is a signal of a more serious condition, evaluation is important for the most thorough and safest approach.

FLOATERS

What are floaters?

Floaters are often specks, spots, lines, cobwebs, or squiggles which appear to be viewed in front of the eyes. In actuality, they occur in the vitreous jelly which fills the back of the eye. The vitreous will become stringy, forming floating threads or spots which can become visible, especially in certain lighting conditions. Often, patients are able to adapt to these annoyances and can see “around” them without issue.

Floaters will occasionally signify significant damage to the eye; floaters can signal many conditions from retinal hemorrhages to Posterior Vitreous Detachments (PVDs). PVDs are most often noted in patients over 70, though can rarely occur in much younger patients. A rapid onset of large and
numerous floaters, especially when combined with flashes of light, can signal an in-progress or impending retinal tear or detachment.

When to get checked:
Any time you notice a change in vision, even a few floaters, it is a good idea to have an evaluation with your eyecare professional. However, it is especially important to be evaluated fully if you notice any of the following:

Floaters which occur suddenly or increase quickly over minutes to hours
Floaters coupled with flashes of light
Floaters that are especially large or numerous
Floaters following trauma or injuries to the head or eye
A painless loss of vision, often described as a curtain coming across vision

FLASHES

What are flashes?

Flashes are the visualization of lights when no flashes of light are actually present. These may look like a camera flash, fireworks, flashes of lightning, or many tiny bright sparkling lights; these will often last for an instant to a few seconds, but may recur. Conversely, some patients will notice jagged, shimmering lights which remain a constant for fifteen minutes or more, often coupled with a headache; this is more often a symptom of an ocular migraine, but should also be evaluated by an eye care or neurological professional.
Flashes of light are a medical emergency, especially if coupled with a loss of vision and/or an increase in floaters. While flashes may be benign, they are often noted with severe retinal complications, including retinal detachments and tears; both detachments and tears of the retina occur treatment immediately as any efforts to save vision may be worthless if the complication is left without treatment for an extended period of time. As with floaters, it is vital to be checked out if there is any sudden or distinct change or increase noted. It is important to be evaluated fully if you notice any of the following:

Flashes which occur suddenly or increase quickly over minutes to hours
Flashes of light accompanied by new floaters
Flashes of light following trauma or injuries to the head or eye
Flashes of light that are especially numerous
Flashes of light accompanied by a headache
A painless loss of vision, often described as a curtain coming across vision

Risk factors for both flashes and floaters are:
Myopia (nearsightedness)
Eye trauma
Diabetes
Cataract surgery and YAG Laser Capsulotomy

A note about myopia: with the benefits of laser surgery (like LASIK), patients who were once highly myopic may forget that they remain at risk as they no longer require glasses; while laser vision correction does provide glasses-free vision, it treats the cornea, not the at-risk retina. While laser vision correction does not put patients at a higher risk for retinal detachments, it does nothing to change or reduce the risks the eye had prior to laser enhancement. This is why it is important to continue routine exams, including dilation, even if your vision is otherwise perfect.