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These spots, strings, or cobwebs that drift in and out of your vision are floaters and are more prominent against a white background.  These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye.  They cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.


As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights.  These flashes can then occur for months.  Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.  This condition is more common in people who:

·      Are nearsighted

·      Are aphakic (absence of the lens of the eye)

·      Have past trauma to the eye

·      Have had inflammation in the eye

 

When a posterior vitreous detachment occurs, there is a concern that it can cause a retinal tear.

Symptoms of a retinal tear include:

·      Sudden increase in number of floaters that are persistent and don't resolve

·      Increase in flashes

·      A shadow covering your side vision or decrease in vision

 

In general, posterior vitreous detachment is unlikely to progress to a retinal detachment.  Around 15 percent of people with PVD develop a retinal tear.  If left untreated, approximately  40 percent of people with a symptomatic retinal tear will progress into a retinal detachment.  A retinal detachment needs prompt treatment to prevent vision loss.

In general, most people get accustomed to the floaters. Surgery can be performed to remove the vitreous gel but there is no guarantee that all the floaters will be removed.  For most people, the risk of surgery is greater than the nuisance that the floaters present.  Similarly, there is a laser procedure that breaks the floaters up into smaller pieces in hopes of making them less noticeable.  However, this is not a recognized standard treatment and it is not widely practiced.  In general, the usual recommendation for floaters and PVD is observation.