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Floaters –Small specks, dots, circles, lines or cobwebs
Flashes – Flashing lights or lightning, often noticed in the corner of vision, even in dark places
Retinal Break – sudden increase in black spots like a “shower” of black dots
Retinal Detachment – a “curtain” or shadow blocking part of your vision
Myopia (short-sightedness), Family history of retinal detachment, History of serious eye injury, previous eye surgery such as cataract surgery
Treatment is not usually needed for floaters. Floaters do not disappear as they are part of the eye, but become less noticeable with time.
The first thing to know is that floaters are part of our eye.
Floaters and flashes are usually not a worry. However, there are times when you should be seen by an eye doctor urgently:
These symptoms can suggest either a retinal break or a retinal detachment.
The retina is a sheet of light-sensitive cells responsible for receiving light signals so we can see. The retina is attached to the inner wall of the eye.
The vitreous gel is a gel-like substance that is attached to the retina. Over time, the vitreous gel shrinks and becomes watery.
As the vitreous gel shrinks, it can pull on the retina causing a retinal tear.
Symptoms of a retinal tear are similar to floaters. That is why it is important to have your floaters checked to rule out retinal tears. Retinal tears can have symptoms such as:
In the case above, we have a retinal tear with no retinal detachment. The treatment in this case would be to perform laser retinopexy which is a clinic-based laser.
In a laser retinopexy, laser is applied all around the tear. This helps to seal the tear and prevent vitreous from entering through the tear and detaching the retina.
This clinic-based laser can only be performed if there Is no retinal detachment. If there is retinal detachment, surgery will be needed. So it is important to find and treat retinal tears early before they become retinal detachments.
Retinal detachments are when the retina detaches from the inner wall of the eye. This occurs when retinal tears are not sealed early. This results in fluid traveling through the retinal tear and under the retina causing a detachment.
Symptoms of a retinal detachment include:
The best results from treatment occur when the retinal detachment has not affected the center of your vision. This usually means that the retinal detachment is not involving the central part of retina called the macular. This is called a macular on retinal detachment and will have better chance of recovering good vision after treatment. Macular off retinal detachment on the other hand, will not do as well, even after successful surgery. That is why it is critical to identify and treat early.
This involves placing a band around the eye to counteract the force that is causing the retina to be detached. This often also involves drainage of fluid from under the detached retina, allowing reattach ent of the retina. This is surgical procedure that is carried out in the operating theatre.
This surgery involves removal of the vitreous gel that is pulling on the retina. Often a gas bubble may be placed in the eye to keep the retina attached while healing takes place. When a gas bubble is introduced, you may need to keep your head in a certain position for a time. Also you will not be able to fly for a period of time as the high altitudes can cause dangerous increase in eye pressure from expansion of the gas bubble. Over time, the gas bubble will gradually be replaced by your own body’s fluids.
Sometimes, an oil bubble may be introduced instead of a gas bubble. An oil bubble will need to be removed later when the retina has fully attached.
A vitrectomy can be combined with cataract surgery and/or a scleral buckle procedure.
Vitrectomy surgery has advanced in recent years and is a relatively safe procedure. The risks include:
An epiretinal membrane is a thin sheet of fibrous tissue that develops on the surface of the macular and can cause problems with central vision.
This is because this membrane can contract and cause distortion of the retina. As the macular is responsible for visually demanding tasks such as reading and sharp vision, epiretinal membranes can affect patients quite a lot.
Epiretinal membranes can occur from:
Epiretinal membranes also increase with age. Studies have shown that 2% of those over 50 and 20% over age 70 can have epiretinal membranes, although most do not need treatment.
Most epiretinal membranes are fairly stable and do not affect vision. Usually observation is sufficient.
However, if worsening of vision occurs, surgery may be needed. There are no eye drops, medications or nutritional supplements to treat this. The surgery performed is similar to retinal detachment surgery and involves a vitrectomy.
Factors affecting the results of the surgery include:
A macular hole is a tear or opening in the macular, the central part of the retina. As the hole forms, the central vision becomes blurry, wavy or distorted. If the hole extends, the central vision can develop a dark spot or blind spot.
Age is the most common cause. Macular holes are more common as we become older. The vitreous gel in our eye shrinks and this causes traction or pulling on the retina and over time can cause a hole to form.
After macular hole surgery:
The eye’s retina has arteries and veins which carry blood to and out of the eye. The retinas has one main artery and one main vein.
A central retinal vein occlusion is when the main vein of the retina is blocked. This causes blood and fluid to seep out into the retina.
The macular (central part of the retina) can also become swollen due to this blockage and cause distortion in central vision.
Central Retinal Vein Occlusion may cause the following symptoms:
CRVO is not common in younger people. It generally affects those who are aged 50 over.
Certain conditions can put you at higher risk:
Not all CRVO cases need active treatment and may only require observation. This is especially if the blood flow is not severely compromised. This type of central retinal vein occlusion is called a non-ischaemic CRVO.
In other cases, the blood flow is significantly blocked and this leads to poor circulation to the retina. This type of central retinal vein occlusion is called a ischaemic CRVO. In ischaemic CRVO, laser to the retina called panretinal photocoagulation is needed to reduce the oxygen requirement of the retina. This is needed to prevent abnormal blood vessels from growing in a process called neovascularization. Neovascularization can lead to serious complications such as vitreous haemorrhage (bleeding in the eye) and glaucoma (high eye pressure).
In some cases, CRVO may cause swelling in the macular (central part of the retina) called macular oedema. In such cases, medication injections in the eye called anti-VEGF injections may be recommended. Occasionally, steroid injections may also be used.