Flashes and floaters and retinal detachment

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Nearly all of us can see subtle floaters from time to time. They reflect the fact that the vitreous jelly (the space in the back of the eye) is not 100% clear.

How do I get rid of floaters?

As we get older, the vitreous gel sometimes detaches from the back of the eye. In fact this occurs in 50% of people over the age of 50 and 70% of people over the age of 65. The process is called a PVD or Posterior Vitreous Detachment.
Usually this process is harmless enough and just causes some new floaters and transient photopsia (flashes) that are most noticeable at night-time.

Just occasionally the PVD can lead to a break in the retina, which if left untreated, can lead to a retinal tear and subsequent detachment. The retina is akin to the film in the back of a camera; it processes the visual information and sends it to the brain. If the retina detaches, it becomes separated from its blood supply and looses function, leading to sight loss. People who have had an injury to the eye, those with myopia (short sighted) and those with a family history of retinal detachment, are at greater risk. Cataract surgery is a risk factor.

What to do if you get floaters or flashes?

If you get new floaters alone (no flashes), and the vision remains normal it is wise to have your retinas checked as soon as possible, by an ophthalmologist.

If you develop flashes, you should arrange to be seen by the ophthalmologist within 24-48hrs.

If there is a previous history of retinal detachment, trauma or there is a dark curtain appearing across the vision from above or below and/or the vision has become blurry, you should see the ophthalmologist as soon as possible. See home page for details of how to get a referral.

What if I have a tear or detachment?

Most tears can be treated with laser. This forms adhesive scars between the retina and the outer layers of the eye, and usually prevents advancement to a detachment.

If there is a detachment, you will need to undergo surgery. The results are very good, particularly when caught early and there has been no loss of vision.

There are broadly two types of operation, depending on the situation with your eye. Either a “buckle” is placed on the back of the eye to stabilize the retina (more rarely performed these days) or the vitreous gel is removed from the eye and replaced with a gas which expands and keeps the retina attached whilst it scars into place.

Can I fly after retinal detachment surgery?

Sometimes after surgery you cannot fly for several weeks due to the expansile gas placed in the eye. Your surgeon will advise you.

You may find the link to a booklet below helpful:

http://www.rcophth.ac.uk/page.asp?section=365&sectionTitle=Information+Booklets

Courtesy Dr Tim Isaacs
These images show a retinal detachment as well as a retinal tear with some surrounding laser spots.