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What is a floater in the eye?

A floater can be described as a small shape floating in the eye that a patient perceives in their field of vision that moves around and can come in various shapes and sizes. Some patients notice these shapes in the form of rings, others may see a spot or perhaps a long narrow strand.

Most people will experience the fact that the shapes, whatever their size, float within the vision as the eyes move. Being aware of a floater and trying to look at it will have the effect of it appearing that the floater has darted away. Most people will learn to live with floaters and hardly notice them but to some other people they can't tolerate the interference to their vision and become very frustrated.  The perception of floaters can be quite gradual with many people not even noticing they have them until they become more numerous or more prominent in their field of vision.

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What is the cause of eye floaters?

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An eye floater will start life in the vitreous of our eyes. (The vitreous is a transparent and gel like structure that occupies the space in the centre of our eyes)  This gel will gradually liquefy as we age and the fibres of collagen that are part of its formation will clump and then float in the fluid that has developed.  The result of this is that these clusters will cast a shadow on the retina of your eye and you will then see that shadow as a floater. 

It is important to note that floaters can be described as non-acute or acute. In non-acute floaters the process is gradual as we age. If floaters suddenly appear then this is a different manifestation and could be the sign of detachment of the posterior vitreous.

Usually it will not be necessary to treat floaters in the eye but if they appear suddenly then they should be seen as a matter of urgency because they could be a sign of PVD (posterior vitreous detachment.) PVD Is something that is definitely experienced more as we age but it can also occur earlier when patients are short sighted, have had cataract surgery or a trauma to the eye.  If anybody does experience this type of sudden appearance of floaters or already present floaters suddenly become a lot more intrusive or numerous with flashing light or shadows in their visual field, they should ensure that they seek medical attention as soon as possible preferably with an eye specialist.

When a specialist is seeing a patient with acute onset floaters they will carry out a full examination of the retina, including the use of an indirect ophthalmoscope with scleral indentation to exclude any type of retinal tear or the possibility of a retinal detachment. Catching a detachment early can save sight and retinal laser or surgery may be used for treating a detachment.  This however, will depend on where the tear or detachment is, the size of the detachment or tear and also on the accumulation of fluids under the retina.

In diagnosing these particular problems measuring the vision with a visual eye chart test will not help in making a diagnosis.

To treat these conditions successfully our team have put together a carefully curated collection of tests designed to assess how floaters and vitreous opacities are affecting the quality of the patient’s vision.

A patient who presents with this type of visual symptom will have to undergo precise testing of their vitreous and will also have visual function tests so that an accurate picture can be formed of the effects of any floaters or vitreous opacities that exist in their vision.  This is a very important testing routine that is crucial before and after surgery for comparison in evaluation.  Testing is lengthy and takes around three hours to complete  but is non-invasive.

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Laser treatment to the retina

Laser treatment works by focusing light that is tuned to very specific wavelengths and to different intensities and delivered over varying durations. The energy that is created will be focused on the tissue of the retina with an extremely high level of accuracy and precision. Heat will be generated by the light energy and this is what produces a reaction in the focused area.

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Is every type of laser treatment used in ophthalmology the same?

No, Ophthalmologists use different types of laser treatment to treat different conditions. Ophthalmology is a constantly evolving specialty and laser eye treatment now features different options such as double YAG, auto tracking laser, pascal and others that will be discussed with you by your eye surgeon who will explain which one you need.

What will I experience if I have to have treatment with laser?

What Happens During a Comprehensive Eye Examination?

When you arrive for your laser clinic appointment a nurse will administer eye drops which will dilate the pupil of your eye. Once you've had these drops you might find that your vision is a bit blurred and this effect may last for anything up to six hours after you've had the treatment, so you will not be able to drive yourself home.

Your consultant will go over your treatment plan again and also explain the consent form to you which you that you will need to sign. You can use this time to ask any questions that you may have thought of after your previous visit to the eye surgeon.  Next, you will be given some drops which will numb the surface of your eye. These may sting a little as they go in but this will subside fairly quickly and is quite normal. Next the contact lens will be put on the front of your eye and this may feel a little bit uncomfortable but it will not be painful.

As your surgeon starts to work on your eye, you might see some flashing lights and you might hear some noises that sound like clicks. These will not be very loud however, and there's nothing to be worried about.  It is important that you listen very carefully for any instructions that your consultant gives you because he or she may ask you to move your eyes to look in different directions. This is so that they can focus the laser accurately on the area of your eye that requires treatment.

During the treatment it is possible that you may feel a little bit of discomfort which is due to some exposure of small nerves around the treatment area zones, but these will die down in a few seconds.

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What difference will I notice to my vision after I have had treatment with laser?

For the first 24 hours or so after you've had your treatment with laser you may find that your vision is a bit blurry and hazy. If very large areas of your retina’s periphery have had to be treated then the peripheral vision may suffer permanent reduction as a result. Your ability to drive will be affected and you need to check that your vision meets the standards for the DVLA driving requirements.  It is also a good idea to bring sunglasses with you to the clinic and of course you would be best not to drive in, because after treatment you won't be able to drive home. You can discuss any points you're not clear about with your consultant.

Sometimes patients will develop diabetic maculopathy or macular oedema and your consultant may need to prescribe medication for this. It is rare but swelling can occur and leave the vision blurred. If this does happen to you then your consultant might give you a course of drops that have an anti-inflammatory property or you might be offered an injection inter-ocularly.

Macula oedema and retinal vein occlusion

Many blood vessels of various sizes make up our eyes, the main one being the artery that supplies the retina with oxygen and then leaves through a major vein where the deoxygenated blood is drained.

Retinal vein occlusion (RVO) Is the result of a blockage in one of the small branches from the main vein or from the main vein itself. When this happens fluid and blood may start to leak and this will usually cause a very sudden vision loss. The blood flow will also be compromised by RVO and compromise the amount of oxygen that reaches the eye. This can cause abnormal blood vessels to grow and can affect macula function in the area of the retina that gives us central vision.

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(RVO) Retinal Vein Occlusion– different types

When there is obstruction of one of the branches of the retinal veins that are responsible for draining specific parts of the retina, this is called branch retinal vein occlusion or BRVO.

(CRVO) Central retinal vein occlusion

This is the term used when the main vein, formed of the four branches draining blood from the retina, becomes obstructed.

What are the possible causes of RVO (retinal vein occlusion)?

It is often not clear what has caused an RVO but blood pressure checks and blood tests may be asked for to help identify the cause.  There are some factors that may contribute to an RVO Such as:

  • diabetes
  • hypertension
  • high levels of cholesterol
  • natural ageing
  • being a smoker

Holes in the macular

If a hole develops in the centre of the macula within the retina the patient will typically notice that their central vision is either blurred, missing or distorted. This condition is not painful but it can lead to complete loss of vision if left untreated.

How is a macular hole treated?

Commonly the patient will undergo an operation that is called vitrectomy. During the vitrectomy the gel that is in the eye will be removed and the tissue of the retina that is on the macula’s surface will be peeled back and used to fill the gap where the hole has developed. Next a gas or an air bubble will be injected into the site aimed at encouraging the hole in the macula to resolve.

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ARMD (Age Related Macular Degeneration)

(ARMD) Age-related Macular Degeneration will affect the central vision in one or both of a patient’s eyes and is a relatively common condition. Our central vision is what we use for our day to day life such as watching the TV or reading and recognising people.

What is the cause of ARMD?

Changes to the macula - the retina’s centre will give rise to ARMD making it malfunction.

There two different types of ARMD:

  • Wet ARMD (exudative)
  • Dry ARMD (atrophic)


This type of ARMD, also known as geographic atrophy, is the most common form of this disease. ARMD, when it becomes geographic atrophy, causes the cells in the macular region that are responsible for our central vision to fail to function. As the cells deteriorate, the central vision will be gradually reduced.


This type of ARMD is the less commonly seen form of this macular condition although its progress is usually faster than is observed in dry ARMD. In the case of wet ARMD it will develop when blood vessels in the macula develop abnormally. With this condition blood will leak with fluid that has come from the blood vessels causing damage to the macula and vision will be reduced.

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Scar tissue (macular epiretinal membrane)

The sensitive section of the retina is called the macula and this is the area that helps us to see and to distinguish colours and recognise people’s faces. When scar tissue is formed on the surface of the macula in the very centre of the retina it is called a macula epiretinal membrane.

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What is the treatment for macular epiretinal membrane?

Vitrectomy is the only treatment for this condition and during surgery the gel from the centre of the eye will be removed. There is no eye drop or prescription for glasses that will help the blurring vision or distortion that is caused by macula epiretinal membrane.

When you undergo a vitrectomy the consultant will make very small incisions in the white part of your eye which is called the sclera. The clear gel, called the vitreous, will be removed from inside the eye and the eye will then be filled with a clear fluid. Then the consultant operating on you will slowly and gently peel away the scarring or macular epiretinal membrane. During the period after surgery your vision should improve slowly but it will take several months. As with many other conditions the earlier that you can see a specialist the better the outcome is likely to be.

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Retinal detachment, what is it?

If the retina at the back of your eye comes away from the wall of your eye this is what is known as a retinal detachment.  The retinal part of your eye should always be attached to work properly. If you suffer a retinal detachment and it is not treated then permanent loss of vision is very likely; if it is detached the retina cannot send signals to the brain.

Usually a retinal detachment will be the result of  a hole or original tear. This is usually caused by a process in which the vitreous gel pulls on your retina. Once a hole or a tear has been formed then fluid will often accumulate behind your retina which will cause it to detach even further.

Whether there has been some trauma to the eye or if a patient is diabetic, what is called tractional detachment might arise. In this process scar tissue develops on the retinal surface. Although this is the usual way that detachments occur it is not always a direct result of a hole or a tear developing.

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How would I know if I had a retinal detachment?

You would not feel any pain with a detached retina but there are signs that indicate that a retinal detachment is about to happen and they are:

  • an increase or a sudden appearance of floaters in the field of vision.
  • experiencing a certain type of shadow in your vision
  • experiencing blurring of your vision
  • (photopsia) - experiencing lights flashing in one or both of your eyes

Examination will take place with a full examination of the retina through pupils that have been dilated, using a slit lamp, indirect ophthalmoscope and biomicroscopy.

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Is there any particular group of people more likely to get a retinal detachment?

Where tears cause a retinal detachment this condition is seen in around one in 10,000 patients each year and can arise in any age group.

There may be a greater chance of having a retinal detachment if:

  • If you have posterior vitreous detachment with symptoms
  • If you've had a retinal detachment in your other eye
  • If areas of your retina are weak
  • If you have previously undergone cataract surgery
  • If you suffer from short-sightedness
  • If anyone else in your family has had retinal detachment

What Is the Treatment for Retinal Detachment?

If any holes or tears in the retina that precede a retinal detachment can be treated with cryotherapy or laser therapy it may be possible to prevent them evolving into a full retinal detachment.

If the retina has detached then surgical treatment can be approached in three different ways to repair the detachment these are:

  • carrying out a vitrectomy
  • treating with a scleral buckle
  • with pneumatic retinopexy

If a retinal detachment is peripheral and quite small and asymptomatic it can sometimes be possible to wall it off with laser treatment so that the detachment cannot expand any further.

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What’s Involved with a vitrectomy?

This is an operation In which the vitreous or clear gel is removed from the inside of the eye. The location of the vitreous is behind the coloured part of your eye which is called the iris and the lens of the eye. It is in the centre of your eyeball directly in front of your retina.

When is it necessary to perform a vitrectomy?

There are some more common reasons for needing a vitrectomy and those are:

  • Bleeding with a diabetic vitreous haemorrhage
  • A retinal detachment
  • Removing scar tissue (macula epiretinal membrane) from your retina
  • Development of a macular hole
  • As a result of serious eye infection endophthalmitis, that can rapidly cause blindness
  • Foreign body removal
  • Cataract Surgery that has been complicated where lens fragments need to be retrieved.
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Maculopathy and Retinopathy arising from eye disease in diabetics:

Diabetes can affect many different functions of our bodies. As far as ophthalmology is concerned retinopathy is the most frequent condition treated. In retinopathy what the smaller blood vessels in the eye begin to bulge. When this happens there can be bleeding and leakage into the eye. Where the eye is not getting enough oxygen, abnormal vessels begin to grow and this can eventually lead to the patient losing their sight.

Where a diabetic patient’s glucose levels are not well controlled conditions such as macular oedema, cataracts and other diabetic eye conditions can be the result. These conditions can often be gradual but the first sign of a problem will often be distorted vision in the centre of the eye as well as blurring and floaters that begin suddenly. With any of these symptoms a diabetic patient should seek medical attention urgently.

It is always recommended that diabetics have a regular eye checks even if there are no symptoms at all. This is because the progress of disease can often be very slow, but if it is allowed to become advanced treatment is less likely to be successful.

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