What are the Small Black Dots in my Vision?
Written by Mr Hadi Zambarakji for Doctify
You may sometimes see small specks or clouds moving in your field of vision. These are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky.
The majority (but not all) of patients who report having occasional floaters of a long-standing duration do not have any underlying serious condition.
However, in some cases the sudden onset of floaters (and/or flashing lights) may indicate the development of a “posterior vitreous detachment”. This is when the “jelly” which fills the back of the eye (also called the vitreous) separates away from the back of the eye (the retina).
A tear in the retina may develop at the time of the separation of the jelly from the retina (called a posterior vitreous detachment). This is a serious complication of the jelly separation process and could lead to a retinal detachment.
A retinal detachment is a very serious condition, which could lead to loss of vision if left untreated. The patient with a retinal detachment will usually but not always notice a shadow in the vision. The shadow will expand until the central vision becomes affected.
If left untreated, a retinal detachment will result in most cases to serious and irreversible loss of vision. If a retinal detachment is treated early (before central vision is lost), there is usually a reasonably good chance of re-attaching the retina and avoiding loss of central vision.
Therefore, patients with an acute onset of floaters and/or flashing lights should always be referred for an ophthalmic assessment and retinal examination within 12-24 hours.
Can you get rid of my floater?
Once we have confirmed that the patient does not have a serious underlying condition such as retinal tear or retinal detachment, we may then discuss treatment options for removing the floaters.
Floaters (figure 1) are the result of liquefaction and collapse of the jelly, which fills the back of the eye (also called the vitreous). Floaters are common in patients over the age of 50 years, and in myopic (short sighted) patients.
I would usually consider the option of performing small gauge vitrectomy surgery (surgery to remove the jelly) once a conservative approach has been tried and failed. If the patient’s symptoms are genuine (by this I would mean that the floaters are truly bothersome and make every day tasks difficult), and we have established that treatment is needed because “doing nothing is not a solution”, a careful explanation of the potential risks and benefits of vitrectomy would be needed.
From my personal experience, patient satisfaction is high following the vitrectomy procedure to treat the symptoms caused by floaters. There are reports of laser treatment for floaters, but improvements are modest at best with laser.
In summary, the process of the jelly in the back of the eye separating from the retina (posterior vitreous separation) usually results in an acute onset of floaters and flashing lights and may be associated with retinal tears or retinal detachment. Patients with numerous symptomatic floaters and no other retinal pathology such as retinal tears or detachment can be considered for removal of the jelly (vitrectomy).
Outcomes of surgery are good, surgical complications are not discussed here. The complete risk profile of surgery would always need to be discussed in detail prior to surgery.