Dr. Brian Zaugg explains what floaters are, why they occur, and why they generally occur more in older people. He'll also tells you some tips for managing floaters.">

May 17, 2017 — People may often see little moving proteins—called floaters—in their eyes. Ophthalmologist Dr. Brian Zaugg explains what floaters are, why they occur, and why they generally occur more in older people. He'll also tells you some tips for managing floaters.

Interview

Interviewer: Those little squiggles that move around in your eyes, I'm talking about floaters, is that something you should be concerned about, and is there anything that can be done about them? We'll find out next on The Scope.

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Interviewer: Dr. Brian Zaugg is an ophthalmologist at the Moran Eye Institute. I know I have them, and I know some other people that have them. Floaters, you know, those things where you close your eyes and you see little squigglies moving around, or sometimes if you're looking into a bright light, you might see them? What's going on there and should I worry about them? First of all, what are they?

Dr. Zaugg: Yeah. Floaters are a big annoyance. I see a lot of patients who complain of floaters every day in my clinics. Generally speaking, what they are is they're condensations of a part of the eye called the vitreous. So the vitreous is a gel-like substance in the back of the eye. When you're younger, it'll liquefy a little bit and collapse on itself, and you'll get little floaters of proteins floating around in the surface inside the eye. As those floaters move around, they create a little shadowing on the retina, so the light can't get to the retina and it creates a floater-like symptom for you.

As you get older, that vitreous continues to liquefy and as it liquefies, it actually shrinks. When it shrinks, it pulls away from the retina. It's kind of adherent to the retina in a few places. Where it's more tightly adherent as it pulls away from there, it creates larger floaters. So they generally get more annoying the older you get if you get floaters.

Interviewer: You might see more the older you get, as well?

Dr. Zaugg: Correct.

Interviewer: All right. So it's not going to get any better on its own for me?

Dr. Zaugg: Well, it usually gets better after the initial onset of the floaters.

Interviewer: Okay.

Dr. Zaugg: So when you get the new floaters coming in, they're very annoying, they're large, there's many of them, and then over time they usually do settle down.

Interviewer: All right. Is it something that I should really be worried about, beyond just an annoyance?

Dr. Zaugg: So when you get new floaters, you should always be thinking about anything else that's going on with the eye. There are definitely associated symptoms that you should pay attention to. A new floater can be a sign of, what we most commonly fear is a retinal detachment. If you have a retinal detachment or a tear in the retina, those can be, not life threatening, but vision threatening symptoms. So if you have flashing lights, that can mean that there's some tugging or mechanical motion that's happening to the retina. The retina only knows light. So if something stimulates it, it sends a message back to the brain that you saw light.

The other thing that's really bad with floaters is if you have a dark curtain blocking part of your peripheral vision. That could mean that the retina has folded over on itself and it's detaching, and that can mean that you're having a more serious complication from floaters.

Interviewer: So if I understand correctly, floaters on their own without other symptoms just are part of life.

Dr. Zaugg: Correct.

Interviewer: But with some of those other symptoms you mentioned, then that can be an indication of a more serious issue?

Dr. Zaugg: Correct.

Interviewer: Okay. How often does it get into that serious world, generally?

Dr. Zaugg: It's more common the older you get.

Interviewer: Okay.

Dr. Zaugg: So if you're over the age of 50 and you're getting a lot of new floaters, then you're a little bit more worried about it, because you're getting the complete collapse or separation of the vitreous from the retina, and it can pull the retina with it. So those are times when you really want to get an eye exam to really determine, because you're not going to know for sure if you're having a retinal tear or detachment. Sometimes you have no symptoms other than the floater. So getting a complete eye exam by an ophthalmologist or an optometrist can help to distinguish if it's a more serious eye condition.

Interviewer: That sounds terrifying. But generally, as long as the floaters are the same old floaters, I'm fine?

Dr. Zaugg: Correct.

Interviewer: All right. Great. Is there anything that you can do about, first of all, the annoying floaters?

Dr. Zaugg: Well, generally speaking, they do decrease with time. Again like I said . . .

Interviewer: Understood. Okay.

Dr. Zaugg: . . . if you get a new floater, it usually goes away with time. Either your brain will start to filter out the floater or gravity will actually bring it down in the eye, so it's not in your visual axis. Usually, they'll come up when you're looking at bright backgrounds. So a lot of times when you're looking at a computer, when you're reading, when you're driving on bright, sunny days.

So outside, something that you can do is wear sunglasses. It filters out the floater a little bit. Inside, if you're working at a computer, it's a little bit more tricky. You can get displays that cover the computer screen that kind of filter it a little bit, use a little bit less contrast in your screen. Sometimes that will diminish the floaters as it bothers you.

Interviewer: So it's about decreasing the glare . . .

Dr. Zaugg: Correct.

Interviewer: . . . in those situations?

Dr. Zaugg: Yes.

Interviewer: That's also the gravity thing, is why when I close my eyes, I'll see them float up sometimes, and then I open my eyes and they go away?

Dr. Zaugg: Well, that's usually a little bit of just the eye movement.

Interviewer: Oh, okay.

Dr. Zaugg: Because when your eye closes, your eye actually moves underneath your eyelid and it'll move the floater.

Interviewer: All right. Is there anything else that I should be aware of floaters? My kind of takeaway is they're a part of life for a lot of people. There are some things you can do to minimize seeing them if they're bothersome. If you start getting some new floaters with other symptoms, I should go see someone like you.

Dr. Zaugg: Correct. There's a couple other medical conditions that you should be thinking about other things. So if you're diabetic, sometimes floaters can be a sign of bleeding inside the eye. Diabetics have a lot of eye problems when they're uncontrolled. So they usually have an eye doctor that they've been with, and that would be a reason to get an eye exam more quickly than others. Other things that can happen, if you've had a recent eye surgery, that's a warning sign that something could be going wrong. So have your eyes examined.

There's other rare inflammatory conditions of the eye, in a category called "uveitis," where the floaters can actually be conglomerations of inflammatory cells that could be signs of other serious eye conditions. So the bottom line is if you get a new floater, get an eye exam so that they can determine what's causing it. If it is one of these benign floaters, then that's great. You move on with your life. But we have to make sure that there's not something more serious going on.

Interviewer: How often do you recommend somebody get an eye exam, anyway?

Dr. Zaugg: Well, that kind of depends on how old you are, and if you wear glasses, if you don't wear glasses.

Interviewer: Sure.

Dr. Zaugg: If you're doing well and there's no issues with your eyes when you're younger, getting an eye exam every 10 years is probably fine.

Interviewer: Oh, okay.

Dr. Zaugg: As you get into your 40s and 50s, maybe every five years. As you get into your 60s, every year or two.

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