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What Are Floaters?

Floaters are little spots or streaks that can look like flies or cobwebs in your vision. They move when you move your eye and most often continue to drift. Some floaters are completely normal at any age, especially in short sighted (myopic) people and the can occur even in children. A sudden increase in the amount or size of floaters particularly if accompanied by flashes is important to get checked.

Floaters look like they are in front of your eye but they are actually floating inside it. The eye is like a round camera with lenses at the front and the film of the camera at the back. The main chamber of the eye is filled with a gel called the vitreous. Floaters are debris in the vitreous.

They may look to you like black or grey specks, strings, or cobwebs that drift about when you move your eyes and appear to dart away when you try to look at them directly.

What Causes Floaters?

  • Posterior Vitreous Detachment – As we age the vitreous jelly starts to break apart and eventually, usual after the age of 55, it peel away from the retina. This is NOT a retinal detachment. Separation of the vitreous gel is almost always associated with more floaters and sometimes flashes. When this happens you should get your eyes examined. This is a common cause of floaters.
  • Posterior Uveitis – is an inflammation in the layers of the uvea in the back of the eye. This condition can cause the release of inflammatory debris into the vitreous that are seen as floaters. Posterior Uveitis may be caused by infection, inflammatory diseases or other causes.
  • Vitreous Haemorrhage – Bleeding into the vitreous can have many causes, including diabetes, blocked blood vessels and injury. Blood cells are seen as floaters.
  • Retinal Tears – Can happen when the vitreous detaches and is the reason that one needs have an eye examination when new floaters occur.
  • Retinal Detachment – retinal tears can lead to retinal detachment. This is NOT a common cause of floaters.

When Should You See an Ophthalmologist?

Sudden onset of a large number of floaters particularly if associated with flashes (streaks down the side of the vision when moving the eyes
in dim light) should always be checked by an ophthalmologist or optometrist.

Are Floaters Ever Serious?

Floaters are only serious with they are associated with a retinal tear or inflammation in the eye. It is always safer to discuss this with either your optometrist or ophthalmologist.

What is an Epiretinal Membrane?

Epiretinal Membrane is scar tissue on the macula which distorts your vision so objects may appear blurred or crooked.

An Epiretinal Membrane is a thin film of fibrous tissue that forms a delicate scar or membrane at the back of your eye. The scar tissue looks like crinkled cellophane lying on top of the retina. This membrane pulls up on the central part of the retina (Macula).

Common Terms For Epiretinal Membrane

Epiretinal Membrane also called a

  • Macular Pucker
  • Premacular Fibrosis,
  • Cellophane Maculopathy

Who Is Affected by Epiretinal Membrane?

Predominantly people over the age of 60 but it can affected younger people.

What is the cause of an Epiretinal Membrane?

We are not sure exactly how epiretinal membranes form and they are commonly referred to as idiopathic, meaning no known cause. Sometimes an epiretinal membrane will form after a retinal detachment, a retinal tear or in diabetics.

Symptoms of Epiretinal Membrane

  • Blurred vision
  • Distorted vision (straight lines may appear wavy)
  • Worsening central Vision

An Epiretinal Membrane does not cause complete blindness as it affects only central vision with peripheral vision remaining unaffected

How is Epiretinal Membrane Diagnosed?

Proper diagnosis of an epiretinal membrane requires imaging with an OCT. A full ocular examination with dilation is very important.

How is Epiretinal Membrane Treated?

Treatment is not required for a mild Epiretinal Membrane that has very little or no effect on vision. However, when vision declines, surgery is the only treatment option available.

Vitrectomy is the surgical procedure performed to remove the Epiretinal Membrane.

What If Epiretinal Membrane Is Untreated?

If you are not aware of any visual problems, you might not need to have surgery. However, if the distortion affects your ability to work, drive, read, or perform other important activities, you should consider having an operation.
Some patients decide not to have an operation and accept the distorted central vision in the affected eye. This is reasonable, especially if the vision in the other eye is not affected.

Epiretinal Membrane may not get worse if left untreated, but if you find the visual distortion troublesome you should consider surgery.

What is a Macular Hole?

A Macular Hole is a small round hole that develops in the centre of the macula, the highly sensitive area of the central retina responsible for detailed central vision.

A Macular Hole can have a significant impact on your vision as the condition can effect detailed vision, allowing us to read, recognise faces, drive and see colour.

Who Is Affected by Macular Hole?

It is not clearly understood why Macular Holes develop, but it is more common in women around the age of seventy.

When a Macular Hole has formed in one eye the fellow eye may also be at risk, so it is important to monitor both eyes in the postoperative period and beyond.

Causes Of Macular Hole

Macular hole formation is related to the vitreous and macular interface.

Trauma is very rarely the cause and a traumatic macular hole is a distinct condition.

Symptoms of Macular Hole

A patient may experience blurring and distortion of central vision. In more advanced macular holes a central blind spot will develop. Macular holes do not lead to complete blindness.

How is Macular Hole Diagnosed?

Occasionally, a Macula Hole is detected as a chance finding, for example when covering the good eye or during a routine Eye Examination by an optometrist.

Definitive diagnosis requires an OCT scan which provides a cross sectional view of the macular.

How is Macular Hole Treated?

Macular hole is treated by vitrectomy surgery. The surgery is performed under local anaesthesia with minimal discomfort. With modern techniques, sutures are usually not required. A bubble of gas is injected to keep the hole dry and allow it to heal. It is helpful to look down for 3 to 5 days to keep the macular hole above fluid. You must not travel by air while gas bubble remains.

What is Retinal Detachment?

A retinal detachment is when the thin layer of cells at the back of the eye (the retina) comes off. Without treatment, a detached retinal is almost certainly a blinding condition.

Symptoms Retinal Detachment

– flashes and floaters
– Dark shadows increasing in size from the edge of vision
– Blurred hazy vision
– Distorted images

What Causes Retinal Detachment?

Retinal detachments are a result of a retinal break or tear. This is not commonly as a result of trauma and most often happens spontaneously, not as a result of any specific action.

Very short sighted (myopic) people are most prone to retinal detachments.

Treatment for Retinal Detachment?

Vitrectomy
This technique is more commonly used and involves removing the vitreous using very fine instruments through wounds in the sclera (white of the eye). The retinal tears are identified and the fluid under the retina is sucked out. A gas bubble is injected in the eye cavity to prevent fluid getting under the retina again. The gas bubble dissipates in 2 to 4 weeks and you may be asked to keep posturing (e.g., look down) for several days. Air travel is absolutely prohibited until gas is completely gone.

Scleral buckle
This is an older technique but still is the most effective option for many types of retinal detachment. A piece of silicone rubber is sewn onto the sclera to push the wall of the eye inwards, bring it closer to the detached retina. The buckle is permanently left in place. Buckle surgery is less comfortable than vitrectomy, and may lead to double vision. In some circumstances it will be combined with a vitrectomy.

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