One of the most common questions I hear is: “I have floaters…should I be worried?”

Let’s take a step back and review ocular anatomy to understand what causes floaters.

The eye is shaped like a sphere. Just like a ball has an outside surface and an inside service, the eye also has an outside surface and an inside surface. The outside can be seen on the front of the eye in the portion between the upper and lower eyelid. The white part of the eye is the sclera and it is covered with a thin tissue called the conjunctiva. The cornea is a clear structure that the iris, which is the colored part of the eye, can be seen through. The pupil is the black spot in the center of the iris and is actually a hole that light enters the eye through.

The inside of the eye is lined with a thin tissue referred to as the retina. The retina lines the whole inside of the eye. At the very back of the eye resides a small portion of the retina called the macula.

The macula is the spot on the eye for high definition vision. If you’ve ever had your eyes examined and remember answering the question “which one looks better, lens one or lens two?” you were actually having lenses focus images on your macula.

Although the eye is a sphere, it is not an empty sphere. It actually is filled with a clear substance called the vitreous. The vitreous is a clear gel substance. If you could picture Jell-O that is clear, this is very close to the consistency of the vitreous inside of the eye.

One of the most common reasons for seeing floaters is small condensations and opacities that form within the vitreous. This naturally happens over time and can develop in patients of various ages.

When we examine your eyes, we can see floaters in the vitreous. As the vitreous ages we’re more likely to see floaters in it. This happens as natural changes in the vitreous occur over time and cause it to become less gel like and more liquid like in appearance. What’s interesting about the vitreous is that it has a thin layer that connects it to the retina. The strongest areas of attachment of the vitreous are at the optic nerve and the macula. Overtime everybody’s vitreous will pull away from the retina. This is a natural process that will occur in everyone’s eyes at some point. The name of the condition when the vitreous pulls away from the retina is a posterior vitreous detachment.

Although the name posterior vitreous detachment initially implies that this is something that is a concerning health issue for the eye, it is a very normal process. At some point in all of our lives, this will occur within the eye.

Unfortunately, when the vitreous detaches from the retina, it leaves visible remnants of vitreous inside of our eyes that we will see as floaters.

Some people describe them as looking like a little circle, others describe them as spots and others will describe them as looking like lines.

The good news about a posterior vitreous detachment is that it’s a normal process. Unfortunately with detachment there’s no widespread treatment. Fortunately, most people will usually get used to the floaters and will eventually ignore them.

Most people will describe sometimes noticing them and other times not noticing them at all. There are other things that can cause floaters in the eye that are more concerning. One of those is a retinal detachment. A retinal detachment is more concerning and is when the retina pulls away from the back of the eye.

If the retinal detachment is small and diagnosed early, it can often be treated effectively. If the retinal detachment continues to occur without intervention it may lead to blindness. It’s one of the reasons that if you do notice a new floater in your vision it’s something that you should see your eye care practitioner about immediately.

There are several reasons someone may develop a retinal detachment. One of the more common causes of retinal detachment is simply an incidental occurrence. There are some people who have ocular anatomies that put them at higher risk for having a retinal detachment and sometimes these simply happen spontaneously.

Injuries to the eye can also cause retinal detachment. As an example, somebody who has experienced blunt trauma to the eye is at a higher risk of having a retinal detachment. Diabetes can also cause a retinal detachment to occur. Diabetes that is uncontrolled can lead to diabetic retinopathy. In more severe forms of diabetic retinopathy, the retina can detach and cause substantial vision loss.

Hemorrhages inside of the eyes can also cause floaters in your vision. One of the more common reasons for hemorrhages to form inside of the eye is untreated diabetic retinopathy. Fortunately, most patients with diabetes who control blood glucose levels will rarely experience any forms of hemorrhaging in the eye that will cause floaters.

One of the best ways to prevent diabetic retinopathy from occurring is to control the glucose levels as best as possible. Understanding the reason that you have floaters is critical. Make sure that you communicate with your optometrist if you do have floaters so that they can tell you exactly what the cause or the reason for the floaters are. Understanding this is critical. Also, contact your optometrist immediately if you have a new onset of floaters. Although most cases of floaters that people notice are benign and do not require any treatment, when they do require treatment early identification is of the utmost importance in preserving vision.

Mile Brujic, OD, FAAO is a 2002 graduate of the New England College of Optometry. He is a partner of Premier Vision Group, an optometric practice with three locations in Northwest Ohio. He practices full scope optometry with an emphasis on ocular disease management of the anterior segment and specialty contact lenses. Brujic is on the editorial board for a number of optometric publications. He has published over 350 articles and has given over 1600 lectures, both nationally and internationally on contemporary topics in eye care.