Not quite sure what floaters or flashes are? In our article this week our Calgary optometrist takes an in-depth look at what causes these vision symptoms and how they can be treated.
Floaters are small moving black/grey specks that bounce around in your field of vision, and often appear as spots, threads, or wavy lines. They tend to shoot away if you try to look at them directly. Most people notice a few floaters here and there, especially with age, and they are not usually noticed until they are larger in size or number.
The other visual symptom that may be observed is the sensation of flashes of light. Movement of the vitreous gel inside the eye as it becomes less viscous moves around more, which can ultimately pull on the fine layers at the back of the eye which creates the flashing symptoms.
Our blog this week from our Calgary eye clinic will tell you:
- How floaters and/or flashes can be signs and symptoms of deeper eye issues including posterior vitreous detachment (PVD), retinal detachments, vitreous hemorrhages, and complex macular problems like macular holes and separation;
- How your optometrist reception team will triage you to be seen often on the same day you experience these symptoms, and
- How your optometrist will assess the exact cause of the floaters and/or flashes with a comprehensive dilated retinal exam along with sophisticated retinal imaging.
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What Causes Floaters?
Floaters occur when the vitreous, a jelly-like substance that maintains the shape of the eye, slowly shrinks and becomes more fluid (less viscous) over time. The vitreous is attached to the back of the eye, known as the retina, which is a light-sensitive tissue that lines the eye and sends signals to the brain via the optic nerve.
As the vitreous shrinks, its collagen fibers congregate into clumps, which cast shadows on the retina that are perceived as floaters. Because the fibrous pieces can move around with activity, the floaters can be more noticeable when first changing position, during extended focusing activity, and they will often stand out more against brighter backgrounds.
What Causes Flashes?
The process of the vitreous shrinking and liquefying is a normal age-related process (known as synchysis and syneresis) that causes floaters, but it can also cause you to perceive flashes of light. This is because as the vitreous shrinks, it begins to pull on the retina, and the only way the retina can react to this is by sending light signals to the brain.
Most of the time, it is a very gentle pulling, and eventually the vitreous shrinks away without causing any damage. However, there is a chance that the pulling leads to a tear in the retina, and continuous pulling on this area as the vitreous moves can lead to a retinal detachment.
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What is a Posterior Vitreous Detachment (PVD)?
A posterior vitreous detachment (PVD) is most often a benign age-related condition in which the fluid sac inside the back of the eye slowly moves away from the nerve layer. It is normally attached most strongly around the optic nerve, and often near some blood vessels. As a result, a larger or more sudden onset PVD can result in a very large and persistent floater, possible bleeding inside the eye, and even increase the risk of retinal detachment. Your optometrist will be able to assess your immediate and long-term risk of PVD versus retinal detachment at your emergency eye care visit.
What is a Retinal Detachment?
A detached retina is a serious condition that can lead to vision loss. The detachment occurs when the retina becomes separated from the underlying supportive tissue. If the retina gets torn (which can occur due to a PVD), the fluid inside the eye can leak underneath this tear and separate the retina from its underlying tissue. Because the retina cannot function when these layers are detached, it needs to be reattached as soon as possible or permanent vision loss can result.
These signs and symptoms may occur gradually as the retina pulls away from the back of the eye, or they may occur suddenly. If you experience any of the following, you should immediately call your optometrist to be seen as soon as possible, as retinal detachments can progress quickly and cause permanent vision loss:
- A sudden increase in the number of floaters (small flecks or threads) or suddenly noticing new floaters
- Darkening in your peripheral/side vision
- Shadow/dark curtain descending over your field of vision
- Sudden blurry vision
- Flashes of light
Note: There will be NO PAIN associated with vitreous and retina changes.
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What Causes Retinal Detachments?
There are a few things that increase your risk of a retinal detachment:
- Injury to the head or eye
- Family history of retinal detachment or retinal tears
- Extreme nearsightedness (myopia) — myopic patients have longer eyeballs, which causes the retina to be thinner and stretched out, and therefore more prone to detachment
- Eye surgeries
- Diabetic retinopathy, macular degeneration, etc. — any eye disease that causes new blood vessels to grow under the retina increases risk of retinal detachment, because the new growth can push the retina away
- Larger, or more sudden onset PVD
How Are Retinal Detachments Treated?
Retinal surgery needs to be performed promptly by an ophthalmologist (often on the same day) in order to preserve as much vision as possible. The rate and speed of progression of vision loss is variable between individuals. Sometimes doctors are unable to predict the visual outcome, but usually the sooner you see the surgeon the better. The retina itself does not have any pain receptors, so most of the following surgeries are relatively painless.
- Laser Surgery: “Welds down the retina” by making small burns around the gap to put the retina back in position, and then it is reattached with cryopexy.
- Gas Bubble: A bubble is injected into the eye to hold the retina down in place, and then it is reattached with cryopexy.
- Scleral Buckle: Reserved for when the detachment has spread through a large area of the retina — a small band is placed around the outer side of the eyeball to exert pressure to bring the inner wall closer to the detached retina.
- Vitrectomy: The jelly-like vitreous substance is removed to release the pulling force it has on the retina, so the surgeon makes a small incision to remove the vitreous and then fills the eye with a harmless gas to push the retina toward the inner wall so it can reattach.
In summary, awareness of unusual vision symptoms should not be ignored. It is important to contact your eye health care and vision teams at My Optometrist Calgary with any of the above symptoms. Alberta Health Care covers examinations and testing for the detailed analysis of the eye. Your optometrist reception team is trained to recognize these possible emergency symptoms and we accommodate emergency care every day.
Additionally, comprehensive eye examinations for all adults includes a peripheral wide field Optos retinal image. This retinal image is offered as a small add-on fee for children and seniors. This image is very helpful to detect risk factors of thin areas of the retina, or otherwise document the normal state of the back of your eyes.
We look forward to your next eye care visit, or to provide emergency care as needed to ensure your access to the best eye care possible.
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Need an eye exam Calgary? My Optometrist Calgary has you covered. Contact one of our My Optometrist Calgary clinics at either 403-256-0606 (Health First Optometry), 403-291-0923 (Sunridge Vision Centre), or 403-443-2040 (Three Hills Optometry).
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