The posterior segment or back chamber of the eye is far bigger and constitutes the bulk of the eye. The total distance between the tip of the cornea and the tip of the back of the eye is typically 21-24mm.
This chamber contains a gel-like substance akin to egg white, called vitreous humour. It is made up of about 1% protein fibres and hyaluronic acid and around 99% water. When we are young it is the consistency of the white of a fresh egg, where all the water components is bound to the long strings of protein molecules.
As we age, it becomes like a 10-day old egg where the proteins start to degenerate causing the water component to become separated, leaving the long protein fibres to clump. These clumps can be sufficiently large or dense to cast a shadow on the retina, which we then perceive as ‘floaters’.
This degeneration is called vitreous syneresis. They are grey splodges or strings a bit like frog spawn, a cobweb, spots, a hair or even a fly moving across your vision. As you eye moves, they follow (with a small time delay). When your eye stops moving, the floaters also come to a slowing halt (again with a small delay). They can be very off putting, especially if they are near the centre of the vision. Most people grow accustomed to them. However, if they are nearer the back of the eye than the front, they may cast a denser shadow on the retina and be more persistently visible.
Floaters can also be a symptom of inflammation in the eye called uveitis. If you are also suffering even a small decrease in your vision, visual blurring, discomfort or redness of the eye alongside the floaters, these could be signs of inflammation in the eye. This is always SERIOUS and you need to be examined by a professional including an optometrist. If they find that you have uveitis you should be referred to an ophthalmologist as it can be serious and caused by serious diseases and infections. In most cases the reason for the inflammation isn’t found and is called ‘idiopathic’. This is generally an immune response to something unknown or a reaction of your own immune system attacking self cells. See uveitis page for more information.
Posterior Vitreous detachment
As the gel continues to change, shrink and collapse away from the retina, the whole body of the gel detaches from the retinal surface. It is more strongly bound to the retinal overlying blood vessels, at the very front edge of the retina, near the ciliary body, behind the iris.
This area is called the pars plana (the ‘plane bit’ in Latin) and also around the rim of the optic nerve. Sometimes there is a little connective that is pulled away where the gel has become detached from the rim of the optic nerve. This form is known as Weis’ Ring. This can be visible in the vision as a ring. As the floaters are positioned nearer the front of the eye, they can become less noticeable. If they are persistent and problematic, you can have an operation to just remove those clumps. This is called a partial vitrectomy. You will need to see a specialist vitreoretinal surgeon to explain and perform this for you.
By Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center - The Eyes Have It, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=16116032
Retinal Tear/ Hole and Retinal detachment
Sometimes the force of the pull on the retina is sufficient to tear a blood vessel or tear the retina. In the first instance, the blood that leaks into the gel would cause a much denser shadow than just a floater and may be much bigger. The bigger the bleed the bigger the dark shadow. If there is a tear in the retina, you are more likely to suffer from random flashes of light. This is caused by the traction on the retina or fluid from the gel passing through the hole and lifting a tiny rim of the retina away from the back of the eye.
Retinal detachments can also occur because of injury to the eye, a blow to the head or car accident causing deceleration injury, or inflammation of the eye. Other risk factors include being short sighted and previous surgery especially cataract surgery. Retinal detachments also rarely occur due to a tumour of the choroid.
If you have a retinal detachment you are likely to perceive a ‘curtain’ across a segment of the vision generally coming from the outer vision and progressing towards the centre. This very serious and you should be seen by a professional (optometrist of A&E doctor) immediately that you notice these symptoms. They may or may not have been preceded by flashing lights and floaters. You need to be referred to an ophthalmologist straight away. Retinal detachments can be repaired successfully though vision might be compromised for life depending on the cause and size of the detachment as well as if it came close to or included the macula (governing the central vision).
If left unchecked and untreated, this can readily lead to a retinal detachment. If you have symptoms of flashing lights, especially if you have new or a changing pattern of floaters, you must seek examination and professional help urgently, either from an optometrist or visit casualty if it is out of office hours. They will discuss your case with an ophthalmologist. If caught early, holes, tears and small detachments can be treated. Once the central vision has become affected, surgery can correct the detachment, but full visual recovery is unlikely and the eye can be blind.
What Can be Done Naturally for Degenerative Floaters?
Degeneration of all proteins around the body is part of the ageing process. Once you have floaters it is difficult to affect a change, other than wait and see where they end up and how symptomatic they are. However, ageing can be slowed by a diet replete with anti-oxidants and natural anti-inflammatories found in fruits and vegetables. Ageing can also be waylaid by a traditional diet with moderated or low carbohydrates, which decrease the amount of sugars that can attach to proteins and lipids around the body. These products are called advance glycation endproducts, AGE’s, and are the bane of normal physiology, repair and cause increased inflammation. All these factors contribute to ageing and early ageing and the development and progression (worsening) of degenerative diseases such as development such as diabetes, atherosclerosis, chronic kidney disease, and Alzheimer’s.
Contact me to arrange your consultation.