VITREOUS FLOATERS DEFINED: Any change to the normally optically transparent vitreous body that is significant enough to cast a shadow onto the sensory retina AND be noticed by the sufferer at least some of the time.

BENIGN VITREOUS FLOATERS: are floaters that are not related to or caused by ocular or systemic disease or abnormal pathological events such as hemorrhage or foreign material. Benign floaters are NEVER a threat to the health of the eye no matter how dense and bothersome they may be.

PATHOLOGICAL VITREOUS FLOATERS: are associated with abnormalities and disease of the eye or body. They may be reactive, autoimmune, hemorrhagic, metabolic, genetic, parasitic or foreign material in origin. Of these, reactive inflammation and hemorrhage are the more common.

The most common causes or associations with the onset of vitreous floaters are AGE, MYOPIA (near-sighted), TRAUMA, and UNKNOWN. There may be molecular changes that occur which begin the process. We know that bare collagen tends to be sticky. If the Hyaluronin molecule is no longer attached or associated with it, the collagen will clump, and stick to itself squeezing water molecules out.

This drawing is another way of visualizing the even distribution of collagen under normal circumstances and well as the proposed mechanism that occurs when hyaluronin (HA) molecules disassociate themselves from the collagen. The sticky collagen molecules begin to clump which squeezes the water out.

POSTERIOR VITREOUS DETACHMENTS (PVD's) are most common event that occurs in the vitreous space. The first event that occurs is thickening of the vitreous as collagen clumps as described above.

The water that is squeezed out collects and pools in the center of the eye. This thickening of the vitreous and pooling of fluid continues until a channel is formed which connects the pooled fluid with the back space between the vitreous and the retina.

As this fluid shifts, the pooled fluid space collapses and the posterior vitreous pulls away from the retina. This separation can be partial or complete. There is a thickened ring of vitreous where the optic nerve enters the eye. This ring, when suspended in the vitreous, casts a distinct shadow and is known as a Weiss Ring floater. It may be a ring, partial ring, or just a amorphous clump but it is typically denser and more fibrous than other types of eye floaters.

DEVELOPMENT OF THE DIFFERENT TYPES OF EYE FLOATERS:
Vitreous floaters are random condensations of the vitreous and come in several varieties or in combinations. They can be small and distinct, stringy like cobwebs, diffusely hazy, or soft and cloudlike. Typically, there is a combination of types of floaters present.

The three most common types of vitreous degenerations are LIQUIFACTION, SHRINKAGE, and OPACIFICATION.

LIQUIFACTION (or SYNERESIS) is an aging process but is also associated or accelerated by nearsightedness (myopia), trauma, intraocular foreign material, other obscure causes. The HA molecules which usually retain the water molecules and form pocket or pools of clear watery fluid and the collagen "scaffold" collapses and condenses as described above. These changes are irreversible but may be so subtle, diffuse, and homogeneous that the changes may not be noticed by the person. On examination, the doctor may see a slight haziness to the vitreous, and it may swirl around with more mobility than normal vitreous gel.

SHRINKAGE is the continuation of the process of liquefaction. As more clear fluid is extracted from the collagen/HA network, the remaining vitreous will shrink and possibly separate from the surrounding wall that is the retina. This separation is commonly associated with shifting of fluid pockets as described above in the posterior vitreous detachment example.

OPACIFICATION is due to continued collapse, coalescence, and condensation of the collagen network. In some cases they may be quite mild or imperceptible except under very specific circumstances or they may be visually debilitating with fixed blockage of the central part of vision or anything in between.

FLOATER GALLERY:
Here are a few images of floaters we have treated. Although floaters are dark and shadowy to the floater sufferer, they reflect light back to the eye doctor and appear light and cream colored.

PSYCHOSOCIAL IMPACT OF EYE FLOATERS:
No discussion of eye floaters would be complete with a discussion of the impact of floaters on the psychological health of the floater sufferer. Most of our patients are highly functional with excellent measured vision. Most would be able to pass any vision and eye health examination as their vision chart acuity, peripheral vision, color vision, contrast sensitivity, eye pressures, and anatomical structures are all normal. What isn't tested is the subjective awareness and annoyance that eye floaters cause.

We have seen diffuse and seemingly significant floater complexes that didn't seem to bother the patient much, and we have seen people put their life " on hold" for the most microscopic of floater debris that is undetectable by most examination techniques. Dr. Johnson has noted that "Floaters are seen through the filter of the sufferers personality". Different personality respond to the eye floaters differently and it is a travesty and a shame that our profession has continued to ignore, or flippantly disregard floaters as nothing to worry about.

If you are reading this and wondering why your friends, family, and colleagues all seem to be able to ignore their floaters, please understand that their are many people suffering these floaters. There are discussion forums in several languages for people suffering floaters including our own found HERE.

Next: We will discuss the special situation of moving visual floater-like shadows in young people HERE