There is a floater-like syndrome NOT caused by degeneration and clumping of the vitreous humor. It is common enough to deserve it's own page.

Patients describe very distinct, hard-edged, lines and dots that move around much like vitreous floaters. They tend to be seen in the central vision region. For the patient population that visit our office, we find these moving shadows occur mostly in young men in their twenties. They are still described occasionally in the third decade and very rarely occur in the 40 or older population.

They often describe them as semitransparent or like a glass rod or "crystal worm". They can draw them with great accuracy and detail. Here are some examples some of our patients have drawn:
these "moving shadows" were ultimately either not visible to the doctor or not treatable. Note how they are very accurately drawn with very distract shapes, lines and balls or knobs. These also tend to be seen well even when the pupil is dilated.

We know that moving shadows are projected onto the retina. There is no central nervous system, neurological condition or syndrome that would duplicate these moving shadows. Because the shadows are very defined and distinct, we can infer that the source of the shadows lie closer to the retina rather than closer to the lens and cornea. In fact no object near the lens or cornea can cast a distinct well-defined shadow.

So on examination we expect to find something very close to the retina. Dr. Johnson describes it as "as looking for a strand of fiberglass, in a pool, at night, with a flashlight". If you are lucky, with a narrow beam of light we may get lucky and see a slight reflection of light on something small. Most often, with young people we simply cannot see anything. Anywhere. The vitreous will be crystal clear.

PREMACULAR BURSA:
We believe that the source of the shadows resides in a "potential space" anatomically described as the Pre Macular Bursa. A potential space exists where two tissue layers lie on top of each other. If fluid gets between them, the tissue layers can separate either a little or a lot. The two tissue layers is the thickened outer cortical thickening of the vitreous (posterior vitreous face) and the other layer is the retina. We believe there may cellular debris or waste or something small that gets trapped in that thin fluid space. This object or matter just needs to be slightly larger that the individual retinal rods or cones to be perceived. If it was immobile and stuck to the retina, the brain would easily ignore it and it would not be seen.

It is unfortunate that something so benign can be so bothersome to an otherwise young, healthy and productive individual. We can not and do not treat these moving shadows. No one even knows what they are. There is one diagnostic test that might confirm the source and location of this matter and it is the Optical Coherence Tomograph (OCT). It non-invasively images high resolution scans showing the layers of the retina and the few microns immediately in front of the retina. This is a theoretical possibility, as I have never seen this debris imaged by any means. [editors note: It would take a motivated and patient OCT technician, but if any of the young readers out there ever get these imaged, please get a copy, digital or otherwise if at all possible]. Before you rush out and try to get an OCT image, keep in mind that it will not likely change any treatment plan, and you have to ask yourself what you would do if you get the test and it does NOT show anything? Does that mean it's there, but wasn't imaged? What if it does show something? It would indeed confirm the source of the problems, but it would not likely be an indication for any treatment. Vitrectomy? In an otherwise completely healthy eye?

The good news is that these moving shadows of the pre macular bursa may eventually be cleared out, even though it could be years. We rarely see patients in their thirties with this type of floater symptoms, and we can only think of one gentleman in his early forties with distinct floaters symptoms and no vitreous degeneration.

Next we will discuss your treatment options HERE