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The spots, strings, or cobwebs that drift in and out of your vision are called “floaters,” and they are more prominent if you’re looking against a white background.

These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye. Floaters cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.

As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights. These flashes can then occur for months. Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.

This condition is more common in people who:

• Are nearsighted.
• Are aphakic (absence of the lens of the eye).
• Have past trauma to the eye.
• Have had inflammation in the eye.

When a posterior vitreous detachment occurs, there is a concern that it can cause a retinal tear.

Symptoms of a retinal tear include:

• Sudden increase in number of floaters that are persistent and don't resolve.
• Increase in flashes.
• A shadow covering your side vision, or a decrease in vision.

In general, posterior vitreous detachment is unlikely to progress to a retinal detachment. Only about 15 percent of people with PVD develop a retinal tear.

If left untreated, approximately 40 percent of people with a symptomatic retinal tear will progress into a retinal detachment – and a retinal detachment needs prompt treatment to prevent vision loss.

Generally, most people become accustomed to the floaters in their eyes.

Surgery can be performed to remove the vitreous gel but there is no guarantee that all the floaters will be removed. And for most people, the risk of surgery is greater than the nuisance that the floaters present.

Similarly, there is a laser procedure that breaks the floaters up into smaller pieces in hopes of making them less noticeable. However, this is not a recognized standard treatment and it is not widely practiced.

In general, the usual recommendation for floaters and PVD is observation by an eye care specialist.

Article contributed by Jane Pan M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ. This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician.

A wrinkle on the retina - which is also known as an epiretinal membrane (ERM) or a macular pucker - is a thin, translucent tissue that develops on the surface of the retina.

The retina is the inner layer that lines the inside of the back of the eye and is responsible for converting the light image into an electrical impulse that is then transmitted to the brain. An epiretinal membrane that forms on the retina goes unnoticed by the patient many times, and is only noticed during a dilated eye exam by an eye doctor.

Epiretinal membranes can become problematic if they are overlying the macula, which is the part of the retina that is used for sharp central vision. When they become problematic they can cause distortion of your vision, causing objects that are normally straight to look wavy or crooked.

Causes of a wrinkle on the retina

The most common cause is age-related due to a posterior vitreous detachment, which is the separation of the vitreous gel from the retina. The vitreous gel is what gives the eye its shape, and it occupies the space between the lens and the retina. When the vitreous gel separates from the retina, this can release cells onto the retina surface, which can grow and form a membrane on the macula, leading to an epiretinal membrane.

ERMs can also be associated with prior retinal tears or detachments, prior eye trauma or eye inflammation. These processes can also release cells onto the retina, causing a membrane to form.

Risk factors

Risk for ERMs increases with age, and males and females are equally affected.

Both eyes have ERMs in 10-20% of cases.

Diagnostic testing

Most ERMs can be detected on a routine dilated eye exam.

An optical coherence tomography (OCT) is a noninvasive test that takes a picture of the back of the eye. It can detect and monitor the progression of the ERM over time.

Treatment and prognosis

Since most ERMs are asymptomatic, no treatment is necessary. However, if there is significant visual distortion from the ERM or significant progression of the membrane over time, then surgical intervention is recommended. There are no eye drops, medications, or nutritional supplements to treat or reverse an ERM.

The surgery is called a vitrectomy with membrane peeling. The vitrectomy removes the vitreous gel and replaces it with a saline solution. The epiretinal membrane is then peeled off the surface of the retina with forceps.

Surgery has a good success rate and patients in general have less distortion after surgery.

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.