Many people experience the sudden appearance of specks, webs, or spots drifting through their field of vision, commonly known as vitreous floaters. While they can be distracting, they are often a normal part of the eye’s aging process. The appearance of new floaters is a reason to seek a thorough eye examination, and understanding their cause and the diagnostic process can provide reassurance.
Understanding Vitreous Floaters
The large, central cavity of the eye is filled with a clear, gel-like substance called the vitreous humor. In youth, this gel is firm, but with age, it begins to change in a process known as vitreous syneresis. This involves the liquefaction of the gel, and the solid components, primarily collagen fibers, can clump together. These clumps cast shadows on the retina, the light-sensitive tissue at the back of the eye, which the brain interprets as floaters.
As the vitreous continues to liquefy and shrink, it can pull away from the retina. This event is called a posterior vitreous detachment (PVD) and is a common cause of a sudden onset of floaters. A PVD occurs in a majority of people, often by the age of 70, and represents a natural aging process. For many, the initial appearance of a large, cobweb-like floater signals that a PVD has occurred.
While a PVD itself is not a threat to vision, the process can sometimes lead to more serious issues. As the vitreous gel peels away, it can tug on the retina. This mechanical pulling can stimulate retinal cells, causing the perception of brief flashes of light, a symptom known as photopsia, often more noticeable in dim lighting.
The appearance of new floaters and flashes necessitates a prompt eye examination. The primary concern is that traction from the detaching vitreous could create a tear in the retinal tissue. Warning signs suggesting a retinal tear include a sudden shower of many new floaters, persistent flashes of light, or a dark, curtain-like shadow in the peripheral vision, which require urgent evaluation.
What is Optos Ultra-Widefield Imaging?
Optos ultra-widefield imaging is a diagnostic technology that provides a panoramic digital picture of the retina. The device is a type of scanning laser ophthalmoscope that captures a detailed, high-resolution image of the back of the eye. This technology is distinct from traditional retinal photography because of the expansive view it provides.
A key feature of the Optos system is its ability to capture up to 200 degrees of the retina in a single image. This covers approximately 82% of the total retinal surface area in a fraction of a second. By comparison, conventional fundus cameras capture a much smaller portion of the retina, between 30 and 45 degrees, requiring multiple images to view the periphery.
The technology works by using two low-powered lasers of different wavelengths, red and green, that scan the retina simultaneously. The green laser captures details in the superficial layers, such as blood vessels, while the red laser penetrates deeper to image structures like the retinal pigment epithelium. This system produces a comprehensive, multi-layered image for a detailed assessment.
For the patient, the experience of having an Optos scan, often called an optomap, is fast and non-invasive. The individual looks into the device, one eye at a time, as if peering through a keyhole. A brief flash of light signals that the image has been captured, and the procedure can often be performed without pupil-dilating eye drops.
Diagnosing Floaters with Optos
When a patient presents with new floaters or flashes, an eye care professional’s primary goal is to ensure the health of the retina. The Optos scan is not used to visualize the floaters themselves, but to perform a meticulous inspection of the underlying retina for complications associated with the PVD that caused the symptoms.
As established, the main concern during a PVD is the risk of a retinal tear. If a tear occurs, liquid from the vitreous cavity can seep through the break and lead to a retinal detachment, a serious condition that can cause permanent vision loss. The ultra-widefield view of the Optos system is particularly useful for detecting this risk. Retinal tears and holes frequently develop in the far periphery of the retina, which can be challenging to visualize completely during a standard exam.
The 200-degree optomap image provides a comprehensive and unobstructed view of this peripheral region, making it easier for the doctor to identify any breaks that might otherwise be missed. During the image review, the doctor examines the entire retinal surface captured in the optomap. They look for the specific signs of a tear, and the technology allows for precise documentation of any retinal pathology for monitoring and treatment planning.
Interpreting the Results and Next Steps
Following an Optos scan for new-onset floaters, the results guide the subsequent course of action. The findings generally fall into one of two categories, each with a distinct path forward. This provides a defined management plan based on the health of the retina.
The most common outcome is an unremarkable scan, where the retina appears healthy and intact. This result offers reassurance that the posterior vitreous detachment has occurred without causing any tears or holes. In this scenario, the floaters are considered benign, and the management plan is observation, as the brain often adapts to their presence over time.
Alternatively, the Optos scan may reveal a retinal tear or hole. This finding indicates that the PVD has caused damage to the retina and requires attention to prevent it from progressing to a full retinal detachment. The ultra-widefield image allows the eye doctor to confirm the diagnosis and determine the location and size of the break.
If a retinal tear is identified, the next step is a procedure to seal the break. Two common in-office treatments are laser photocoagulation and cryopexy. In laser photocoagulation, a laser creates tiny burns around the tear, which induces scarring that “welds” the retina to the underlying tissue. Cryopexy achieves the same result by using a freezing probe on the outside of the eye to create a scar, and both procedures create a barrier that prevents fluid from causing a retinal detachment.