FAQ

What is Age-Related Macular Degeneration?

Age-Related Macular Degeneration (ARMD) is the leading cause of vision loss in older American adults and the most common reason patients are referred to Cape Fear Retinal Associates for further evaluation, treatment and care. Patients afflicted with ARMD may note a worsening of their central vision while retaining good peripheral vision.

Many patients with macular degeneration share a common misconception and fear that the disease will automatically progress to blindness. As suggested by its name, ARMD only affects the macula. The macula is the central part of the retina responsible for detailed visual tasks. In macular degeneration, patients suffer varying degrees of destruction to this tissue and can experience a wide spectrum of visual problems. These include, but are not limited to, blurred central vision, increasing difficulty with reading, patchy visual loss, and the distortion or warping of straight objects. However, even patients with advanced macular disease tend to retain excellent peripheral vision.

Who is at Risk for Developing Macular Degeneration?

Macular degeneration primarily affects older, caucasian individuals, although cases have been reported in younger patients and those not of caucasian descent. Additionally, a number of risk factors predispose certain people to the development and progression of the disease, including:

Regarding the last risk factor, much research has been done regarding the genetics of macular degeneration. Although there is currently no way to definitively predict who will or will not develop ARMD, those with affected relatives are at significantly higher risk. As a result, adult relatives of ARMD patients should schedule an appointment with a retinal specialist and undergo a baseline evaluation and dilated exam.

Is There More Than One Kind of Macular Degeneration?

Generally, patients with ARMD are grouped into one of two categories:

Dry ARMD“Dry” Age Related Macular Degeneration - the most common form of macular degeneration is caused by aging and thinning of the tissues of the macula. Dry ARMD is characterized by thinning of the macula and gradual deterioration of vision. It develops slowly and usually causes mild vision loss. As this form of the disease develops, people often notice a dimming of vision while reading.

Wet ARMD“Wet” Age Related Macular Degeneration - Wet ARMD is so called because it is marked by an accumulation of fluid underneath the retina. In contrast with dry macular degeneration, patients with wet ARMD often, but not always, experience sudden and severe visual losses.

Symptoms Include:

What Tests are Helpful in Aiding Diagnosis?

Dry and wet macular degeneration impact vision in different ways and are also treated quite differently. Sometimes it is difficult to differentiate between dry and wet ARMD, so our Dr. Brownlow will use a variety of clinical tests and exam techniques to make an accurate diagnosis.

During an initial visit for macular degeneration, patients typically undergo two tests: Fluorescein Angiography (FA) and Optical Coherence Tomography (OCT). These tests may even be performed prior to consulting with Dr. Brownlow.

Fluorescein Angiography (FA) is considered the “gold standard” for differentiating between dry and wet ARMD. It involves the injection of a small amount of vegetable-based dye through a patient’s peripheral vein -- usually the arm or hand. Shortly after, a certified ophthalmic angiographer will take a series of time-dependent retinal photographs. The injected dye lights up the retina’s intricate vascular network and helps our specialists pinpoint a precise area of leakage in those patients with wet macular degeneration. Not only is this useful in determining the extent and progression of the disease, but it also helps when targeting specific treatment zones with specialized laser therapy.

Optical Coherence Tomography (OCT) is a relatively new, non-invasive, quick exam that has gained universal acceptance during the last decade and is now used by many ophthalmologists. Using reflected light rays, OCT provides a detailed, highly magnified, cross-section view of a patient’s macula. Sometimes, it will uncover tiny areas of leakage not readily apparent to a retina specialist during a microscopic exam.

Patients Play an Important Role in Diagnosis and Care

Despite recent advances in ophthalmic imaging, there is no single test that can be relied upon to direct treatment and clinical decision-making. A patient’s relationship with Dr. Brownlow is at the core of our practice philosophy, and good patient-physician communication is critical. When making important decisions about retinal health, it is very much a joint effort. The patient’s perception of his or her visual health and the patient’s perception of any vision changes, however slight, is every bit as important in directing care as are the clinical tests.

As a result, every patient diagnosed with macular degeneration should establish a daily routine for monitoring their own vision. This is most simply and reliably performed with an Amsler grid, a simple patchwork of straight vertical and horizontal lines. We are happy to provide one to you at no cost – simply ask one of our nurses.

Amsler Grid

The Amsler Grid may be helpful in revealing signs of wet age-related macular degeneration (AMD). It is not a substitute for regularly scheduled eye exams and testing.amsler-grid

Directions

  1. Do not remove glasses or contacts you normally wear for reading.
  2. Stand approximately 13 inches (33 cm) from the grid in a well-lighted room.
  3. Cover one eye with your hand and focus only on the center dot with your uncovered eye. Repeat with the other eye.
  4. If you see wavy, broken or distorted lines, blurred or missing areas of vision, you may be displaying symptoms of AMD and should contact your eye care provider immediately.

Often, patients with subtle progression of macular disease will report new “waviness” or “missing areas” when monitoring their grid. Should you or a family member notice new changes on an Amsler grid, contact us promptly. Either Dr. Brownlow or one of his trained ophthalmic nurses are always available to consult with you by phone. As a general rule, patients who receive treatment in a more timely fashion tend to fare better than those who delay evaluation by a retinal specialist.

What Treatments are Available?

Medical researchers have thrown themselves fully into the battle against macular degeneration, and dramatic progress has been made in the effort to combat age-related vision loss. The most promising new treatments are Avastin™ and Lucentis,™ which help block certain growth factors that are thought to cause “leaky” blood vessel growth in wet macular degeneration. Both of these medications are introduced directly into the eye through a tiny needle. While the thought of an “eye shot” might cause many to cringe, in our experience, there is little, if any, patient discomfort, and the spectacular visual gains far outweigh any fears. Avastin™ and Lucentis™ are the first medicines that have actually improved vision for many patients with wet macular degeneration. While most retina specialists feel that both work equally well, this has yet to be proven in a large, nationwide, prospective clinical trial. While they have received much media attention and deserved fanfare for their impact on wet ARMD, invaluable work continues on the dry ARMD front as well. A number of vitamin therapies are already available to slow the progression of dry ARMD, and Dr. Brownlow is currently monitoring the second-generation vitamin study that will hopefully prove even more beneficial than previously prescribed supplement regimens.

Low Vision Rehabilitation

This can help people who have experienced mild to severe vision loss adjust to their condition and continue to enjoy active and independent lifestyles. Low Vision Rehabilitation may involve anything from adjusting the lighting in your home to learning to use low vision aids to help you read and perform daily tasks. Dr. Brownlow can refer patients to local low vision specialists for this assistance.

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What is a Retinal Detachment?

Retinal DetachmentYou have been diagnosed with a retinal tear or detached retina. Symptoms of retinal detachment include:

Flashes and floaters occur when the vitreous gel that fills up 80 percent of the volume of the eye begins to liquefy and pulls away from the back of the eye. Floaters are protein aggregates that are more pronounced when they first occur and are typically seen most easily against a bright background. Bleeding inside of the eye can also cause a sense of looking through floaters.

If the inner lining of the eye (the retina) is thin, the vitreous can pull on this area to produce a tear. Persistent pulling on the tear can lead to a retinal detachment, a condition in which fluid gets under the retina and lifts part or all of the retina away from the back of the eye.

Risk Factors

Risk factors for retinal detachment include:

Treatment

Fresh retinal tears and detachments should be treated urgently since rapid loss of vision can occur. The success rate for repair of a recent uncomplicated retinal detachment approaches 90 percent.

Laser treatment can often be conducted in the office to seal a retinal tear if there is no detachment. However, close follow-up is necessary to make certain that the retina does not detach despite laser treatment.

Pneumatic retinopexy is also an office-based procedure using laser or freezing therapy to seal off a tear, followed by injecting a small gas bubble into the eye to reattach the retina from inside the eye.

Scleral buckle surgery is conducted in the operating room. A permanent, external support to the peripheral retina is supplied by placing a silicone band around the outside of the eye. Such a buckle is generally not visible after the eye has healed.

Vitrectomy surgery is also an operating room procedure that is used by itself or can be combined with a scleral buckle. A small cutting instrument is used to enter the eye through a 1 mm incision, and the vitreous gel is removed and replaced with a gas bubble. The advantage of this method is that all the debris, scar tissue and membranes on the retina can be removed, and the retina flattened at the time of surgery. A laser is used to seal off the tears.

Gas and silicone oil are support agents used inside the eye to keep the retina attached while permanent bonding occurs. A gas bubble is gradually absorbed over a period of several days to several weeks, depending on the specific gas used. A patient cannot travel by air with a gas bubble inside the eye. Silicone oil may be necessary if longer support is required. This allows the eye more time to heal. However, silicone oil is often removed from the eye by a later surgical procedure once the retina is stable. Patients with silicone oil inside their eyes can fly safely.

Vitrectomy, scleral buckle and gas are sometimes used in combination. Anatomical success rate can be as high as 80 – 90 percent. However, some eyes will develop a recurrent retinal detachment and may need additional surgery.

Surgery is generally performed as an outpatient procedure, and patients may go home the same day.

Recovery

Healing time varies from several weeks to months depending on the extent and severity of the detachment. If the center part of the retina (macula) has been detached, the central (reading) vision may not completely return.

Dr. Brownlow will instruct you about postoperative eye drops and activities. Generally, allow at least one month before returning to full physical activity. As noted above, always check with Dr. Brownlow to determine if it is safe to resume air travel.

Your eye power may change after the surgery. Glasses or contact lenses are prescribed 6 to 8 weeks after successful healing.

Expect the eye to be puffy and red for several days with clear, reddish tears and discharge. Cold packs on the closed eyelids help the swelling go down and provide comfort.

Please contact us immediately during the postoperative period if you experience the following symptoms:

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What is a Macular Hole?

The eye functions much like a camera. It has a lens system in the front of the eye to focus light onto the “film” in the back of the eye, the retina. The light passes from the surface of the eye to the retina by passing through the clear vitreous gel which fills the inside of the eye.

As we age, the vitreous jelly in our eye turns to liquid. The vitreous pulls away from the retina as it liquefies. In a small percentage of people, as the vitreous separates, it exerts traction on the macula – the center of the retina that is responsible for our sharp, central vision functions like reading small print, threading a needle, or identifying small objects with fine detail. This tugging can ultimately lead to a hole forming in the center of the macula – a macular hole.

The Procedure

Prior to the early 1990s, there was no cure for macular holes. Different attempts were made to try to repair such holes surgically, with limited success. In the early 1990s, however it was discovered that if the vitreous gel were removed surgically from the eye and the vitreous cavity was filled with a temporary gas bubble, the hole would seal itself, resulting in visual improvement. This requires face-down positioning to allow the gas bubble to press against the hole to help it close.

As we have improved techniques of hole closure during the last 10 years, face-down positioning time has been decreased, and the rate of hole closure has improved to 90 percent or greater. As with any surgery, there are surgical risks. These risks include cataract formation, retinal tears and detachment, failure of hole closure and infection or bleeding in the eye. With these relatively low risks, many patients elect to proceed with surgery with a realistic expectation of better vision when the repair is performed in a timely fashion.

Without treatment, the blind spot caused by the macular hole usually enlarges, and most patients’ ultimate visual acuity is 20/400 or worse (the size of the big “E” on the eye chart.) Macular holes rarely close without surgery. There is also approximately a 9 to 10 percent chance of a hole forming in the opposite eye with time.

Before Surgery: “Open” Macular Hole

Before Surgery

After Surgery: “Closed” Macular Hole

After Surgery

What to Expect

Macular hole surgery is done as an outpatient procedure and usually can be performed in one hour or less. The gas bubble that results from the surgery is slowly reabsorbed into the bloodstream over a period of 2 to 8 weeks, depending on the concentration of gas that is used by Dr. Brownlow.

The eye refills itself with a watery fluid as the gas bubble is reabsorbed. The eye does not make more vitreous gel. While the gas bubble is in the eye, the patient may not travel by air or inhale nitrous oxide (commonly used by dentists—“laughing gas”) as either of these activities will cause the gas in the eye to expand, often leading to pain and possible blindness.

To assist patients with the face-down positioning, there are positioning aids that may be rented from specialty companies. Ask your doctor for this contact information.

The most common side effect of macular hole repair is cataract formation that often requires surgery within 6 months of the macular hole repair. Please discuss this and other implications of surgery with Dr. Brownlow.

Commonly Asked Questions

  1. How frequently does cataract formation occur? If you have not had cataract surgery, you will likely develop a cataract and may need surgery in the next 6 to 12 months.
  2. How often does retinal detachment occur? Retinal detachment occurs in 1 to 2 percent of patients and is usually repairable
  3. How long will I need to assume the face-down position? In general, rigorous face-down positioning is encouraged for 7 to 10 days.
  4. What happens to the gas bubble and how long will it last? The gas bubble will slowly be absorbed by the body. It may persist in the vitreous space for as long as eight weeks.
  5. When can I travel by air? Generally, you should not fly until the bubble is completely gone. Your doctor may allow you to travel by air sooner if it is safe to do so.

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What is a Macular Pucker?

The macula is the small, central part of the retina that allows you to read and see fine details. Damage to the macula can significantly affect central vision.

A macular pucker occurs when a clear membrane, like cellophane, covers the surface of the macula. The membrane is made up of a thin layer of cells that settle and grow on the surface of the retina. This condition can occur at any age, but more often occurs in people over the age of 40. Often these membranes remain completely flat and cause no vision problems. However, in some cases, the membrane will start to contract on the surface of the macula which leads to wrinkling or puckering of the retina beneath.

Symptoms

Symptoms of a macular pucker include:

Macular puckers are associated with several eye conditions such as a torn or detached retina, inflammation inside the eye, blood vessel damage in the retina and previous eye surgery.

A macular pucker is diagnosed by your ophthalmologist during a dilated eye exam and can be further evaluated with special tests like optical coherence tomography (OCT) or fluorescein angiogram.

Treatment Options

For mild symptoms, a macular pucker can be observed and generally does not cause any damage to the underlying retina. Changing your eyeglasses prescription can help improve vision.

If a patient is experiencing more severe symptoms, the membrane can be removed surgically. Surgical removal involves a vitrectomy which requires removal of the vitreous gel that fills the back of the eye through three small incisions in the white of the eye. After removal of the gel, the membrane is gently peeled from the surface of the macula using fine, microscopic instruments. The eye is then filled with a saline solution, and the incisions are closed. Once the membrane has been removed, the retina can flatten back to its normal shape. Vision gradually improves over a period of weeks after the surgery.

The major risks of a vitrectomy include:

Discuss the risks with Dr. Brownlow prior to surgery.

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What are Retinal Vein Occlusions?

A retinal vein occlusion occurs when one of the veins of the retina becomes blocked and cannot drain blood from the retina normally. This blockage leads to a back up of blood and fluid into the retina. This back up of blood can be seen in the retina as hemorrhages. The amount of swelling in the retina varies and depends on the degree of blockage of the retinal vein.

Two Types of Vein Occlusions

Risk Factors for Vein Occlusions

  1. High blood pressure
  2. Diabetes
  3. Age
  4. Blood clotting disorders

Symptoms

Symptoms of a retinal vein occlusion can vary based on the severity of the blockage in the vein and amount of swelling in the retina. Common symptoms include:

Treatment

There is no cure for a vein occlusion. However, the main reason for decreased vision from a retinal vein occlusion is swelling in the central part of the retina called macular edema. Treatments for swelling include:

In mild vein occlusions, often there is no significant swelling, and no treatment is indicated. In severe cases of CRVO, abnormal blood vessels can develop that can lead to glaucoma. These cases are often treated with laser and/or injection with a medication to decrease blood vessel leakage. Some patients do require surgery to control eye pressure even after laser or injections.

What is Uveitis?

Uveitis (y-o -o-’v-e--i’tis) refers specifically to inflammation of the “uvea” or middle layer of the eye. However, it is commonly used as a general term to refer to any inflammation of the eye. Uveitis is a rare disease. Even the most common type occurs in only 1 person out of 12,000.

To understand uveitis and its treatment, it is easier to think of uveitis as arthritis. Arthritis is inflammation of the joints of the body. The body’s immune system becomes confused and starts to attack or reject the cartilage in the joints of the body, leading to joint damage and loss of function. The only way to prevent this damage is to suppress the immune system with corticosteroids or immunosuppressive drugs. Similarly, in uveitis, the body’s immune system attacks the eye. Unless the immune system is kept in check by the use of either steroids or other immunosuppressive drugs, loss of vision, retinal damage, cataracts, and glaucoma can occur.

Uveitis is classified by the location. If the inflammation affects the “white” part of the eye, or sclera, it is known as scleritis. If the inflammation affects the front part of the eye, it is called iritis or iridocyclitis. Inflammation that affects the middle part of the eye is known as pars planitis or intermediate uveitis. Inflammation that affects the back part of the eye is known as a posterior uveitis. Finally, inflammation that affects the whole eye is known as a panuveitis.

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What is Diabetic Retinopathy?

Diabetes damages the body’s normal circulation, which is why people with diabetes may have problems with circulation to their legs, kidneys, heart, brain, and eyes. At least 50 percent of all diabetics will develop diabetic retinopathy (abnormal retinal blood circulation), and the incidence increases with the duration of the disease. After 20 years, more than 90 percent of diabetics have some degree of diabetic change.

Diabetic retinopathy is a leading cause of blindness in the United States in middle-aged adults. Fortunately, new methods of treatment in recent years have decreased blindness among diabetics and have increased the possibility of retaining useful vision.

Types of Diabetic Retinopathy

Non-Proliferative Diabetic Retinopathy

There are two main types of diabetic retinopathy: non-proliferative and proliferative. In non-proliferative diabetic retinopathy, there is leakage caused by damage to small retinal blood vessels (capillaries). This leakage allows proteins and lipids from the blood to accumulate in the retina, causing swelling. If this swelling occurs in the area of central vision (macular edema), sight may be significantly diminished. As the disease progresses, retinal capillaries may also become closed off, resulting in poor retinal nutrition. Lack of circulation to the center of vision (macular ischemia) can result in severe and permanent loss of central vision.

Proliferative Diabetic Retinopathy

When there is widespread impairment of retinal nutrition due to capillary leakage and closure, proliferative diabetic retinopathy develops. The poorly nourished retina sends out a chemical “distress signal” which causes new blood vessels to grow (proliferate) on the retinal surface. Unfortunately, these new blood vessels are very fragile and often rupture, allowing bleeding to occur within the eye (vitreous hemorrhage). Scar tissue can also grow around the abnormal blood vessels which may lead to retinal detachment and possible permanent blindness. The proliferative form of diabetic retinopathy is present in approximately 20 percent of patients with diabetes of ten years duration.

Widespread impairment of retinal blood circulation leads to the development of new, fragile blood vessels. Large clinical trials have shown that a procedure called scatter laser photocoagulation can be effective in halting or reversing new vessel growth. Many eyes, even without visual problems, need to begin laser treatments if there are certain abnormal vessels present. Those eyes, having no visual problems, must be detected by examination. Overall, the incidence of blindness over two years can be reduced by 66 percent for eyes with new vessels on the optic nerve and by 37 percent for eyes with new vessels in other locations. The laser treatment consists of applying multiple laser burns to the peripheral retina, often divided into several sessions. Although mildly uncomfortable, the treatment usually can be done without the need for local anesthesia. The main complications from treatment are loss of some peripheral vision, a decrease in night vision, occasionally some loss of central vision, and possible mild enlargement of the pupil. If laser treatment is needed, the risk factors of not being treated are much higher than the risk of being treated.

Again, a new class of medications targeting VEGF produced by poorly nourished retina can be directly injected into the eye. The anti-VEGF drugs Avastin and Lucentis have been used with good results in managing proliferative diabetic retinopathy, often along with scatter laser photocoagulation treatment.

Symptoms

In the early stages of diabetic retinopathy, there are usually no symptoms. Therefore, it is very important that all patients with diabetes have a comprehensive dilated eye examination at least once a year before any symptoms develop. During this exam, Dr. Brownlow can check for any signs of damage to the retina and optic nerve, including leaking blood vessels, swelling of the macula, and growth of new vessels. To help prevent the development and progression of diabetic retinopathy, patients are urged to control their blood sugar, blood pressure, and cholesterol levels.

Treatment

Good control of diabetes with intensive management and control of blood sugar will delay, and possibly prevent, both the development and progression of diabetic retinopathy. Patients with diabetic retinopathy frequently need to have special photographs of the retina taken. This series of photos is called fluorescein angiography (FA).

Laser photocoagulation is one of the most common treatments for diabetic retinopathy. Focal photocoagulation consists of a laser directed at the retina to seal living blood vessels in patients with background diabetic retinopathy. Panretinal photocoagulation consists of laser spots scattered through the sides of the retina to reduce abnormal blood vessel growth (neovascularization) and help seal the retina to the back of the eye in patients with proliferative diabetic retinopathy. This can help prevent retinal detachment. There is little recuperation needed after laser surgery for diabetic retinopathy. Laser surgery may require more than one treatment to be effective.

Vitrectomy surgery is scheduled for patients with very advanced proliferative diabetic retinopathy or retinal detachment. In vitrectomy surgery, Dr. Brownlow removes the blood-filled vitreous and replaces it with a clear solution. This allows light to pass through the clear fluid to the retina, where the images are conveyed to the brain.

Pharmacotherapy: Increasingly, a variety of medications are being used to treat the manifestations of background and proliferative diabetic retinopathy. These involve intravitreal injections of small amounts of medication into the eye.

The type of retinopathy, as well as the patient’s general health and eye structure, will determine the kind of treatment needed and the type of anesthesia utilized.

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Macular Edema

Macular edema is caused by damage to retinal capillaries which leads to leakage of blood products into the retina. Large clinical trials have shown that the application of focal laser to areas of retinal swelling can stabilize the vision and reduce the risk of vision loss by 50 percent.

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Vitreous Hemorrhage and Tractional Retinal Detachment

In cases where laser treatment is not successful in preventing hemorrhage into the eye or when a retinal detachment from scar tissue has occurred, a type of surgery called vitrectomy is often helpful. In the operating room, a microsurgical instrument is inserted into the eye, and the blood-stained vitreous is removed and replaced by a clear sterile solution. Fibrous bands which may cause retinal detachment are removed to allow the retina to flatten and return to a more normal configuration. Vitrectomy remains an operation performed only on eyes in which no other treatment is useful. Approximately 60 percent to 70 percent of selected eyes, otherwise hopelessly damaged, can be restored to at least ambulatory vision. Some eyes, however, actually can return to very good vision.

Protecting Your Vision

It is critical for all diabetics to have a comprehensive eye exam at least once a year to evaluate for the presence of retinopathy. Patients should remember that both macular edema and proliferative retinopathy can develop without symptoms. Patients with visual symptoms and/or visual loss, at any stage of the disease, should be evaluated without delay to find out the cause of the visual change. Early detection and timely treatment can prevent vision loss.

Summary

The overall maintenance of health is important in avoiding circulation damage to the brain, heart, kidneys, and eyes. Although perfect solutions are not available for the prevention of visual loss, the outlook for maintenance of useful vision is favorable. Early detection and appropriate therapy can be sight-saving. All diabetics should work to lower their vascular risk factors. Important advice includes:

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Floaters and Light Flashes

What Causes Floaters and Light Flashes?

Most occurrences of floaters or light flashes relate to changes in the jelly-like substance called vitreous which fills the entire back cavity of the eye. The vitreous is transparent and has a solid consistency similar to gelatin. As people grow older, the vitreous undergoes a normal aging process, becoming more liquid and less jelly-like. Often the partially liquefied vitreous will abruptly “collapse” inside the eye causing a shower of floaters to appear. The floaters are aggregates of protein which have formed in the vitreous during the liquefaction process.

When the vitreous collapses, it begins to separate from the retina. The mechanical pull of the vitreous on the retina during this separation causes light flashes. Sometimes during this separation process a retinal tear develops and can lead to a retinal detachment. Often when a retinal tear occurs, at least a small amount of bleeding is present in the vitreous and may be noted by the patient as a multitude of black dots or a hazy decrease in vision.

Floaters

Many people, at some time in their lives, notice floaters in one or both eyes. These are perceived as small spots or strands that seem to drift in the field of vision, traveling rapidly with eye movements and then floating slowly when eye movements cease. Floaters are most readily seen against a bright background such as well illuminated reading material, a computer screen, or bright sky.

Light Flashes

Light flashes may occur in conjunction with floaters or may occur separately. Unlike floaters, light flashes (photopsias) are typically perceived in subdued lighting or even total darkness. Photopsia can range from minimal light twinkles to flashes that are bright enough to suggest a neon sign or camera flash.

Know the Warning Signs

The sudden occurrence of floaters or flashes can be an important warning signal of impending retinal problems. A small percentage of people who develop the abrupt onset of prominent floaters or light flashes in an eye will be found to have a retinal tear on careful ophthalmoscopic examination. Retinal tears can often be treated with laser or freezing methods if a beginning retinal detachment is not present.

Fortunately, the majority of people who experience floaters or light flashes do not develop serious retinal problems. In most instances, the floaters and flashes gradually subside over a period of time with no permanent alteration in vision. Since flashes and floaters can, however, be an important warning of a retinal tear or impending retinal detachment, their sudden appearance is of sufficient concern to warrant careful evaluation by Dr. Brownlow.

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