Gone in a flash: ‘Floaters’ in field of vision can warn of vision issue

At first, flashes of light or floating debris-like shapes appear in a person’s field of vision. If the condition progresses, a curtain of darkness can be seen as the field of vision narrows.

“I just remember thinking, ‘That’s not good,’ but it was 1 or 2 in the morning, so there was nothing I could do about it then,” said Acton, who had been experiencing flashes of light and ‘floaters’ for years. She was on a work trip in Reno when a spider web-like flash occurred as she rolled over in bed. “When I woke up, I could tell my vision was different.”

As the morning progressed, Acton could see her field of vision narrowing into a curtain-like effect. She quickly sought out a retinal specialist who confirmed the diagnosis: retinal detachment. She was offered the option of undergoing surgery in Reno, which would require her to remain there for recovery.

After discussing risks with her provider, Acton chose to undergo the procedure closer to home. She flew back to the East Coast and sought care at Walter Reed National Military Medical Center in Bethesda, Maryland, where her doctor awaited her arrival.

The National Eye Institute describes the retina as a light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it’s lifted or pulled out of position.

“The most important aspect of retinal detachment is early detection and prevention,” said Dr. David Eliason, an ophthalmologist and deputy director for the Department of Defense/Veterans Affairs Vision Center of Excellence located at Walter Reed.

A common cause for retinal detachment is a hole or small tear in the retina, which allows fluid to pass through and collect behind the retina until it separates from the wall of the eye, Eliason said. If a retinal tear is diagnosed before it becomes a detachment, it can be treated with a simple, low-risk laser procedure.

Nearsightedness, age, family history of retinal issues, and patient history of eye surgery or trauma can increase risk for retinal detachment. Lattice degeneration, a condition of the retina in which portions are particularly weak and prone to tearing, is also a risk factor. In Acton’s case, the detachment was a result of higher than average nearsightedness, caused when the eyeball is slightly longer than average or the cornea is too curved. As the retina is stretched over a larger area, it has a greater chance of tearing, Eliason explained.

Symptoms of retinal detachment include seeing light flashes as well as floaters, which are pieces of tissue that have been torn off the eye wall and float in the clear and thick fluid that fills the eye. According to the NEI, floaters are small, dark shapes that can look like spots, thread-like strands, or squiggly lines, and move as the eyes move. They don’t follow eye movements exactly, usually drifting when eyes stop moving and seeming to dart away when attempts are made to look at them directly.

When Acton began having these symptoms about 10 years ago, before the diagnosis of detached retina, she sought medical help and continued to be monitored for tears or detachment over time. On a few occasions, she underwent laser treatment to prevent retinal tears.

“Because I’ve been myopic my whole life, I’ve stayed on top of my eye health and I’ve educated myself about vision issues,” said Acton, who started wearing glasses at age 6.

Retinal tears and detachment can only be diagnosed through a dilated eye exam. Depending on the severity of the case, treatment can range from laser treatment to surgery, sometimes requiring more than one procedure, said Eliason.

“The sooner a person seeks medical attention for symptoms, the better the outcomes can be for that patient’s vision,” he urged. “The smaller the detachment and the earlier the intervention, the less likely that the patient will require multiple surgeries.”

Once the retina has detached, surgery is necessary to reattach it, but a successful surgery does not guarantee that a patient will regain full vision, said Eliason. If the center of the retina, which is used for 95 percent of vision, becomes detached, permanent loss of function in that eye is likely, he said.

“When the retina has just begun to detach, a difference of hours in delay for treatment can have lifelong consequences,” he said.

In preparation her surgery, Acton had a gas bubble inserted in her eye to hold the retina in place until the detachment-repair surgery could be performed. As part of her surgery, a larger bubble was inserted to help keep the retina in place during the healing process. Movement was restricted, which meant spending two weeks lying on her side for 23 hours a day.

“My vision is back, not 100 percent yet, but my prescription hasn’t settled yet,” said Acton. Now six months post-surgery, she described recovery as successful. After taking the time she needed to heal, she is free to do what she wants again.

“Retinal detachment is not something a lot of people know about, but they may be at risk and there’s a lot at stake,” said Acton, stressing the importance of being aware of the signs and getting an eye exam. “If you see sudden flashes, a lot of sudden floaters, or a curtaining effect in your field of vision, get to your eye doctor ASAP. You can’t let it go, or you’re putting your long-term vision at risk.”