Should I be worried if I’m seeing spots?

Ever had spots, specks, or cobweb-like lines float across your field of vision—only to drift away when you shift your eyes to focus on them? Maybe you notice them more when you’re looking at a plain background, such as a computer screen, white sheet of paper, or a clear sky.

These so-called "floaters" are common. They can also be distracting and downright annoying. The good news, however, is that they’re usually not cause for concern, according to Jay Thompson, MD, an ophthalmologist in Ladson, South Carolina.

"Floaters can appear at any point in life," Dr. Thompson points out. But your odds of seeing these darting dots and lines increase as you get older, he adds.

Over time, usually starting around 50 years of age, the eye’s vitreous humor—a gel that fills up the space between the lens and the retina—shrinks. It can also become thinner, Thompson explains. "When you age, your vitreous humor jelly undergoes a liquification—known technically as vitreous syneresis—and that is the cause of many floaters," he says.

Floaters are actually small clumps of fiber or protein inside the vitreous humor. When floaters appear, you are actually seeing the shadows that these clumps cast on your retina, or the lining on the back of your eye that receives light from your lens, Thompson explains.

When the aging vitreous starts to liquefy and pulls on the retina, it can also produce a fleeting flash of light, Thompson notes. Like their floating counterparts, occasional flashes don’t typically require treatment, he adds.

One important distinction: Some people see flashes before the onset of a migraine (migraine with aura). In these cases, however, the source of the phenomenon is the brain, not the retina.

Other risk factors for floaters

Getting older isn’t the only reason why floaters may appear. Some people are at higher risk than others, including those who:

• Have myopia, or are nearsighted and need glasses to see at a distance
• Have had cataract surgery
• Have had an eye injury
• Have had an eye infection or inflammation (swelling)

When to see your healthcare provider

It’s true that most floaters aren’t anything to worry about. But there are some symptoms you shouldn’t ignore because they could signal a more serious problem. It’s important to see an ophthalmologist right away if you:

• Experience a sudden or significant increase in floaters or flashes
• See flashes of light in either eye or both eyes
• Lose peripheral or side vision, or part of your vision appears dark or shaded

"If you have one little black dot that hasn’t gotten worse, it is likely not a cause for concern, but a whole swarm of new floaters is a little more concerning," Thompson says.

A sudden increase in floaters with light flashes or side-vision loss may suggest retinal detachment, a vision-threatening condition, Thompson advises. This occurs when any part of your retina is pulled away from its normal position at the back wall of your eye. If not treated quickly, a retinal detachment can lead to permanent vision loss in the affected eye.

An influx of eye floaters can also be a sign of diabetic retinopathy, a complication of diabetes that occurs when high blood sugar levels damage the blood vessels in the retina. In advanced cases, your retina starts growing new blood vessels that can bleed into the vitreous humor and hinder vision. In these situations, blood can be the source of the floater, according to Thompson.

"We need to make sure there is not a tear in the retina, retinal detachment or progressive diabetic retinopathy that has led to bleeding," he says.

When floaters require treatment

If you are experiencing any worrisome new or worsening symptoms, make an appointment with an ophthalmologist. These doctors are specially trained to diagnose and treat disease and conditions that affect the eyes and vision. A dilated eye exam, which widens your pupils, will help determine what is causing your symptoms.

If you have an underlying health issue that is causing your floaters, like diabetic retinopathy, it’s important to get treatment right away to prevent scarring. Treatment for diabetic retinopathy may include injectable medicine, laser treatment or surgery.

Diabetic retinopathy also increases the risk for retinal detachment, which can lead to permanent vision loss. Retinal detachment can also occur due to aging or eye injury. The retina tears before it detaches, Thompson points out, noting that prompt treatment can help preserve vision.

"If you catch it early when it’s a tear, it can be fixed with a laser in the office," he says. In some cases, Thompson adds, surgery to remove the vitreous can stave off a retinal detachment.

When quality of life is affected

There is no treatment needed for run-of-the-mill floaters, Thompson says. "If there isn’t any retinal pathology or bleeding, you learn to live with them and they will become less noticeable with time," he says.

But what happens if you have really big and bothersome floaters that are otherwise harmless? A Weiss ring, for example, is a large floater that occurs when the vitreous gel shrinks and detaches from your optic nerve. Like the name suggests, a Weiss ring casts a ring-shaped floater.

If your floaters are really taking a toll on your quality of life, there may be some treatment options, Thompson notes. "If you have tons of floaters that make you crazy or a large floater, surgery can be considered, but this is typically reserved for extreme cases," he says.

Vitrectomy is a surgical procedure used to treat problems involving the retina and vitreous. An ophthalmologist removes some or all of the vitreous from the middle of the eye, repairs the eye problem, and then replaces the vitreous with saline, a gas bubble, or silicone oil.

Laser treatment known as YAG vitreolysis is also approved for floaters. The YAG laser breaks up the floaters into smaller pieces by using a well-controlled high energy plasma. "This is controversial as it may increase your risk for a tear in the retina," Thompson cautions.

There is some evidence that YAG vitreolysis may be a safe option, but studies have had notable limitations—they have been small and have had short follow-up periods. More research is needed to assess the procedure’s long-term risks and outcomes.

If you are concerned about floaters or flashes, make an appointment with your doctor to get an accurate diagnosis and learn more about treatment options that may be appropriate for you.

Don’t neglect your eye health

Having routine eye exams is key for protecting your eye health and preventing vision loss. An ophthalmologist can help determine your risk for serious issues, including retinal detachment. And if you ever develop a problem, you’ll already have a relationship with an eye specialist who can help treat or manage your condition.

The American Academy of Ophthalmology recommends adults younger than 40 years old without risk factors for eye disease get one comprehensive eye exam in your 20s, and two in your 30s. Every adult should have a complete exam at age 40. By the age of 65, adults should get a comprehensive eye exam once per year or every other year.

People with certain risk factors may need eye exams earlier and more often. For example, those of African American, Hispanic, or Asian descent are at higher risk for eye diseases such as glaucoma, and may need more frequent screenings.

If you have risk factors for conditions that can affect your eyes or your vision, such as high blood pressure or diabetes, you may also need to have your eyes examined more often. For example, according the American Diabetes Association:

• People with type 1 diabetes should be examined by an ophthalmologist within five years of being diagnosed.
• Those with type 2 diabetes should have an exam shortly after diagnosis.
• After the first exam, people with either type of diabetes should be examined once yearly.

Other people who may need earlier, more frequent eye exams include those who wear contacts, have a family history of eye disease, or have an eye injury or infection.