Friday, 1 July 2011

Don’t ignore new onset flashes and floaters

So your vision is good, you are proactive with your eye health and see your Optometrist regularly, but one day all of a sudden you notice some flashes of lights and floaters in your vision.  You have 2 options:
Option 1- Ignore these symptoms because you believe they aren’t serious.
Option 2 - Visit your Optometrist. 

Here’s why you should choose Option 2.

My first concern when patients tell me they have been experiencing flashes and/or floaters is whether they have a retinal tear or detachment. Investigation of the symptoms will most likely include drops that dilate your pupils, as this allows me to view the peripheral retinal where tear often occur. This morning I had a patient with increased floater, and reduced vision, which after examination was diagnosed with a retinal tear.  A referred for surgical consult with a retinal specialist was made as soon as he could get to their office in Calgary, so that a treatment plan could be formed.  Treatment plans for retinal tears and detachments may include laser for smaller tears, insertion of gas or oil bubble into the vitreous cavity or scleral buckle surgery for larger tears, but the key is to have it done in a timely matter which will limit the lost of vision.  If you wait for these symptoms to go away, you risk a poorer vision outcome after treatment is preformed. 

A condition that can cause sudden onset flashes and/or floaters is a posterior vitreous detachment (PVD).  Typically PVD occur after the age of 45 years and frequency increase as we continue to age.  Some studies suggested 15-30% of PVD will go on to retinal tears.  I like to rule out retinal breaks as close to onset of flashes and/or floaters and complete a follow-up 5-6 weeks after symptoms started to ensure that no tears have developed in this period of elevated risk. 

Since my patient picked Option 2, and came to see me within 24 hours of increased symptoms, I was able to diagnose the retinal tear, and have the case reviewed by a retinal specialist within hours.  I am confident the treatment will be successful given short duration between onset and surgery.  

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