“Flashes and floaters” are some of the most common complaints from patients. The vitreous gel is composed mostly of water but also has collagen fibers. As we all age, the vitreous gel shrinks which causes these fibers to contract and start pulling on the attached retina. The flashing lights patients complain about usually result from the vitreous gel tugging and pulling on the retina. Because the retina has no pain sensation, we sense flashing rather than pain or pinching as if someone was pulling on our skin. If the vitreous tugging is strong enough, a retinal tear can develop which can then proceed to a retinal detachment. Floaters are these collagen fibers coalescing often in a normal fashion called a PVD. Sometimes though floaters are due to pigment or blood associated with a tear in the retina.
A recent study looked at 8,000 eyes with acute PVD. About 20% of patients had either a retinal tear or a detachment at their initial visit. Interestingly, about 4% of patients had delayed breaks and delayed detachments meaning that the retina was completely normal on initial exam yet had problems a few months later at repeat exams.
We strongly recommend any patient with flashing lights and floaters to come into the office for a dilated retinal exam and retinal photos as soon as possible. Because of the possibility of delayed tears and detachments, 1 or sometimes 2 follow-up appointments are needed.