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Flashes and floaters

By Alen Sulzbacher [email protected]

Dr. Sulzbacher is a consultant eye specialist. He trained in Germany and is now working at Lisbon´s biggest eye hospital.

Flashes of light or black floaters that look like spiders or tadpoles are quite commonly seen by people with normal eyes. They occur because of changes in the vitreous jelly, which lies directly in front of the retina. Any changes in the vitreous jelly can give rise to the appearance of floaters but do not  usually lead to any serious problems. Therefore no treatment is necessary.

Separation, or detachment of the vitreous from the retina, is a common phenomenon particularly in people over 50 years of age. In 90 per cent of patients, this is an entirely innocent change with no damage to the retina. Vitreous detachment is a once in a lifetime event and the vitreous cannot become re-attached. Often the floaters will persist but become less noticeable with time.

Flashes and floaters usually remain the same or get better. If they are troublesome, the effect of floaters may be minimised by wearing dark glasses. This will help, especially in bright sunlight or when looking at a brightly lit surface.

The situation is entirely different should you see flashes or floaters in connection with a black shadow or a curtain effect, that interferes with your vision. These changes could indicate a detachment of the retina. Detachment of the retina and changes in the vitreous can be connected.

The retina is the crucial part at the back of the eye, where the actual physical process of vision takes place. For visual acuity, the integrity of all parts of the retina, particularly though of the central parts, is crucial.

When I worked as a casualty doctor, these flashes and floaters often presented a tricky problem because the symptoms of those harmless changes in the vitreous and those of a detachment of the retina are pretty much the same, only that the latter could leave the patient blind in the affected eye. The diagnosis can only be made with a thorough eye examination after dilating the pupil to be able to inspect the retina in its full extension. I always felt this should be left in the hands of a specialist eye doctor (ophthalmologist). As casualty officer you have no choice and we did our best not to miss anything. If I was not 100 per cent certain, I always referred on to the eye department. There is no point taking any risks when it comes to the precious eyes.

Now that I am a fully trained ophthalmologist with many years of experience, I value the availability of modern technology, in this case particularly the ultrasound for the eye. Most important though is the practical experience you gather during the years of training with experienced colleagues.

I am often asked by GPs how to differentiate safely between a floater and retinal detachment. My honest answer is “by sending the patient to an eye specialist”.

Advances in Ophthalmology

There are quite a few exciting new developments:

The examination of the back of the eye, which is a crucial test for every diabetic patient can now be done with the retina camera. This fantastic piece of equipment takes photographs of the retina without even having to dilate the pupil. This is very convenient for the patient. These photos can then be stored for comparison at a later stage. Patients with diabetes and high blood pressure should have a thorough eye check every year, including the retinal camera.

Macular degeneration, which is a common reason for deterioration of visual acuity that can lead to blindness had no treatment for many years. There are now new drugs that can be injected into the affected areas. These treatments show promising results.

Cataracts can now be removed with very sophisticated surgical techniques. These procedures are only minimally invasive and can be done as day surgery under local anaesthetic.

Laser surgery for short sightedness can be done in various fashions. A safe way of doing it is by ‘LASIK’. If you consider any of these treatments make sure that you get good impartial advice from an eye specialist. I advise strongly against ‘eye surgery at the shopping centre’.

With regards to Laser surgery, make sure that the centre you go to has a lot of experience with the operation and that the latest equipment is being used.

And last but not least, my tip for the coming hay fever and summer season. Protect those precious eyes from the pollen, dust and radiation. Always use good quality sunglasses. The boot market is not the place where you should buy them. Go to a good optician and make the most of their skill to find the best glasses for you.

Your Dr. Alen Sulzbacher, Consultant Eye Surgeon

Dr. Sulzbacher is available twice a week at the Vale do Lobo Medical Centre. Tel 289 398 009.