What are these black spots in my vision?

One of the most common reasons that patients come into my office for an urgent appointment is gray or black spots in their vision. These spots are called floaters and they can range from small black spots that look like pepper flakes or gnats to larger opacities that may resemble a mosquito or a spider web. The floaters may be accompanied by flashes of light or more ominously a loss of part of your side vision.

Most people, even as children or teenagers, will see translucent, gray, fiber-like images in their vision if they look up at a clear blue sky. What you are seeing is the gel that fills up the back 2/3rds of your eyeball, between your lens and your retina. This gel is known as the vitreous humor. When you are born the vitreous is a clear gelatinous mass composed of fine, evenly spaced fibers. As you age the vitreous begins to have subtle changes. The fine fibers began to become coarser and the gel begins to become more liquid-like. Most of the time you won’t notice these changes in your vision until you look at a solid, well-lit background like a white wall or a blue sky.

The more dramatic changes occur when the gel-like vitreous begins to become more and more liquid-like. Eventually, the vitreous gel collapses forward. This is what is known as a posterior vitreous detachment. At this point, the patient notices the sudden onset of significant new floaters in their vision. The detachment of the vitreous membrane from the retina begins in center of the retina and goes toward the periphery of the retina. It is this pulling on the retina by the detaching vitreous that causes the symptoms of flashing lights. The light flashes are a mechanical stimulation of the retinal photoreceptors. With each little movement of the eye the vitreous tugs on the retina until eventually it separates completely. Once there is no more traction the light flashes stop. The floaters remain in the eye but become much less noticeable over time. For the patients that have extremely symptomatic floaters there is a surgery that can be done to remove them. It is called a vitrectomy and is performed by a retinal surgeon. I typically advise patients to wait at least 6 months before deciding to have a vitrectomy done.

A posterior vitreous detachment is a normal part of aging and is a benign condition. The problem that can arise is that the detaching vitreous can tear the retina. A retinal tear can lead to a detached retina which is a condition that can lead to permanent vision loss if not caught and fixed in time. There is often no difference in the symptoms between a vitreous detachment with or without a retinal tear. You need to have a thorough exam of your retina by your eye doctor to determine if you need treatment or not. I recommend being seen within 48 hours of the onset of your symptoms.

A friend of our family was in North Carolina, vacationing in his motor home. He called me from the road and said he was noticing a floater and could he wait to see me when he got home in 2 weeks. Now the odds were that he would be fine. However, I advised him to go ahead and see an eye doctor up there. It turned out that he had a retinal detachment and had emergency surgery to repair it. That doctor saved his eyesight. The moral of the story is if you have new floaters in your vision to please have your eyes checked to avoid any permanent damage to your vision.

Therapy for dry eyes

Amniotic Membrane Grafts

The amniotic membrane is a unique tissue that has innate properties which makes it ideal to assist in wound healing. Innovative technology has made it possible for it to be used in the treatment of many eye diseases that affect the ocular surface. These diseases include severe dry eyes, cornea infections and inflammation. The cornea is the clear outer dome of the eye that allows that light to pass through the eye and be focused on to the retina. When this clear tissue loses its transparency vision is decreased. The amniotic membrane is placed on the eye in your eye doctor’s office similarly to a contact lens. A contact lens is then placed over the membrane and left in place for 3 to 7 days while the membrane dissolves. The contact lens is then removed. This treatment reduces ocular pain and discomfort and decreases the amount of scarring that can occur.

New Technology in Eye Care

Wide Field Imaging

Another technology that is changing the way that eye exams are performed is ultra wide field imaging. Typically, one of the patients least favorite parts of the traditional eye exam is the dilation. The bright lights are uncomfortable and it causes the vision to be blurred for several hours. However, it is important to exam the outside edges of the retina for problems like retinal tears, lesions and vascular abnormalities. Wide field imaging allows for up to 85% of the retina to be captured in a high resolution image in a single photograph. Although, it does not necessarily eliminate the need for dilation it is an excellent substitute for many patients and enables your eye doctor to create a digitally recorded baseline that allows them to easily compare changes over the years.

These and many more advances in technology are allowing your eye doctor to provide better, more efficient and more comfortable health care for you eyes. As a result patients are seeing more clearly and having better outcomes when they develop vision changes and eye diseases

New Developments in Eye Care

Contact Lenses

Contact lenses are worn by over 30 million Americans. They are so common that many patients don’t realize that contact lenses are medical devices that have the potential to cause serious ocular infections if not used properly. Some studies have shown that more than 85% of contact lens wearers are non-compliant with how long they keep their lenses, how often they sterilize or dispose of their contact lens cases and how well they clean their contacts. Enter the breathable daily disposable contact lens. These lenses are thinner and more breathable than traditional contact lenses resulting in better comfort, clearer vision and less eye infections. Breathable daily disposable contact lenses are also available with astigmatism correction and in bifocals. The main concern with daily disposable contact lenses has been price but new technology has reduced the cost and many brands are available at less than a dollar a day.

Ocular Allergies

Eye allergies are one of the most common reason that people visit the eye doctor. Studies estimate that ocular allergies affect 15 to 40% of the population. The characteristic symptoms include itchy, red, watery and swollen eyes. Upper respiratory symptoms such as a runny nose, sneezing and coughing may accompany the ocular symptoms. The two main types of allergies are seasonal and perennial.Eye allergies are on

The yellow pollen dust that starts to cover everything in late February on Merritt Island signals the coming of spring and seasonal allergies. The ubiquitous fairy-dust like pollen that coats even garage-kept cars is pine pollen. Other major tree pollen contributors include oak, cypress and juniper trees. Tree pollen allergy season typically runs from February to April. Grass pollen allergies take off in April and goes through October and ragweed allergies occur from August to November. These are all considered seasonal allergies. Perennial allergies include mold, dust mites and animal dander. These irritants are present year round.

An allergy is an inappropriately exaggerated immune response to a relatively harmless substance. When an allergen, such as pollen, lands on the surface of the eye it is attacked by an immune cell. The immune cell will make an antibody to fight the allergen. If the antibody encounters the allergen again it will activate a cell called a mast cell which start the allergy cascade by sending out a blast of chemicals including the famous histamine. These chemicals are what will produce the itchy, red eyes. Although the medical community understands the process of the allergic response fairly well it is still a mystery as to why only some people have allergies, why childhood allergies can disappear and why some people develop allergies later in life.

There are several available treatment options for people that are affected by ocular allergies. As a first step, I may start my patients on preservative-free artificial tears. Patients that have dry eyes have a higher incidence of ocular allergies due to the fact that there are not enough quality tears to wash the irritant out of the eyes. Artificial tears dilute the concentration of the allergen in the eye. Oral anti-histamine pills may help ocular allergy symptoms in some people but studies have shown that anti-histamine pills do not reach the eye in concentrations comparable to that achieved with eye drop medications. You must also be aware that antihistamine pills can have a drying effect on the eye and indirectly worsen symptoms. Over-the-counter allergy drops provide relief from symptoms by blocking the histamines released by the mast cell. However, they do not have any effect on the other chemicals released. The most common medication that I prescribe for my allergy patients are the newest prescription allergy drops which are both anti-histamines and mast cell stabilizers. These medications block histamines which provides immediate relief but they also work by stabilizing the mast cell. By targeting the mast cell these medications prevent more of the allergy symptoms and provide a longer lasting effect. Steroid eye drops can be used for a short period of time to get effective control of severe cases. I often will begin my patients with the worse symptoms on a steroid eye drop to get effective control of severe cases and then taper them to anti-histamine/mast cell stabilizers. Effective management of allergic eye disease can reduce the symptoms and greatly improve quality of life.