Flashes and Floaters in Jacksonville, Florida
Floaters and flashes are usually the ordinary result of the vitreous gel separating from the retina with age. Usually — but not always. About one in ten people with a sudden new onset turns out to have a retinal tear, and a tear found early is a fifteen-minute laser treatment instead of an operation. That is the whole reason to get it looked at.
What floaters actually are
The inside of the eye is filled with vitreous, a clear gel. With age the gel liquefies and shrinks, and eventually peels away from the retina at the back of the eye. This is a posterior vitreous detachment, and it is a normal event, not a disease. Most people go through it, usually in their fifties or sixties, earlier if they are nearsighted or have had cataract surgery.
As the gel pulls away it clumps and casts shadows on the retina. Those shadows are what you see drifting across your vision — specks, threads, cobwebs, or a ring. They move when your eye moves and drift on when it stops. They are most obvious against a bright plain background: a white wall, a page, the sky.
Why flashes happen
The retina cannot feel pulling; it can only report light. So when the separating gel tugs on it, the retina does the only thing it can do and sends a flash. Flashes are typically brief arcs at the edge of vision, more noticeable in a dark room or when you move your eyes quickly.
Flashes from a vitreous detachment are different from a migraine aura, which usually builds over ten to thirty minutes, affects both eyes, and often has a shimmering or zigzag quality. If you are unsure which you are having, get it checked.
The part that matters: when there is a tear underneath
As the gel separates it can pull hard enough in one spot to tear the retina. Roughly 1 in 10 people examined for a sudden new posterior vitreous detachment are found to have a retinal tear — published series range from about 5 to 15 percent depending on how patients were referred. If there is blood in the vitreous as well, the odds are far higher, in the range of 50 to 70 percent.
A tear is not a detachment yet. Sealed with laser in the office, it usually never becomes one. Left alone, fluid can pass through it and lift the retina, and then it is an operating-room repair with a much longer recovery and less certain vision. More about retinal detachment and retinal tears.
There is a second point that used to be underappreciated. A tear can appear later, after an initially normal examination — about 2 to 3 percent in the first weeks, and higher over the following years. More than half of those delayed tears show up after the traditional six-week recheck. Which means a clean exam today is genuinely reassuring about today, and is not a permanent guarantee. If your symptoms change, you need to be looked at again.
When to be seen
New flashes or new floaters warrant a prompt dilated examination. In most cases a visit to your regular eye doctor is enough to establish whether there is a tear, and that is a perfectly reasonable first step. What is not reasonable is waiting to see whether it settles down.
These warrant urgent attention:
- A sudden shower of floaters, or what looks like soot or pepper
- A shadow, curtain, or dark area moving across your vision
- A sudden drop in vision
- Flashes that are new, frequent, or worsening
Any of those, call us at (904) 666-5050. We see urgent cases within 24 hours.
What we do at the visit
The examination is a dilated one, using a lens at the slit lamp and indirect ophthalmoscopy with scleral depression to see right out to the far edge of the retina, where tears usually are. We also image the eye in our office the same visit — optical coherence tomography and ultra-widefield fundus photography — which gives us a baseline to compare against if your symptoms change later. More about our imaging and diagnostic testing.
If a tear is found, we treat it the same day with laser retinopexy.
Living with floaters that are not dangerous
Most floaters, once a tear has been ruled out, are a nuisance rather than a threat. What to expect is this: they rarely disappear entirely, but they usually become much less noticeable over several months. Some of that is the floater settling out of the line of sight, and a great deal of it is the brain learning to ignore it — a real phenomenon called neuroadaptation, and the reason most people stop noticing floaters they were once tormented by.
Treatment for floaters — where we stand
Observation
The right answer for the large majority of patients, and not a brush-off. Time and neuroadaptation do most of the work.
Vitrectomy for floaters
Vitrectomy removes the vitreous gel and the floaters with it. It reliably relieves the symptom — published series report satisfaction rates above 90 percent — but it is real intraocular surgery for a symptom that is not sight-threatening, and that trade-off deserves care.
Our position: we consider floater-only vitrectomy for patients whose symptoms are prolonged, have not resolved, and are genuinely interfering with daily life. Outside of that, we discourage it.
The reasons are in the numbers. A systematic review pooling 18 studies and 2,077 eyes found cataract in about 32 percent of cases, retinal tear in about 2.9 percent, retinal detachment in about 1.5 percent, and endophthalmitis — infection inside the eye — in about 0.18 percent. In patients over 50 who still have their natural lens, cataract after vitrectomy is closer to the rule than the exception. And there has never been a randomised controlled trial of vitrectomy for floaters; the entire evidence base is uncontrolled case series.
None of that makes it the wrong operation for the right patient. It makes it a decision to take deliberately, with the numbers in front of you.
YAG laser vitreolysis
A laser aimed at breaking up a floater. The evidence is thin — a small number of short-term randomised studies, mostly in patients with a single Weiss ring, with mixed results. It is not established for diffuse or multiple floaters. We do not think the current evidence supports offering it as a routine solution.
Questions patients ask
Will my floaters go away?
They usually become far less noticeable within a few months, partly because they settle and largely because your brain stops reporting them. Complete disappearance is less common. Most people who were distressed at week one are not thinking about it by month six.
Is it dangerous to have floaters?
The floaters themselves are not. What matters is whether a retinal tear caused them, and that is answered by one dilated examination.
I have had floaters for years. Do I need to be seen?
Long-standing, unchanged floaters are not urgent. A sudden increase, new flashes, or a shadow in your vision changes that immediately.
Can eye drops or supplements dissolve floaters?
No. Nothing taken by mouth or applied as a drop has been shown to clear vitreous floaters. Products sold on that claim are not supported by evidence.
I was told my exam was normal, but I have new symptoms now. Should I come back?
Yes. A tear can appear weeks or months after a normal examination, and more than half of delayed tears are found after the standard six-week recheck. A previous clean exam does not cover new symptoms.
Getting seen
We accept urgent referrals and see urgent cases within 24 hours. Call (904) 666-5050. Our office is open 8:00 am to 5:00 pm, Monday to Friday, at 3627 University Blvd S, Suite 605, Jacksonville, FL 32216. Our staff speak English, Arabic, and French.
Dr. Elkeeb operates at HCA Florida Memorial Hospital and Baptist Medical Center Jacksonville.
Referring physicians and optometrists: our referral information is here.
Sources: American Academy of Ophthalmology, Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern; prospective PVD referral cohort, Eye 2023; delayed retinal tears after acute PVD, Ophthalmology Retina 2023; systematic review and meta-analysis of pars plana vitrectomy for symptomatic floaters, Ophthalmology and Therapy 2022.
This page is general information about a medical condition and is not a substitute for examination and advice from your own physician. Do not start, stop, or change any medication based on what you read here.