Floaters and Retinal Holes: Expert Insights and Guidance

Q: Floaters and Retinal Holes: Expert Insights and Guidance

Hello Ms. Chen： 1. I apologize for not being able to see it, so I cannot make a judgment. If you truly cannot decide, I recommend getting an examination at a hospital with a retina department. 2. Sometimes, issues at the peripheral areas are harder to detect

Regarding floaters and retinal tears?

Hello Doctor: A few months ago, I discovered floaters in my vision.
During this time, I visited different clinics for dilated eye examinations.
Initially, several doctors said there were no tears, until the last one found a tear at the six o'clock position in the lower part of my right eye, at the very edge.
I would like to ask the doctor:
1.
The doctor who discovered the tear recommended laser treatment.
They took a photo of the tear and showed it to the previous doctor, who said that since there seemed to be some spots forming and it looked like there had been some self-repair, they felt that laser treatment might not be necessary.
Which doctor's advice should I follow?
2.
I have seen many doctors, about one per week, and the tear must have been present for some time.
Why were some doctors unable to detect it? Is it because the retinal tear at the lower edge is difficult to notice? Does this mean I should not rely on a single doctor for examinations in the future? During examinations, can all retinal tears be detected, or are there areas that may go unnoticed?
3.
I wanted to hear more opinions, so I went to a retinal specialist at a large hospital.
That doctor said the tear was somewhat inconspicuous and spoke ambiguously, ultimately saying that if I was concerned, I should go ahead with the treatment.
Does this mean that the tear is not urgent at this moment?
4.
The last doctor I saw was quite busy and scheduled the laser treatment for two weeks later.
However, if the retinal tear is not very urgent, is it necessary to have laser treatment? Should I trust this last doctor? He mentioned, "Because the tear is located at the lower part of the retina, the vitreous will hold it in place, making it less likely to detach compared to if the tear were at the upper part." Is this correct?
5.
After laser treatment, aside from peripheral vision defects, will there be any long-term side effects? I am only 32 years old, and I am worried that undergoing laser treatment might lead to complications like macular folds in the future.
What is your personal recommendation?
6.
I read online that if all individuals with high myopia were dilated for examination, some would have tears without knowing it.
Are there individuals with retinal tears who do not experience floaters or flashes? If so, are those individuals just waiting for retinal detachment? I find this a bit confusing.
I apologize for the many questions; I am truly distressed about whether or not to proceed with laser treatment.
Thank you!

Ms. Chen, 30~39 year old female. Ask Date: 2021/10/24

Dr. Gao Pilin reply Ophthalmology

Hello Ms.
Chen:
1.
I apologize for not being able to see it, so I cannot make a judgment.
If you truly cannot decide, I recommend getting an examination at a hospital with a retina department.
2.
Sometimes, issues at the peripheral areas are harder to detect, which can lead to such situations.
3.
Some holes may not easily lead to complications, but no doctor can guarantee a 100% assurance.
So if you are concerned, it is advisable to proceed with treatment.
4.
I have not conducted an examination, so I apologize for not being able to make a judgment.
5.
Injections in the peripheral areas usually do not cause macular folds.
If you are worried that the holes may lead to further retinal degeneration, I recommend proceeding with the treatment.
6.
Therefore, individuals with high myopia should have regular check-ups even if there are no symptoms, rather than waiting for retinal detachment to occur.

Reply Date: 2021/10/24

More Info

When it comes to understanding floaters and retinal holes, particularly in the context of high myopia, it's essential to grasp the underlying mechanisms and the implications of your symptoms. Floaters, or "muscae volitantes," are tiny spots or strands that drift through your field of vision, often caused by changes in the vitreous gel inside the eye. In individuals with high myopia, the risk of developing retinal issues, including holes and tears, increases due to the elongation of the eyeball and the associated stress on the retina.

1. Consultation and Recommendations: In your case, you have received differing opinions from multiple eye care professionals regarding the necessity of laser treatment for the identified retinal hole. It's crucial to consider the expertise and experience of the doctors involved. If one doctor recommends laser treatment while another suggests monitoring, it may be beneficial to seek a third opinion from a retinal specialist who can provide a comprehensive evaluation. The presence of a retinal hole, especially if it is located at the periphery, can sometimes be less urgent than a hole located in the central retina. However, the risk of progression to a retinal detachment is a significant concern that warrants careful consideration.

2. Detection of Retinal Holes: The difficulty in detecting retinal holes can be attributed to their location and the nature of the examination. Peripheral retinal holes, particularly those located at the lower edge, can be challenging to visualize during a standard examination. This emphasizes the importance of thorough and possibly repeated examinations, especially for individuals with high myopia. A comprehensive dilated fundus examination is essential, but even then, some holes may remain undetected. Therefore, it is advisable to have regular follow-ups with an eye care provider who is experienced in managing high myopia and retinal conditions.

3. Urgency of Treatment: The ambiguity in the urgency of treatment can be frustrating. If a retinal specialist indicates that the hole is not urgent, it may suggest that immediate intervention is not necessary. However, this does not mean that the situation should be ignored. Continuous monitoring is vital, and if symptoms worsen or new symptoms arise, such as an increase in floaters or flashes of light, you should seek immediate medical attention.

4. Laser Treatment Considerations: The statement regarding the location of the hole is accurate; a hole located in the lower retina may be less likely to lead to immediate detachment compared to one located superiorly. However, this does not eliminate the risk entirely. Laser treatment can help to seal the hole and prevent further complications, and while it is generally safe, there are potential risks associated with any surgical procedure. Discussing these risks with your eye care provider can help you make an informed decision.

5. Post-Laser Concerns: After laser treatment, some patients may experience peripheral vision defects, but serious complications such as macular wrinkling are rare. Your age and overall eye health are factors that can influence the outcome. It is essential to weigh the benefits of preventing potential retinal detachment against the risks of the procedure.

6. Asymptomatic Retinal Holes: It is indeed possible for individuals to have retinal holes without experiencing floaters or flashes. This is particularly common in high myopia, where the vitreous gel may not exert enough traction to cause symptoms. Regular eye examinations are crucial for early detection of such conditions, as asymptomatic individuals are at risk for sudden complications.

In conclusion, your situation requires careful monitoring and possibly intervention. It is advisable to maintain open communication with your eye care providers, seek multiple opinions if necessary, and stay vigilant for any changes in your vision. Regular follow-ups are essential in managing your eye health, especially given your history of high myopia and the recent discovery of a retinal hole.

Similar Q&A

Understanding Retinal Holes: Causes, Symptoms, and Treatment Options

1. To determine whether the floaters are caused by residual retinal tear or bleeding, an eye examination by an ophthalmologist is necessary. They may use imaging techniques such as optical coherence tomography (OCT) or a dilated fundus examination to assess the condition of the r...

Dr. Gao Pilin reply Ophthalmology
Hello: 1. A dilated fundus examination will provide the necessary information. 2. Minor bleeding will typically be absorbed within a few days to a few weeks. 3. Since it involves retinal debris, it will not disappear. 4. The action may not necessarily be the cause; the primary re...

Understanding Laser Surgery for Retinal Tears and Post-Operative Symptoms

Hello Doctor, I have been troubled by persistent floaters in my right eye, which has led me to have regular dilated eye examinations. This month, I discovered a small hole in my left eye. I underwent laser surgery yesterday, and after the procedure, I noticed dense red streaks at...

Dr. Gao Pilin reply Ophthalmology
Hello Ms. Hao: 1. There are red streaks in the area of the retinal hole, and it may be necessary to consult your attending physician, as this cannot be determined without further evaluation. 2. If the entire optical system of the eye cannot focus the image, it may lead to double...

Understanding Retinal Issues: Insights on Holes and Laser Treatment

Hello, Doctor. I previously inquired about the issue of floaters, and to be cautious, I went to a clinic today to check the condition of my retina. The clinic used a non-dilated ultra-widefield fundus camera (200 degrees) to take images and found a black spot at the 10 o'clo...

Dr. Gao Pilin reply Ophthalmology
Hello Kelvin: It's hard to say for sure, and I cannot make a judgment out of thin air. If you are unable to trust the information, it would be best to find time to visit a hospital with a retina department and have a retina specialist examine you; this should provide you wit...

Understanding Retinal Issues: Floaters and Related Symptoms Explained

Hello Doctor, I started experiencing symptoms of Retinitis Pigmentosa (RP) this year, such as photophobia and difficulty adapting to changes in light. A few months before the onset of these symptoms, I suddenly developed floaters in both eyes. The range of the transparent and clo...

Dr. Gao Pilin reply Ophthalmology
Hello: Regarding floaters, this is a symptom characterized by the perception of small spots or debris floating in the field of vision, typically associated with tiny particles in the vitreous gel or remnants of blood vessels within the eye. Generally, floaters are not directly re...