Flashing Lights in Vision: Causes and Treatments

Q: Flashing Lights in Vision: Causes and Treatments

Hello： 1. <br>Macular folds may affect drug penetration. <br>The ophthalmologist's examination indicated that "the retina appears to have no significant issues, and regular follow-up visits are sufficient," so you can be reassured. <br>2. <br>There should be no major impact; just

Flashes of light in the eyes?

Hello, Doctor Gao! I have a series of questions that span issues related to flashes in the eyes, the retina, and the macula.
Recently, the "flashes" have been the most troubling, so I apologize for the number of questions.
I first experienced floaters in April of last year, and after several examinations at various ophthalmology clinics, a thorough dilated examination by a careful doctor revealed that I had a macular fold in my left eye.
Since then, I have had regular OCT dilated examinations, and as of July this year, I was told that "the retina is somewhat thin but intact, the fold remains stable, the optic nerve looks good, and the intraocular pressure is normal," so I was advised to continue monitoring.
However, in August of this year, I discovered "multifocal choroidal neovascularization," and I received an injection of the anti-vascular endothelial growth factor (VEGF) agent "Avastin" in early November.
However, during a follow-up examination, it was found that my sensitivity (effectiveness) to this medication was not good, and my vision had declined.
The doctor mentioned that the macular fold could affect the efficacy of the anti-VEGF treatment and suggested that I see a retinal specialist for surgery to address the macular fold and the neovascularization issue, indicating that I should not waste money on the out-of-pocket "Eylea" injections anymore.

So, my first question is: "Does a macular fold really affect the efficacy of anti-VEGF agents?" Additionally, recently, after doing some simple, non-strenuous, and non-weight-bearing exercise at home, I noticed a new persistent flickering phenomenon in the upper right area of my left eye while driving in the afternoon (previously, I only experienced a white haze when turning my head or blinking).
I was alarmed and immediately returned for a dilated examination, where the ophthalmologist found that "the retina looks fine, and I should continue regular follow-ups," but "this flickering phenomenon cannot be treated." I have read your previous responses, which state that this "flickering phenomenon, like a light bulb about to burn out," is also caused by the traction of the vitreous pulling on the retina.
It can improve after waiting for a period as the vitreous detaches and the traction decreases.

My second question is: "Does doing simple exercise strengthen the traction of the vitreous on the retina, or is there not much correlation?" My third question is: "How long might it take for the vitreous to completely detach and reduce the traction?" My fourth question is: "If I decide to undergo surgery for the macular fold, which requires a vitrectomy and the injection of an isotonic solution, will the floaters potentially disappear? Will the reduction in traction from the vitreous detachment improve the persistent flickering condition?"
Thank you for your patience in listening to my multiple cross-disciplinary questions.
The changes in my left eye's pathological floaters over the past year have caused me significant anxiety, and I often visit psychosomatic clinics.
The recent appearance of flickering in my left eye has been particularly distressing, severely impacting my daily life.

Kunrao Jiaolv de Dashu, 40~49 year old female. Ask Date: 2021/12/05

Dr. Gao Pilin reply Ophthalmology

Hello: 1.
Macular folds may affect drug penetration.
The ophthalmologist's examination indicated that "the retina appears to have no significant issues, and regular follow-up visits are sufficient," so you can be reassured.
2.
There should be no major impact; just avoid vigorous movements.
3.
Not necessarily.
4.
If a vitrectomy completely removes the vitreous gel, then this pulling sensation will naturally disappear.
Even if there are floaters, they will not affect the retina.

Reply Date: 2021/12/05

More Info

Understanding the phenomenon of flashing lights in vision can be quite complex, especially when it intersects with conditions like retinal issues and macular folds. Your concerns are valid, and I appreciate the detailed context you've provided regarding your eye health journey.

Question 1: Do macular folds really affect the efficacy of anti-vascular growth factors?
Yes, macular folds can indeed impact the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) treatments like Avastin and Eylea. The presence of a macular fold can alter the anatomy of the retina and the distribution of the medication, potentially leading to suboptimal treatment outcomes. When the retina is not in its optimal position, it may not respond as well to the medication, which is designed to inhibit abnormal blood vessel growth. This is particularly relevant in cases of choroidal neovascularization, where the structural integrity of the retina plays a crucial role in treatment efficacy. Therefore, addressing the macular fold surgically may improve the overall condition and enhance the effectiveness of subsequent treatments.

Question 2: Can simple exercise lead to increased vitreous traction on the retina?
Generally, light to moderate exercise should not significantly increase vitreous traction on the retina. However, any sudden movements or activities that involve rapid head motion could potentially exacerbate existing vitreous traction, especially if there are pre-existing conditions like vitreous detachment. It’s essential to listen to your body; if you notice that certain movements trigger symptoms like flashing lights, it may be wise to modify your activity level or consult with your ophthalmologist for personalized advice.

Question 3: How long does it take for the vitreous to completely detach and reduce traction?
The timeline for complete vitreous detachment can vary widely among individuals. In many cases, vitreous detachment occurs gradually over several months to years. Once the vitreous has fully detached, the traction on the retina typically decreases, which may lead to a reduction in symptoms like flashing lights. However, the exact duration can depend on individual factors such as age, the presence of myopia (nearsightedness), and overall eye health. Regular follow-ups with your eye care provider are crucial during this period to monitor any changes.

Question 4: Will vitreous surgery alleviate the flashing lights caused by vitreous traction?
If you undergo surgery to address the macular fold, which often involves vitrectomy (removal of the vitreous gel), it is possible that the flashing lights may diminish or resolve. By removing the vitreous, you eliminate the source of traction on the retina, which can lead to a reduction in symptoms associated with vitreous traction, such as flashing lights and floaters. However, it’s important to note that outcomes can vary, and not all patients experience complete relief from symptoms post-surgery. Discussing your expectations and concerns with your retinal specialist before the procedure is essential.

Conclusion
Your experience with flashing lights and the associated anxiety is understandable, especially given the complexity of your condition. It’s crucial to maintain open communication with your healthcare providers and to seek support for your mental well-being as you navigate these challenges. Regular monitoring and appropriate interventions can help manage your symptoms and improve your quality of life. Remember, while the journey may be difficult, advancements in ophthalmic care continue to provide hope and solutions for conditions like yours.

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