Floaters and Retinal Degeneration: A Student's Concerns

Q: Floaters and Retinal Degeneration: A Student's Concerns

Hello Lily： 1. A dilated fundus examination is the same as a fundoscopic examination. 2. Mydriatic agents relax the ciliary muscle, which helps slow the progression of myopia. Other than that, there should be no significant effects. 3. Whether the lights a

Vitreous floaters and retinal degeneration issues?

Hello, doctor.
I am a 20-year-old student with high myopia, with a prescription of -6.50 in my left eye and -9.00 in my right eye.
I started noticing floaters about two years ago (I can hardly see floaters in my right eye, but I can see significant dark shadows in my left eye).
Initially, I didn't think much of it, but over the past year, I've been seeing a doctor every three months.
Regardless of whether I visit a clinic or a large hospital, they only perform dilated fundus examinations and tell me that my retina currently shows no issues, just simple degeneration.
1.
I would like to know why they do not perform a fundus examination? Is a dilated examination sufficient to rule out any problems?
2.
Some doctors have prescribed me dilating drops, and I notice that after using them, the floaters appear blurry, and I don't think about them as much.
However, is it good for me to use them long-term? For example, could there be retinal tears that I am not aware of because of this?
3.
The issue is that even though the doctors say there are no problems, sometimes at night in the dark, I seem to see flashes (just a couple of faint flashes that can only be perceived in the dark).
I feel anxious before going to sleep and hesitate to turn off the lights.
What should I do about this?
4.
Additionally, today when I woke up and stood up, I suddenly saw dozens of black dots flying around (they looked like the rapid movement associated with vitreous detachment), but it seemed to affect both eyes (I didn't feel it for long).
I also felt a bit dizzy, but it went away after a few seconds.
Is this a sign of retinal detachment or some other issue? (I just had a follow-up appointment a few weeks ago, and the dilated examination showed no problems.
Should I go back for another check?)
5.
Sometimes, after walking or running and then stopping, I see a slight black spot that seems to pulse in my vision (it appears to beat with my heartbeat).
After a while, it goes away.
What could this indicate regarding my retina?

lily, 20~29 year old female. Ask Date: 2022/03/21

Dr. Gao Pilin reply Ophthalmology

Hello Lily: 1.
A dilated fundus examination is the same as a fundoscopic examination.
2.
Mydriatic agents relax the ciliary muscle, which helps slow the progression of myopia.
Other than that, there should be no significant effects.
3.
Whether the lights are turned off or not has no relation to the condition of the retina; if the examination showed no issues, you should feel reassured.
4.
It is likely to be floaters, which should not be related to retinal detachment.
They may disappear, so you can continue to observe them.
5.
I am not sure about that; it could be the pulsation of the ocular blood vessels or the floaters moving in sync with your heartbeat.

Reply Date: 2022/03/21

More Info

It's understandable to feel anxious about your vision, especially given your history of high myopia and the symptoms you've been experiencing. Let's break down your concerns one by one.

1. Why are only dilated fundus examinations performed?
Dilated fundus examinations are a standard procedure to assess the health of the retina and the vitreous body. During this examination, the eye doctor uses special drops to widen your pupils, allowing for a better view of the back of your eye. While this method is effective for detecting many retinal issues, it may not always reveal subtle problems like small retinal tears or holes. Some practitioners may also use additional imaging techniques, such as optical coherence tomography (OCT) or fundus photography, to provide a more comprehensive view of the retina. If you feel that your concerns are not being adequately addressed, it’s perfectly reasonable to ask your doctor why certain tests are not being performed or to seek a second opinion.

2. Is long-term use of dilating drops safe?
Using dilating drops can temporarily blur your vision and may make floaters appear less distinct. While this is generally safe, it’s important to communicate any new symptoms or changes in your vision to your eye care provider. If there is a concern about retinal tears or other issues, your doctor may recommend more frequent monitoring or additional tests. It’s crucial to maintain open communication with your healthcare provider about your symptoms and any anxiety you may have regarding your vision.

3. Experiencing flashes of light in the dark:
Seeing flashes of light, especially in low-light conditions, can be concerning. These flashes can be a normal phenomenon related to the vitreous gel pulling on the retina, but they can also indicate more serious issues, such as retinal detachment. If these flashes are new or have increased in frequency, it’s essential to report this to your eye doctor. They may want to perform a thorough examination to rule out any potential problems.

4. Seeing numerous black spots upon waking:
The sudden appearance of multiple floaters or flashes, especially if accompanied by dizziness, can be alarming. While it’s possible that this could be related to the normal aging process of the vitreous, it could also indicate a more serious condition, such as a retinal tear or detachment. Given your history and the recent symptoms, it would be wise to schedule an appointment with your eye doctor for a thorough evaluation, even if your last visit indicated no issues.

5. Seeing black spots during physical activity:
The phenomenon of seeing spots or flashes that seem to correlate with your heartbeat may be related to changes in blood flow or pressure in the eyes during exertion. This could be benign, but it’s essential to discuss this with your eye doctor, especially given your history of high myopia and the recent symptoms you’ve described.

In summary, while many of your symptoms may be related to the normal aging process of the vitreous and are common in individuals with high myopia, it’s crucial to remain vigilant. Regular check-ups with your eye care provider are essential, and don’t hesitate to seek further evaluation if you notice any changes or new symptoms. Your vision is vital, and addressing your concerns proactively is the best approach to maintaining your eye health.

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