Eye Symptoms: Floaters, Flashes, and Macular Degeneration

Floaters and flashes?

Doctor, I have a question: I have had macular degeneration in both eyes for over ten years, and I recently noticed the following symptoms: 1.
In my right eye, there is a curved black line on the right side, along with many black dots and hair-like strands.
In the center, there is a small arc-shaped black dot resembling a swarm of mosquitoes at dusk, and there is an arc line on the left side.
My left eye does not have this phenomenon! On sunny days, when I close my eyes and face a bright light, I can still vaguely see the black dots on the right side and the arc line on the left side! 2.
When I turn my head to the left and then quickly turn back, there is a fleeting circular black shadow (black fog?) in the visual field near the bridge of my nose on the right side; however, there is no such phenomenon when I turn my head to the right.
3.
At night, outdoors, my right eye often experiences flashes of light, sometimes at the edges and sometimes in the surrounding visual field.
When I try to observe with my eyes closed, it seems that there have never been any flashes.
Recently, I went to a hospital associated with a certain entrepreneur for an examination, and the doctor only used a dilating agent and a bright light device, holding a circular lens to examine my retina.
There were no tears or detachment phenomena, and the doctor advised regular check-ups, saying not to worry too much about the floaters! I want to ask...
is this examination really thorough enough? What do the persistent black dots and the black shadow (black fog) when I turn my head indicate? Are these black dots, shadows, and flashes really not serious? Will they never disappear? The arc lines, moving shadows, and black dots have already affected my daily life.

Xiao Qiang, 30~39 year old female. Ask Date: 2008/10/29

Dr. Zhang Yanrui reply Ophthalmology

The examination you underwent is a fundus examination, which is sufficient to identify any issues.
While floaters can be bothersome, they do not affect eye health, so there is no need to worry too much.
However, flashes can be more concerning; if the flashes do not subside, it is advisable to have a follow-up examination in two weeks.
Floaters cannot be improved unless surgery is performed to remove them, but this surgery is not recommended due to the high risks involved.

Reply Date: 2008/10/29

More Info

Based on your description of the symptoms, it appears that you are experiencing a combination of visual disturbances that may be related to your long-standing macular degeneration and possibly other ocular conditions. Let's break down your symptoms and address your concerns.

1. Curved Black Lines and Spots: The presence of a curved black line and multiple black dots in your right eye, especially when looking at bright light, could be indicative of several conditions. One possibility is that these are related to the degeneration of the macula, which can lead to visual distortions known as metamorphopsia. This occurs when the light-sensitive cells in the macula are damaged, causing straight lines to appear wavy or distorted. The small black dots and "hair-like" structures you see could be floaters, which are common and often harmless, but they can be more noticeable in certain lighting conditions.

2. Transient Black Shadows: The fleeting black shadow you observe when quickly turning your head could be a result of the vitreous gel in your eye pulling away from the retina, which can happen with age or due to changes in the vitreous body. This phenomenon is often benign, but if it occurs frequently or is accompanied by other symptoms, it should be monitored closely.

3. Flashes of Light at Night: The flashes of light you experience at night, especially in your right eye, can be concerning. These flashes, known as photopsia, can occur when the vitreous gel pulls on the retina or when there is irritation in the retina itself. While your recent examination showed no retinal tears or detachment, it’s important to keep an eye on these symptoms, as they can sometimes indicate more serious conditions.

4. Importance of Regular Eye Exams: You mentioned that your recent examination involved a basic check of the retina and that the doctor advised regular follow-ups. While this is a good practice, it’s crucial to ensure that comprehensive examinations are performed, especially given your history of macular degeneration. Advanced imaging techniques, such as Optical Coherence Tomography (OCT) or fundus photography, can provide a more detailed view of the retina and help detect subtle changes that may not be visible during a standard examination.

5. Impact on Daily Life: The visual disturbances you are experiencing can understandably affect your quality of life. It’s essential to communicate these impacts to your eye care provider. They may be able to suggest strategies to cope with these symptoms, such as visual aids or specific exercises to help your brain adapt to the changes in your vision.

6. Long-Term Outlook: Regarding your concerns about whether these symptoms will persist or worsen, it’s difficult to predict without ongoing monitoring. Some floaters and visual disturbances may become less noticeable over time, while others may remain. Regular check-ups will help track any changes in your condition and allow for timely interventions if necessary.

In conclusion, while some of your symptoms may be benign, they warrant careful monitoring and possibly further investigation. If you feel that your current eye care provider is not addressing your concerns adequately, it may be beneficial to seek a second opinion from a specialist in retinal diseases or a comprehensive ophthalmologist. They can provide a more thorough evaluation and tailored management plan to help you cope with your symptoms and maintain your vision.

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