With uninterrupted sight being of utmost importance when acquiring targets, Ed Lyons talks ways to combat floaters
One of the most common questions I get asked is what are the causes of and treatment options for ‘floaters’ in the eye. I was recently contacted by a shooter struggling with this exact issue: “I wonder if I can ask a couple of questions to help me decide my options regarding problems I am having with floaters in my right eye?”
Floaters are small shapes that some people see floating in their field of vision. They can be different shapes and sizes and often look different for different people. For some, they can appear as tiny black dots, while others see small, shadowy dots. Some shooters have reported seeing larger, cloud-like spots or long, narrow strands.
The floaters are particularly evident in Trap disciplines. At present I inevitably have a floater at my visual hold point, resulting in a squiggle through the trap mark, or whatever I happen to be using. I have several long, loopy, squiggly thread floaters, which are somewhat annoying but don’t really impinge on my shooting. The most troublesome floater, though, is what I can only describe as a Zeppelin airship in cloaking mode (thinking of Star Trek or Stargate). It is a fat, cigar-shaped cloud that I can see through but that distorts and obscures anything lying behind it.
There are three questions that crop up time and time again; first, do different coloured tints make any difference to experience of floaters? Second, are there any eye exercises or training routines, which can make the visual cortex ignore them more effectively? And third, have you any experience of clients going for laser vitreolysis treatment?
You may have many small floaters in your field of vision or perhaps just one or two larger ones. Most are small and quickly move when you try to look directly at them. This is summed up quite succinctly by Family Guy’s Stewie Griffin:
Squiggly line in my eye fluid, I see you there lurking on the periphery of my vision. But when I try and look at you, you scurry away. Are you shy squiggly line? Why only when I ignore you do you return to the centre of my eye? Oh squiggly line it’s all right. You are forgiven.
Floaters are often most noticeable when you’re looking at a light background such as a bedroom ceiling, white wall or clear sky – the latter being quite irritating when shooting.
The structures in the front of the eye (the cornea and lens) focus rays of light onto the retina. Light bouncing from images around us focuses onto the retina and allows us to see. The light going to the retina passes through the vitreous humour – a jelly-like material made up of 98 per cent water and two per cent collagen that occupies the back two-thirds of the eye.
At birth and during childhood, the vitreous gel is usually totally clear and transparent. Later in life, strands, deposits or liquid pockets very commonly develop within it and each of these strands casts a small shadow onto the surface of the retina. These shadows may be perceived by the individual as eye floaters and their colour usually ranges from light black to grey. As the eye moves from side to side or up and down, these strands, deposits or pockets also shift in position within the eye, making the shadows move and appear to float or undulate.
Floaters can occur as your eyes change with age but can also be secondary to trauma. In most cases, they don’t cause significant problems and don’t require treatment. However, they can be troublesome and serious to varying degrees, and myopes or short-sighted people such as myself are more predisposed to them, as are people who suffer with diabetes.
In rare cases, floaters could be a sign of a retinal tear or retinal detachment – where the retina starts to pull away from the blood vessels that are supplying it with oxygen and nutrients – and these do require urgent attention as they can have sight-threatening consequences if left alone.
Research suggests that presence of either new floaters or flashing lights gives a 14 per cent risk factor for retinal detachment and our local ophthalmology department is very strict on how a symptomatic patient is examined. Undilated fundoscopy (a regular look inside the eye with an ophthalmoscope) or even pupil dilation with one per cent tropicamide is insufficient to rule out any peripheral breaks. An additional drug, 2.5 per cent phenylephrine, must be added, and the examination has to be carried out with a super-wide field lens rather than a standard 90D one.
If someone experiences another episode of new floaters, I would strongly recommend requesting a full dilated retinal exam as it is very easy to miss potentially sight-threatening tears at the periphery of the retina without doing so.
Most eye floaters are caused by normal ageing-related changes within the eye. However, someone with a sudden appearance of eye floaters should be checked by an ophthalmologist as soon as possible to make certain that there is no associated eye abnormality or systemic disease that requires treatment.
A sudden onset of many eye floaters or the forming of those associated with flashing lights could signify a retinal tear that would require treatment to prevent retinal detachment. A curtain or cloud in the vision or a loss of side vision could be a symptom of associated retinal detachment and so should be looked at urgently.
So, what can be done about them?
I have had a few clients over the years who have undergone successful laser vitreolysis for large, vision-obscuring floaters, although some consultants are wary of performing this. Floaters that are too close to the lens or the delicate fovea are generally not targeted due to the possibility of damaging these structures, inducing traumatic cataract in the latter. Typically, a patient may need to undergo the laser process three or four times to break the large floater (and subsequent regroup) up sufficiently for the collagen fibres to be less visible, and there is evidence to suggest that the very fine dispersed debris can sometimes block the drainage meshwork, which then causes the eye pressure to rise, leading to secondary glaucoma.
I have also assessed post-operatively shooters who have opted for full vitrectomy (removal of the vitreous humour and floaters contained within) and while it is a more invasive procedure, the results have generally been excellent. Often, combined crystalline lens removal and pars plana vitrectomy are carried out at the same time, as traumatic secondary cataract will generally occur later if the vitrectomy is carried out alone.
> Tinted lenses
Tint choice is very subjective but the general rule for floaters is to experiment with the darker filtrations as they reduce the amount of incident light entering the eye and therefore reduce the perception of the shadows. We then of course have to balance the effect of the floater reduction versus the ability to see the target.
> Other options
I haven’t seen anyone who has successfully trained the brain to completely ignore them, although one gentleman found hypnosis was of some benefit. If surgery is not wanted and the floaters are particularly bad in the shooting eye, swapping shoulders is of course another option – but this brings its own challenges!