Hiking in Peru, Lucy Schoonhoven realised with some alarm that she couldn’t make out the sides of the mountain path she was walking on.
‘I felt unsafe,’ she recalls. ‘I couldn’t see the edges because every time I looked down, it was like I had a mass of cloudy seaweed in front of my eyes.’
The vision problem wasn’t new. Lucy had started getting a few ‘floaters’ – small dots or strands that drifted across her vision – in her late 40s.
But the 59-year-old gardener says: ‘Once I hit 50 they increased a lot over a short space of time and it was like I had Vaseline on my eyes all the time.’
Floaters are a natural consequence of ageing. As we get older, the vitreous gel – the jelly-like substance inside the eyeball – becomes more liquid, allowing strands of collagen (protein fibres in the gel) to clump together.
These clumps then break away and float around in the main body of the gel.
This debris is what we see as floaters when they cast shadows on the retina – the area at the back of the eye that converts light into visual signals sent to the brain to produce sight.
‘This process happens in everyone’s eyes and can’t be prevented,’ explains Mahi Muqit, a consultant ophthalmic surgeon at Moorfields Eye Hospital in London and spokesman for the Royal College of Ophthalmologists. Generally, they’re not a problem. Most people will get some floaters between their late 30s and their 50s, but the brain can usually shut off the signals from their shadows effectively, so we don’t notice them, he explains.
Lucy Schoonhoven started getting a few ‘floaters’ – small dots or strands that drifted across her vision – in her late 40s
But they can become debilitating. As Louisa Wickham, a consultant vitreoretinal surgeon and medical director at Moorfields, explains: ‘For some, the floaters can be very large or form large sheets which can be described as like a smoke screen, spider’s web or lace curtain.
‘In these cases, the floaters can sometimes sit centrally in a person’s vision, making it difficult to drive, read or use a computer.’
Floaters can also affect the ability to see contrast – for example, being able to distinguish between two shades of the same colour.
For Lucy, a mother-of-two who lives in Fulham, west London, with her husband Julius, 54, a clock conservator, having permanent floaters was ‘incredibly demoralising and exhausting’.
In the years leading up to the Peru trip in November 2023, Lucy says she’d gone from being an ‘incredibly positive’ person to constantly feeling low.
That day on the mountain was ‘the final straw’.
It meant hiking was yet another of the things she loved that she felt was being taken away.
She’d already changed her job in 2020 due to the floaters, having been a book conservator working with rare or historical books and manuscripts.
Floaters are a natural consequence of ageing. As we get older, vitreous gel – the jelly-like substance inside the eyeball – becomes more liquid, allowing collagen to clump together
She explains: ‘It involved a lot of close-up work which made me very tired as my brain was working extra hard to get my eyes to focus with the floaters. So I became a gardener, something I’d always done as a side line.’
By late 2023, Lucy says she was struggling to read for any length of time, adding: ‘I also didn’t have the confidence to drive at night because the headlights hitting my floaters made it hard to see.
‘I was only 56 and I wasn’t sure if I could carry on living the life I’d been accustomed to with these eyes. I felt so low and miserable.’
Lucy is not alone in this. A paper published in the journal International Ophthalmology in 2024 found that people who had floaters experienced a significantly higher incidence of depression and anxiety than people who don’t have them.
While small floaters that have been present a long time or don’t have an impact on daily life are fine to ignore, a sudden increase is alarming and should always be investigated, says Mr Muqit.
Your first port of call should be an optician, who can do an optical coherence tomography scan (OCT), which takes an image of the retina and vitreous gel.
Floaters appearing suddenly can be a sign of inflammation or bleeding in the eye, Ms Wickham says. For this reason, people with diabetes can be more prone to floaters because advanced cases of the disease can affect blood vessels in the eye.
They’re also more common among the very short-sighted, who may get them earlier – ‘often in their 20s or 30 because their eyes are slightly longer, which means they have a larger volume of vitreous gel inside the eye, which can lead to it breaking down sooner’, adds Mr Muqit.
Meanwhile, lots of floaters that suddenly occur at the same time as flashing lights always need urgent attention.
While this could indicate a posterior vitreous detachment (when the vitreous gel has become so liquefied with age that it separates from the retina, which is usually harmless), it is important to rule out retinal tears and treat them as an emergency before they lead to a retinal detachment, says Paulo-Eduardo Stanga, a professor of ophthalmology at University College London and founder and chief medical officer of The Retina Clinic in London.
‘As the gel separates, floaters can be released due to the movement and the act of separation can excite the retina, causing flashing lights,’ explains Ms Wickham.
Although a vitreous detachment usually settles with time, a retinal tear requires urgent laser treatment and a retinal detachment requires urgent surgery, otherwise it can lead to permanent sight loss.
However, treatment is also available for floaters that aren’t strictly speaking a medical risk but are causing someone significant distress.
Unfortunately, many patients aren’t told about this – or are told there’s nothing that can be done and they need to get used to them, says Professor Stanga.
‘Surgery known as a vitrectomy is the gold-standard treatment,’ Mr Muqit says.
Done under local anaesthetic, it involves removing around 95 per cent of the vitreous gel through micro-incisions on the eyeball, which also removes the floaters. It takes 30 minutes in each eye.
‘The vitreous cavity is immediately filled up with clear aqueous fluid from the front of the eye,’ he says. New floaters won’t form as this new fluid does not contain collagen, unlike the vitreous gel.
Usually, vitrectomies are done privately, but they are offered in small numbers on the NHS for people who are severely impacted by floaters, says Mr Muqit.
‘They should be offered more on the NHS, but only if and when the NHS can cope with more urgent eye issues, which it can’t,’ adds Professor Stanga.
Treatment using an yttrium-aluminium-garnet laser – or YAG laser – is also available privately (at a cost of £900 or more). This uses laser energy to break up the collagen clumps that cause floaters. More than one round of treatment is often required.
‘However, there are no large-scale studies to show the efficacy or the safety of laser treatments, so they are not offered on the NHS,’ says Ms Wickham.
After that worrying moment on the mountain, Lucy went to see a retinal surgeon privately. She first saw him in 2020 after her optometrist recommended it when the floaters got worse.
At the time, when she was still able to read and carry on largely as normal, she felt too squeamish and nervous about the procedure to have it done.
However, in January 2024 Lucy had a vitrectomy in each eye, four weeks apart, as well as cataract surgery. She was advised to have both procedures done at once as a common side-effect of floater surgery is the risk of exacerbating cataracts, which is when the lens of the eye becomes cloudy, causing blurred vision.
The treatment cost her £27,000 – as Lucy explains: ‘My private health insurance covered a small amount but it was largely self-funded – I felt I had to use inheritance money I’d received to pay the rest because the floaters were ruining my life.
‘The recovery took a few weeks and involved using eye drops to dilate my pupils, which made everything blurry, but once I could stop using them as much, my eyesight was amazing.’
Dilating the pupils puts the eye at rest and reduces the risk of inflammation. She adds: ‘Now I can read and drive at night, I’m able to go hiking and travelling – I feel like I’m 35 again.
‘I had naively always taken for granted that I’d be able to do the things I love until old age, so I was shocked when my eyes became so debilitating in my 50s.
‘I don’t know what state I’d be in if I hadn’t had the surgery when I did.’
