Floaters: what are they, how do you prevent them and treat them?

 

Vitreous Floaters: Pathophysiology, Molecules, and Evidence

Level / Process	Key Mechanism	Main Molecules / Elements	What Happens	Key PubMed Sources
Normal vitreous scaffold	Collagen–GAG network maintains transparency	Collagen II, IX, XI; hyaluronan; proteoglycans; chondroitin sulfate	Fine collagen fibrils stabilized by GAGs create a clear gel matrix	Scott JE. Eye. 1987;1:641–653. Sebag J. Vitreous Biochemistry (textbook)
Age‑related liquefaction (synchysis)	Collagen aggregation + HA mobility → phase separation	Collagen fibrils, hyaluronan, proteoglycans	Collagen bundles and liquid pockets form floaters	Sebag J. Graefes Arch Clin Exp Ophthalmol. 1987;225:89–93.
Posterior vitreous detachment (PVD)	Vitreoretinal adhesion failure	Collagen, laminin, fibronectin, integrins	Posterior hyaloid collapses → Weiss ring / sheets	AAO Vitreous Chapters
Enzymatic/structural degradation	Loss of macromolecular integrity	Hyaluronan, chondroitin sulfate, collagen	Enzymatic digestion reduces stiffness and clarity	Filas BA et al. Invest Ophthalmol Vis Sci. 2014;55:55–63.
Oxidative stress & glycation	ROS + AGEs damage collagen	ROS, AGEs, glucose, ascorbic acid	Cross‑linking and fragmentation accelerate degeneration	Beebe DC, Shui YB. Prog Retin Eye Res. 2011;30:280–292.
Inflammatory floaters	Cellular/protein debris in vitreous	Inflammatory cells, fibrin, cytokines	Uveitis/infection produces dense opacities	Skowronek & Święch. Ophthalmol Ther.
Hemorrhagic floaters	Blood products in vitreous	Erythrocytes, hemoglobin, fibrin	Trauma/tears cause dense floaters	Skowronek & Święch. Ophthalmol Ther.
Myopic & post‑surgical changes	Axial elongation + surgical disruption	Collagen network, hyaluronan	Accelerated liquefaction and PVD	AAO EyeNet; Retina Today reviews