Floaters

by Glen Swartwout

 

Factor Prevention Risk
Diet whole, natural foods refined, processed & junk food
Specific Foods fresh fruits (raw, well chewed pineapple, apple, pear, orange), vegetables (raw, well chewed carrot, spinach), preferably local organic produce, small cold water fish, almonds, sunflower seeds, soy (unless sensitive) plain yogurt with L. bifidus (Friendly Flora), garlic (Garlic Oil), whole grains, fresh juices avoid meat, poultry, dairy, eggs and most nuts, as well as nightshades. Also avoid excess salt.
Vitamins A, beta carotene, B6 (in Star Gold), C & bioflavonoids (Triple Ascorbate C & Ginkgo Q), E (succinate as in Natural Dry E400 or undiluted mixed tocopherol in Unique E) stress (Stamina Plus), alcohol, caffeine, chocolate, sugar and smoking deplete nutrients (take Energessence to help ease elimination of caffeine or chocolate; take Chromium with any sugar exposure)
Minerals Calcium (Structural Integrity), Chromium (picolinate, aspartate or polynicotinate), Manganese, Selenium (monomethionine), Vanadium, Zinc (e.g. picolinate) in bioavailable forms, plus Copper if deficient Cadmium, Lead, Mercury: coffee methylates Mercury making it 1000 times more toxic; Vanadium, Iron or Copper in excess
Body Chemistry Give natural support to antioxidants (e.g. SOD), liver metabolism, sugar regulation, digestion, elimination
“Just say no to drugs”
Fluids 4 ounces of water every half hour (at least 30 minutes before meal & 2 hrs after) (Microwater or Coral Calcium), perspiration excess or deficient fluids, caffeine, alcohol, carbonated beverages, undiluted fruit juice
Herbs Emphasize herbs high in bioflavonoids such as Quercetin (red onion), Ginkgo, Pycnogenol (pine bark or grape seed), Rutin, Bilberry. Also used are Hsiao Yao Wan (bupleurum, peony, dong quai, atractylodes, poria, ginger and licorice), horsetail, dandelion and milk thistle. Also Evening Primrose Oil (especially in diabetics). Herbal parasite (Silver & Clove, Diatoms), candida (Kolorex or SF722), liver (Pycnogenol Plus or Maxogenol, plus Yucca) and colon cleanse programs
Homeopathy Consider: Arnica, Gelsemium, Hamamelis, Kali I., Merc. i. f., Phosphorus, Seneg., Staphysagria, Sulphur. Protomer or homeopathic Merc. sol. for removing Mercury; Heavy Antitox for heavy metals
Light Color therapy, full spectrum lighting (Ott lights) Artificial light, excess or deficient UV, sun exposure without adequate vision correction
Exercise Vision Training (Neuro-Fitness Training), swim, rebound, walk Sedentary lifestyle; contact sports
Stress and Circulation Stress reducing lenses (Performance Lenses if not wearing glasses), visual hygiene lack of eye movement in reading (Pursuit Reading NFT activity), TV, driving (shift vision to dash & mirrors)
Attitude Relax and smile! Muscle tension


Floaters:

“Out, Out, Damned Spot!”

Floaters are usually caused by changes in the clarity of the vitreous humour, a jelly-like connective tissue which fills the back 2/3 of the eye. Such changes can be caused by deposition within the tissue, dissolution of the tissue, bleeding into the vitreous, or even normal structures within the eye. These changes cast shadows on the retina that move as though floating in water, because of the gelatinous movement of the vitreous in which they are imbedded. Floaters are often more noticeable in bright light and against a plain background such as paper or the sky. This is because in such bright illumination the pupil constricts, and the shadow cast on the retina becomes darker and more focused. This can be quite annoying, for example when trying to read, and certain types of floaters can be cause for serious health concerns as well.

“Normal” Floaters

The typical floater is called muscae voluntantis, and is thought of by most eye doctors as physiological. In other words, it is not considered a pathology or disease. It is caused by the shadow of a “ghost” blood vessel, the hyaline artery, which carries blood to feed the growing fetal lens of the eye before birth. The empty vascular structure remains in the vitreous throughout life, but can become optically more dense, casting an annoying shadow on the retina that moves with eye movement. This shadow can become more dense with factors like food allergies, and congestion in the colon and liver areas. Avoidance of allergenic and congestive foods, particularly dairy products, can improve symptoms sometimes within a week. In some cases, as with other symptoms related to food sensitivities, symptoms may get initially worse for up to 3 days, as the body begins to detoxify and eliminate built up deposits in the tissues.

Vitreous Detachment

Another common type of floater is caused by detatchment of the vitreous from its connective tissue link to the optic nerve head. As the vitreous body shrinks with aging and degenerative changes, it can begin to pull on this attatchment, causing flashes of light to be seen in one out of three cases, especially when moving the eyes rapidly. The tissue which attatches the vitreous to the optic nerve contains pigment in the shape of a ring, so when this detatches and floats in front of the retina, it casts an intense and disturbing shadow. When the actual detatchment takes place, it can even pull on blood vessels, causing bleeding into the vitreous in 13 to 19% of cases. This causes additional floaters which can appear red in color, like a flock of birds, or just a blurry reddish smoke, but which can eventually be reabsorbed by the body. There is even some risk that a vitreous detatchment could trigger a more serious retinal detatchment, that can cause blindness. This is typically experienced as a curtain or shadow off to the side in one eye. Prompt diagnosis and treatment by an eye doctor is critical in such a case. Since the combination of bleeding and the pigment ring on the detached vitreous presents the onset of multiple floaters at the same time, it is important to have a professional eye examination when more than one floater is noticed. 24% of patients with multiple floaters do in fact have a sight-threatening condition. A single floater is usually not a concern in terms of potential loss of vision. 25% of all people do experience vitreous detatchment, fortunately most occuring without any complications such as bleeding or retinal detatchment. The top risk factor for vitreous detatchment is diabetes. People who are myopic (nearsighted) tend to experience vitreous detachment 10 years sooner than others and 64% of all eyes with floaters are myopic.

Risk Factors

Risk factors for floaters include myopia (nearsightedness), diabetes, migraine, contact sports, excess UV exposure and aging. The highest rate of complaints of floaters is among people over age 60. Vitreous detachments increase in prevalence from less than 10% in those under age 60, to 27% for those in their 60’s, and 63% in those over 70.

Women are at nearly twice the risk as men for syneresis (shrinkage of the vitreous connective tissue) and vitreous floaters visible to an eye doctor via an ophthalmoscope.

Nearly half of all eyes eventually lose 50% or more loss of vitreous integrity to syneresis (liquefaction). When lacunae (lakes) of liquid are adjacent to the retina instead of the normal jelly-like vitreous humour, there is increased risk of vitreous traction (pulling on the optic nerve head, blood vessels or the macula), retinal tearing and detachment, as well as infiltration of cellular debris into the vitreous causing floaters. Vitreous syneresis increases the risk of vitreous detachment, cellophane maculopathy and other related macular diseases.

Candidiasis is also a common finding in people with floaters. Beneficial flora supplements as well as anti-fungal remedies such as the herbs Pau D’Arco and Garlic, the colloidal trace mineral Silver and fatty acids like Caprylic acid may be beneficial.

Light

Preventive action may include UV absorbing lenses, since UV can promote syneresis (shrinkage), degeneration, synchysis (liquefaction) and clumping of vitreous proteins. After cataract surgery, when more light enters the vitreous, more floaters are experienced as well. This appears to be caused by a free radical called singlet oxygen. In the uncorrected or undercorrected myopic eye (as well as the overcorrected or overaccommodating hyperopic eye), direct rays from the sun can be focused on tissue within the vitreous, much as a magnifying glass can focus the sun’s light on a piece of paper. This intense light energy containing high energy photons, generates superoxide radicals which damage the vitreous when the level of superoxide dimutase is low.

Diet

Typical floaters are often a result of congestion in the liver and colon. Specific dietary changes have been successfully used in clinical practice to improve these underlying conditions which affect the biological terrain within the vitreous of the eye.

For protein, avoid meat, poultry, dairy, eggs and most nuts while emphasizing fish, soy (unless sensitive or allergic to soy), almonds, sunflower seeds, and sesame (e.g. tahini). For carbohydrates avoid refined and processed grains, while emphasizing brown rice and other whole grains, including whole grain breads, cereals and pastas. For sweetening, avoid chocolate, sugar, honey and sweetened foods in general while substituting molasses and all-fruit preserves. For beverages, avoid dairy, coffee, tea, cocoa and alcohol, substituting soy or rice milk, carob, herb tea, grain beverages, unsweetened fruit juice (diluted to about 1/4 strength with good water). For oils, avoid all fried foods, instead steaming, baking or sauteeing in extra-virgin cold-pressed olive oil or grape seed oil. Also don’t overdo avocados. Emphasize vegetables except the nightshade family (tomato, potato, eggplant and pepper). Minimize the intake of fruits, especially citrus and sweet fruits like bananas, but do eat fresh ripe pineapple, melon, and grapes. Also minimize salt intake.

Nutrition

Antioxidants including vitamins C and E, as well as beta carotene and bioflavonoids may slow or prevent damage to the vitreous that causes floaters. Improved nutritional regulation of blood sugar, especially in diabetics, may be beneficial as well.

Fatty Acids

Supplementation of evening primrose oil (EPO) is suggested in cases related to diabetic retinopathy.

Vitamins

Vitamin A

Extra vitamin A supplementation has been suggested in cases involving retinal detachment.

Vitamin B6

Extra doses of vitamin B6 may be helpful in cases involving diabetic retinopathy.

Vitamin C

Vitamin C acts as an antioxidant and strengthens connective tissues. It is also specifically concentrated in the vitreous of the eye, reaching the highest or second highest level found anywhere in the body. As with all beneficial substances, excess can be as harmful as a deficiency. It appears that supplementation of more than 1500 mg/day of ascorbic acid can increase the risk of vitreous damage, due to reduction in the absorption of minerals like Calcium, Chromium and Copper. For women over 40, taking over this level of supplemental ascorbic acid increases the risk of vitreous floaters in general by 8 fold and specifically for fibrillar floaters by about 23 times. Men, however, may show an increased risk for non-fibrillar floaters. In vitro studies also show that excess ascorbic acid, when energized by light, can liquefy the sodium hyaluronate complexed with collagen which forms the vitreous.

It is suggested that ascorbic acid intake be limited to no more than 1500 mg/day, with any additional vitamin C desired to be taken in the form of alkaline mineral ascorbates or neutral pH esterified polyascorbates. Polyascorbates, widely known as Ester C, are also absorbed twice as efficiently at both the gut and the cell membrane levels, and are retained in the body twice as long as ascorbic acid. Thus, therapeutic intracellular levels are achieved with 25% of the necessary dose of ascorbic acid, and maintained over time with one eigth the needed dose of ascorbic acid. The combination of lower doses and non-acidic pH (eliminating the side-effect of diarrhea seen with ascorbic acid, which greatly reduces absorption of all nutrients) makes this a more biocompatible form of vitamin C. It is important to note, in selecting a formulation, that whatever minerals, such as Calcium, Magnesium and Zinc are combined with the esterified vitamin C will also be well absorbed into the intracellular compartment.

Because of biochemical individuality, however, extra vitamin C supplementation may be needed in some cases, for example in diabetic retinopathy.

Bioflavonoids

Bioflavonoids are synergistic with Vitamin C. Extra supplementation of bioflavonoids is especially important in cases involving problems with the blood vessels, such as in diabetes.

Vitamin E

Extra supplementation of vitamin E has been suggested in cases involving diabetic retinopathy.

Minerals

Calcium

Calcium is needed for connective tissue integrity. Calcium complexes with sodium hyaluronate in the collagen matrix of the vitreous, changing its conformation (shape) and thus altering the packing of this space-filling protein macromolecule. This increases the viscosity of the vitreous tissue. Calcium is pulled from connective tissues to buffer excess acidity. Extra Calcium may be needed when supplementing more than 1500 mg/day of ascorbic acid. Stalky vegetables like broccoli are a good source of calcium. The best form is Microcrystalline Hydroxyapatite (MCHA) which is the actual mineral form of bone. Five studies show actual increase in bone density with this form of calcium, which turns on active absorption of calcium in the digestive tract, doubling the absorption not only of the MCHA supplement, but also of any dietary calcium taken at the same meal. MCHA should be from healthy organically raised animals, and should also be assayed to be sure that it is completely free of contamination by lead. A recent study in Canada found significant lead levels in 80% of calcium supplements. Quality control is of the utmost importance in nutritional supplements as it is in food and environmental products.

A low level of calcium in the blood, in proportion to phosphorus, is related to myopic progression as well as decreased viscosity in the vitreous. Excess dietary and blood calcium on the other hand help to cause increases in hyperopia (or decreases in myopia), associated with an 11 fold increase in risk of visible floaters consisting of fibrillar degeneration of the vitreous. These excess levels of calcium also contribute to the risk of calcium soap deposits in the vitreous known as asteroid bodies. 93% of patients with floaters caused by asteroid bodies are also hyperopic.

In one study, all patients with non-fibrillar floaters had very low calcium intakes relative to phosphorus, with an average ratio of 0.45. The risk of floaters in general was also increased by a factor of 3.5 times by low calcium to phosphorus ratios in the diet.

Chromium

Chromium helps regulate blood sugar, circulation and fat metabolism. Chromium also helps to prevent myopia which is itself a risk factor for vitreous degeneration and resulting floaters. Low chromium levels increase the risk of floaters by a factor of 8. In this study, all but one case of floaters also showed a low ratio of Chromium to Vanadium (a trace mineral which is antagonistic to Chromium). Extra Chromium may be required when supplementing more than 1500 mg/day of ascorbic acid for extended periods. Ascorbic acid supplementation in the optimum range of 500 mg to 1300 mg/day, however, appears to enhance Chromium absorption.

Copper

Copper is necessary for the antioxidant enzyme superoxide dismutase (SOD). Extra Copper may be needed when supplementing more than 1500 mg/day of ascorbic acid over extended periods. Copper should also be kept in balance with zinc. Excess copper not only creates zinc deficiency, it also promotes free radical pathology.

Manganese

Supplementation is recommended in cases associated with allergies or blood sugar problems.

Phosphorus

Excess phosphorus, which is high in meat, poultry, fish, grains and nuts, imbalances calcium. Phosphorus is an acid forming mineral, which pulls calcium from the connective tissues to balance pH. This includes loss of calcium from its complex with glycosaminoglycans in the vitreous, as well as the sclera, potentially leading to both floaters and myopia (which further increases the risk for floaters). Because Americans have such a high intake of phosphorus, the RDA is double that which has been established in other countries.

Selenium

Selenium is synergistic with vitamin E as an antioxidant. Extra selenium supplementation has been suggested for cases associated with diabetic retinopathy. The organic form L-Selenomethionine is preferred over the inorganic mineral Selenite.

Vanadium

Vanadium appears to counteract chromium. Excess vanadium in relation to chromium is a risk factor for vitreous problems such as floaters. Vanadium is high in large ocean fish, kelp, commercial poutlry and wheat bran.

Zinc

Zinc should be kept in balance with copper. An excess of either one can cause deficiency of the other. Extra zinc supplementation has also been suggested in cases associated with retinal detachment and diabetic retinopathy.

Enzymes:

SOD

Depleted levels of the body’s first line of antioxidant defence, the enzyme superoxide dismutase (SOD), are strongly linked to visible fibrillar floaters, resulting in a 30 times increased risk. For adults who are not farsighted (i.e. myopic or emmetropic) this risk factor increases to 55 times, while the lack of farsightedness alone only results in an increase of about 4 times. Fortunately SOD levels respond well to nutritional factors including adequate and balanced levels of copper and zinc.

When SOD levels drop even further (<3.1) and vision is either undercorrected in myopes or overcorrected in hyperopes, the risk factor reaches a whopping 105 times normal. This is likely due to the optical focusing of sunlight within the vitreous under these conditions, combined with the inability to quench the resulting free radicals generated.

SOD can prevent liquefaction of hyaluronic acid in the vitreous, but in vitro studies do not show protection against liquefaction caused by excessive levels of ascorbic acid.

Herbs

Between 1,000 to 3,000 mg/day of Bilberry extract has been recommended for those experiencing floaters. It can also be used with other herbs as an eyewash.

For black specks floating before the eyes with reading, the herbDelphinium staphysagria has been used traditionally (1/2 to 1 minim of ointment). However, because of its potential toxicity, it must be dosed with care and caution. Staphysagria is also available as a homeopathic remedy without the risk of toxicity.

The herb Pilocarpus jaborandi has been used to treat vitreous floaters (10 to 30 minims of fluid extract taken orally). An alkaloid extracted from this herb, pilocarpine, is still used today, primarily to treat glaucoma. It constricts the pupil, and one of its effects is thus to produce a pin-hole effect in which the vision is relatively clear at all distances. Because of its toxicity and side effects (such as severe brow ache), this natural remedy is not recommended except in homeopathic doses.

Homeopathic Remedies

Many homeopathic remedies have been found to be helpful with floaters. A few commonly suggested remedies include Arnica for floaters associated with trauma, Hamamelis when there is retinal bleeding, and Phosphorus for floaters with misty vision. These can be safely taken as a self-help remedy 3 times a day in a 6C potency for up to one week.

For vitreous opacities:

  • colch
  • gels
  • ham
  • hep
  • kali i
  • merc c
  • merc i f
  • morg g
  • phos
  • prun
  • psor
  • seneg
  • sulph
  • syc co
  • thuj

for turbid vitreous opacities:

  • chol
  • kali i
  • phos
  • prun
  • seneg
  • sulph

Retinal bleeding can produce floaters. This is often secondary to diabetic retinopathy, in which case Arnica 30C is recommended every 2 hours for up to 6 doses. If the condition is not stabilized at this point, switch to Conium 6C. Once stabilization is achieved, take Lachesis 6C every 4 hours for up to 6 doses. Other homeopathics that can help speed the reabsorption of blood are Crotalis horridis and Hamamelis. A nosode to consider for retinal bleeding is Salmonella typhi. Streptococcus hemolyticus (and with lesser severity, streptococcus viridans) symptoms can include photophobia, crying with no cause, impaired vision also retinal hemorrhage. Taenia solium (pork tapeworm) should be considered for flickering before the eyes, with blisters in the internal eye tissue associated with uveitis, iritis or iridocyclitis. 50% of these tapeworm cysts are found in the eyes. Toxoplasmose nosode is also used for choroiditis, chorioretinitis and iridocyclitis. In infants the clinical picture may consist of central chorioretinitis in both eyes as well as problems like coloboma, iridocyclitis, strabismus and cataract.

For retinal bleeding in general, classical homeopathic remedies to consider for use as first aid or as an adjunct to any required surgical care may include:

acon
apis
arn
bell
both
croc
crot h
dub
gels
glon
ham
LACH
led
merc c
PHOS
prun
sul ac
sulph
symph

Hemorrhagic retinitis is covered by Arnica montana, Belladonna(deadly nightshade), Crotalis horridus (rattlesnake venom),Duboisia myoporoides (cork wood tree), Lachesis mutus(bushmaster snake venom), Mercurius corrosivus andPhosphorus.

For first aid treatment of retinal detachment, in early stages of the detachment process take Apis 30C every 15 minutes for up to 10 doses until professional help can be obtained. If the condition is not stabilized within 2 hours, however, switch to Gelsemium 6C. If the cause is known to be traumatic, however, used instead Arnica30C. If it is a recurrent problem, try Aurum muriaticum 30C twice a day for 5 days. Remedies to consider for retinal detachment, used only as an adjunct to any necessary surgical intervention, include:
APIS
ARNICA

arsenicum album
AURUM METALLICUM
aur m
bryonia
dig
hepar sulphuris calcarea
kali iodata
GELSEMIUM
mercurius solubilis
naphtin
phos
piloc
rhus toxicodendron
ruta

Testing

Direct Ophthalmoscopy

The first visible change in the health of the vitreous occurs when liquefaction of the hyaluronic acid matrix is just beginning. The microscopic collagen fiber network which maintains the integrity of the vitreous begins to clump into visible fibrils.

Laboratory Tests

  • ESOD (erythrocyte superoxide dismutase) measures the body’s first line of antioxidant defence.
  • Liver function tests, such as Phase I and Phase II detoxification
  • Stool tests, such as Digestive Analysis and Ova & Parasites.

(See print version for 73 footnotes)

See: Natural Eye Care: An Encyclopedia (print) for exercises and Oriental Medicine recommendations.