Call the office the same day if any of these start. A sudden increase in floaters. Flashes of light, especially off to the side. Sudden blurring. A shadow or curtain across part of your vision — that one should not wait for office hours at all, and if you cannot reach us, go to an emergency room. (609) 246-0236
Most people with these symptoms are fine. But of every hundred who turn up with a sudden change in floaters or flashes, roughly five are found to have a retinal tear and four already have a retinal detachment. That is about one in ten — not rare enough to wait out, and not common enough to panic about.
The inside of the eye is filled with a clear gel. With age it liquefies and shrinks, and at some point it peels away from the retina at the back. That event is a posterior vitreous detachment. It happens to almost everyone eventually, usually between 45 and 65, earlier if you are short-sighted or have had an injury.
The floaters are the collapsed gel casting a shadow. The flashes are the gel tugging on the retina as it separates — the retina cannot feel pain, so it reports the pull as light. On its own this needs no treatment, and the floaters usually become less noticeable over months.
The risk is what happens on the way out. Where the gel is stuck firmly, peeling away can tear the retina. A tear lets fluid pass underneath, and fluid underneath lifts the retina off — a detachment. That is the sequence worth interrupting, and it is why a symptom that is usually harmless still gets a same-day appointment.
You cannot tell the difference from the inside. A harmless vitreous detachment and one that has torn the retina produce the same flashes and the same floaters. There is no home test and no symptom that separates them. It takes a dilated examination.
The curtain is a late sign, not a warning. People often assume they would notice if things got serious. In the study above, only about half of the patients who actually had a retinal detachment reported a shadow or missing area in their vision. The other half had no such symptom. Waiting for a curtain to appear before calling means half the time it never appears until the damage is done.
And the window matters more than people expect. A retinal tear caught early is treated with a laser by a retinal specialist, in a single visit, and usually that is the end of it. Once it has progressed to a detachment it becomes operating-room surgery. More importantly, a detachment repaired before it reaches the macula — the small central part of the retina you read and recognise faces with — has a far better visual outcome than one repaired after. Central vision that has been detached often does not fully come back, even when the surgery succeeds.
That is the whole argument for the same-day appointment. Not that the odds are bad, but that the cost of being in the unlucky ten percent goes up sharply with each day.
These raise the odds and should lower your threshold for calling:
If any of these apply, do not wait to see whether the symptoms settle down.
You will be dilated for this one. A tear almost always sits in the far periphery of the retina, and reaching that edge means a dilated examination with indirect ophthalmoscopy — usually with scleral depression, where gentle pressure on the outside of the eye rolls the very edge of the retina into view.
This is the situation where wide-field photography alone is not enough. A photograph is a flat image of a curved surface, it does not reliably reach the far edge, and it cannot be depressed or viewed in three dimensions. For these symptoms, drops are not optional.
One of the things being looked for is not the tear itself but a scattering of fine pigment granules floating in the gel — released when the retina tears. In one study of two hundred eyes, it was present in the great majority of eyes that had a tear and in almost none of those that did not. Finding it means searching the periphery until the tear is located.
Plan on about an hour. Bring sunglasses, and arrange a driver if reading a dashboard would be difficult — vision stays blurry up close for roughly four hours afterwards.
If a tear is found, you are referred to a retinal specialist and it is usually sealed within days, with a laser applied around the tear so fluid cannot get underneath. It is done in a clinic under anaesthetic drops.
If a detachment is found, the referral goes the same day. Repair is surgical and the timing is driven by whether the macula is still attached.
If nothing is found — the likely outcome — you will still be asked to come back. That is not over-caution. About two in every hundred people with a clean first examination develop a tear in the following weeks, as the gel finishes separating. In the largest study of this, the delayed tears showed up a median of about six weeks after the symptoms began — which is why a second look at around that point is the standard. If you are short-sighted, follow-up should run longer, because myopia is one of the strongest predictors of a delayed tear and they can appear months later.
And in the meantime: new symptoms restart the clock. A fresh shower of floaters, new flashes, or any shadow means calling again, regardless of how recently you were checked and told everything was fine.
New flashes and floaters need a same-day eye examination, not an overnight emergency room visit — and an eye clinic is better equipped for it, because the test required is a dilated peripheral examination that most emergency departments cannot perform.
A shadow or curtain across your vision is different. That needs attention immediately, and an emergency room is the right call if you cannot reach an eye doctor quickly.
No. Long-standing floaters that have not changed are common and are not the concern. What matters is a change — new floaters, a sudden increase in how many there are, or floaters arriving alongside flashes of light.
Yes. A tear does not announce itself by continuing to flash. Symptoms settling means the gel has finished pulling away — it tells you nothing about whether it did any damage on the way.
Not for this. Wide-field imaging is useful for a great deal, but a tear in the far periphery can sit outside what a photograph reaches, and a photograph cannot be depressed or viewed in three dimensions. For these symptoms the dilated examination is the test, and imaging does not substitute for it.
Usually they become less noticeable rather than disappearing. The gel settles, and the brain gradually stops reporting a shadow that never changes. Most people find them much less intrusive within a few months. Floaters that persist and genuinely interfere with vision are worth raising, because there are options — but that is a conversation for after the urgent question has been answered.
No. Call the office directly. If a tear or detachment is found, the referral to a retinal specialist is arranged from here, the same day where that is needed.
If any of this describes what you are seeing, call rather than book online, so the appointment can be fitted in today.
Call (609) 246-0236 or send a text
Text messages are not a secure channel. Use them to ask for a call back — not to describe symptoms, and not for photographs. For anything you are seeing right now, call.
Khoury Eye Care, Hamilton Mall, 4403 Black Horse Pike, Mays Landing. Dilated examination and retinal imaging are done in this office.
