A question I recently received:
“I’ve had vitrectomy surgery in both eyes for floaters…followed by cataract surgery in both eyes….and recently capsulotomy by YAG laser in both eyes….vision is 20-20…..however the left eye has 3 large floaters…from the capsulotomy as well as 3 or 4 smaller ones…..I’m considering another vitrectomy…..the floaters float about in and out of vision…could your procedure help…they are debris from the capsule…not vitreous floaters I had before.”
The YAG capsulotomy is a very common procedure performed for people who have undergone cataract surgery with a lens implant. The artificial lens is placed into the original “capsule” which held the lens before surgery. The capsule is relatively dense basement membrane between 2-20 microns thick. Fragments of the capsule liberated during a capsulotomy can behave like a more typical floater caused by vitreous gel condensation. Because they are denser, tey are more of a challenge and require very focused energy and repeated shots to “fluff it up” and vaporize the material. The pieces should be relatively small if typical of what I’ve seen before. It would seem like a vitrectomy would require a accepting a moderate amount of risk for something so small. Likely the laser could fragment and obliterate it if it is not too close to the retina. It is certainly less risk and to do the laser procedure would not prevent you from later doing a vitrectomy if it didn’t work. Your situation is interesting: 1. You develop floaters… 2. Underwent the “Gold-standard” vitrectomy procedure to remove floaters… 3. Developed cataracts as a common side effect of vitrectomy… 4. Capsule opacifies, and you undergo YAG Capsulotomy which is a common side effect and treatment after cataract surgery… 5. You develop floaters. A rather circuitous route, I’d say. So back to your specific question… If the floaters can be seen, and they are not too close to the retina, you might do well with the laser procedure. I think it would be preferable than returning to the operating room, especially if the fragment is small. Cheers, Dr. Johnson
I have had floaters since I was about 18 I think and I’m now 32 and I have read your answers on the website on others my age who have them and those that are younger and I’ll admit I’m a bit discouraged by what I read. However I thought I’d ask and see what you thought about mine and if you could tell just from my description if they are treatable. I have a lot of floaters but I notice that they will move with my eye movements and will drift from the top to the bottom and only a few seem to be somewhat stationary all the time. What do you think is the likelihood of them being treatable as they move away from my center field of vision, which I suppose would be moving away from the optic nerve? I would love to get rid of them as they seem to multiply as the years go by and at some point I’m afraid I may not be able to see properly or have “semi-blindness” because of them. Thank you for whatever advice you can give.
Heath, I know my advice to younger patients is discouraging. It is intentional and part of my effort to temper expectations for the younger floater sufferers. Your description of of movement of the floaters with eye movements and drift is not really helpful. These are also features of well-positioned and treatable floaters. The optic nerve does not correspond to your center field of vision, you are more likely referring to the fovea and macula of the retina. The optic nerve is actually a physiologic blind spot. I can not predict whether your floaters will shift, or whether they are currently treatable or more treatable over time. The good news is that I have never seen floaters in young people visually disable them. they always been primarily an annoyance and distraction. – Dr. Johnson