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
Im 54 years of age – I’m on coumadin for heart valve replacement, I have the lazy eye in my right eye. My left eye two days ago had a brown spot, which the following day became almost the shape of a fried egg ( floater ) with thousands of black spots in the center. I can tolerate the spots , but the ring around the edge impedes me. With all that I explained am I a candidate?
answer: the determination of the “treatability” of any individual ultimately must be done here in person. Your description of what sounds like a sudden-onset moving shadows with the thousands of black spots is suggestive of a small hemorrhage associated with a posterior vitreous detachment. The fact that you are on Coumadin (which is a blood thinner and decreases the clotting ability of the blood) perhaps makes a small hemorrhage even more likely. Sometimes when the vitreous pulls away from the retina it can tear a superficial and small blood vessel. It does not take much blood, even a fraction of a drop, to release tens of thousands of individual red blood cells. These, if sitting close enough to the retina, will be seen as round or donut shaped shadows. It is also possible that in the process of a posterior Vitreous detachment the vitreous may have pulled and tugged on the retina and caused a small retinal hole or tear. with either possibility, I would strongly recommend that you get a thorough and dilated eye examination by a qualified eye doctor. It is not an emergency, but it should be done in a timely manner. If your Doctor can competently rule out any retina involvement, then you can expect that much of the red blood cells will clear on its own. Some of them do become trapped and embedded in the thick and sticky vitreous gel and so you might see reasonably formed shadows with a speckled or dotted appearance from the individual red blood cells. RBC’s have a maximum lifespan of about 3 to 4 months. I would give it at least that amount of time before considering have any anything done about your eye floaters.
I have had floaters since i was 18yrs and now 20yrs and are getting really worse with time affecting my normal life..i am thinking of removing it surgically..pls i need your advice.
answer: I suggest you read the advice I have for younger patients here: http://vitreousfloatersolutions.com/floaters-in-young-patients/
Floaters in younger patients are usually very small and commonly close to the retina where they can not be safely treated with the laser. There are exceptions occasionally, but they are not very common.
Hello Dr. Johnson,
I’m 22 now and have had a long history of glaucoma and iritis since I was 10. I recently got a YAG capsulotomy done on my right eye about two months ago. I got the procedure done on my left eye a few months ago as well and it went fine. The problem is now that I have the capsule floater in my right eye still moving around even after two months. It’s getting to be a bit of annoying because it moves around with my eye movements. Is there anything that can be done about it? Thanks!
There may be some important information missing from your history. Is the glaucoma caused by the iritis (iritis is typically an autoimmune inflammatory condition of the eye)? Did you develop a cataract from the use of steroids to control the inflammation? Are your floaters due to inflammatory cell exudate residual material? Lots of unknowns in a much more complicated history than I usually deal with. If you have glaucoma, your plumbing drainage system may be compromised and not very robust. You may not be able to drain some of the debris that is formed by lasering the larger floaters. If you wish, you can contact me via email using the contact form here: if you wish to elaborate on your condition. My initial thoughts, based simply on your age and the history of glaucoma, is that I would not be very enthusiastic in treating you. But I’d need to know more. Regards, Dr. Johnson
Hello, Dr. Johnson,
I have suffered from floaters since childhood (I am now 45), but learned to accept them until about a year ago when I began developing large “mats” or tangled webs of floaters, one of which sits directly in my line of vision. I had an eye exam just yesterday and the doctor had a hard time seeing the back of my eye due to the size of the floater! I am in Canada and am wondering if you know of anyone in this country who is doing YAG laser treatment for floaters? Many thanks, Ann
Response: I am not aware of anyone in Canada performing this procedure even occasionally. And due to the difficulty and technical skill set required to do it well, I wouldn’t go to someone who just dabbles in it. I have had several patients from Canada as well an many other countries make the trek to my office. I advance you that it is inconvenient, logistically challenging, and expensive. BTW, I don’t think anyone should be expected to endure a floater that large and oppressive and occlusive. I am curious as to your doctor’s recommendation. If a lens cataract was that occlusive, you’d already be on the schedule for cataract surgery. -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