The 30 to 45 year age group is an in-between and difficult to describe or predict group when it comes to their eye floaters. They may have the typical fine, small, close-to-the retina vitreous condensations common to the younger age group, or they may have prematurely experienced a posterior vitreous detachment (PVD) typical of the older age group.
In my experience, this not-quite young and not quite mature age patient commonly has overall clear vitreous fluid with sporadic, cob-web like strands of condensed vitreal collagen. These strands (or groups of strands) typically reside in the posterior 1/3 of the globe and for reasons I can’t not explain, typically reside or move to the upper recess of the eye. They move quickly like they are tethered by elastic fibers. In other words, they will move across or near the central vision with head movement, then return to its preferred position in the anatomical upper recess of the eye. Because vision is reversed from position of the floaters, the patient with see a reasonable well-defined group or cluster of fiber appear to move UP toward the central vision and then drift down toward their feet.
As far as the “treatability” of these floaters, it is also difficult to predict. They are more treatable than the typical 20 year old, but not as treatable as a group compared to a 60 year old who probably has much more material, mass, and volume to treat. In addition, the fibers tend to be fairly dense, requiring good energy delivery which is sometimes difficult working in the posterior 1/3 as well as peripheral nether regions of the globe.
That all said, we have enjoyed some notable successes in this age group, and we find that many of these otherwise healthy patients with long careers ahead of them do appreciate the improvement in the quality of vision when they are treatable.
The following was posted to the old discussion forum by a 31 year old from Singapore. My comments follow:
I had my laser vitreolysis done on two consecutive days- 9 and 10 May 2009. The floaters in my left eye seemed like a L-shape monofilament fishing line and semi-translucent. Dr. Johnson had been very patient in looking through my vitreous humour. I was initially skeptical about the possibbility of seeing any improvements on the first round, since I have done laser vitreolysis with Dr. Tsai Wu Fu in Taipei, and have not seen very much improvements. Having travelled all the way from Singapore to Los Angeles, I was here to try out a different laser equipment- Dr. Tsai uses Nidek YC1800 while Dr. Johnson deploys the Ellex Ultra-Q. Experience of treatment: perhaps because of the laser equipment used, or the way Dr. Johnson manipulates the lenses on my eyes, the overall treament seems “smoother” and more tolerable than my treatment in Taipei. I was able to endure the same position for longer hours. Dr. J seemed pleased that my description of my L-shape floaters correlated to what he saw through the lenses. He went also blasting the floaters out assiduously. The right eye was done in a similar fashion. Results: Even though Dr. J was rather pleased with the results, and expected a roughly 80% symptomatic improvements. I was more conservative because I thought my results might be somewhat affected by the LASIK treatment which I had done several years ago, which might have affected the optics of the Nd-YAG laser as well as my previous experience which yielded less than satisfactory results. After the first treatment, I could still see my L-shape floater, albeit slightly different in shape and configuration. They also seem lighter. This, together with the fact that when my pupils are dilated, I don’t see my floaters at all, works in my favour that I might not fall into the category of young patients (I am 31 y.o.) suffering from floaters stuck in the pre-macular bursa region, which would be untreatable. I was a little disappointed that my floaters in both my left and right eye seem to remain despite the best efforts of Dr. J. I admit he has been obsessive in trying to remove the tiny dots and any translucent strands he could see in both my eyes. He even spent an inordinate amount of time scanning the macular region of my right eye to see whether he could pick up any smallest floater which might have discomfited me. However, he eventually said my vitreous humour was really clear and he couldn’t see any distinct floaters which might cause the symptoms I experienced. Possible deductions: 1) My LASIK procedure might have affected the focussing and the detection of any floaters present: I suspected that maybe the reshaping of the cornea might have made detection, and focusing of the laser onto the vitreous humour slightly harder. Dr. Tsai has written about this possibility in his book on laser vitreolysis. 2) My floaters in my left eye did get slightly fainter. Perhaps because it’s situated in such a peripheral corner that Dr. J has trouble focussing the laser energy on it- I will make one last ditch-effort to clear out that L-shape translucent strand. I believe Dr. J would do his best before i go back to Singapore. 3) My floaters, especially the dots, might have been the floaters stuck in the pre-macular bursa region, which in that case, might not be treatable. I would have the accept that. Joshua Lau
Thank you Joshua. I re-posted this because not all floater conditions are treatable and I want this website resource, in part, to create a realistic expectation as to the potential for treatment – especially for younger patients. This patient had some vitreous densities that were visual on my examination AND were located in a treatable region of the eye. This is what I treated as he described so well. Unfortunately, the material I treated were apparently NOT the fine small microscopic floaters that were ultimately responsible for his symptoms. Occasionally these treatment will be better described as “diagnostic treatments”. I will sometimes need to do a treatment and clear out the central and treatable material to determine if that material is responsible. Sometimes, like with Joshua, you can’t know for certain until you actually attempt a treatment. – Dr. Johnson