There are some floaters that are caused by pathological conditions such as autoimmune disorders, infections, diabetes, and hemorrhage. The treatment for these floaters is directed at the underlying disease or disorder and not within the scope of this practice or website. The remainder of floaters are generally benign. They are benign in the anatomical and “health” aspect, but not so benign when you consider the psychological effect floaters can have on the floater sufferer. They are not so benign when you factor in the sometimes devastating effect on the quality of vision and quality of life.
If we then consider benign vitreous floaters, there are essentially three options available:
- 1.DO NOTHING,
- 2.VAPORIZATION and REDUCTION BY LASER, and
- 3. COMPLETE SURGICAL REMOVAL OF ALL OF ALL OF THE VITREOUS.
- In addition, there are always rumors and anecdotes of naturopathic and other folk remedies for eye floaters.
OPTION 1: “DO NOTHING”: The ophthalmology and optometry training programs spend very little time on the subject of benign eye floaters. The emphasis in these programs is on actual pathology and disease. Doctors are also taught to be pessimists and to ask, “What is the worst thing these symptoms could be”? So when a patient enters with a new visual complaint of moving shadows, the doctor will mentally create a list of possible disease conditions that they must rule out (the “differential diagnosis). New floaters could be caused by a retinal tear or detachment, various inflammatory conditions, hemorrhage, etc. The exam is directed toward making sure these conditions do not exist (“ruling them out”) and once the doctor is satisfied they are not the cause of the floaters, they are done. There are many common phrases offered as reassurance: “You’ll get used to it”, “It will drop out of the way”, “It will eventually reabsorb”, and “Just ignore it”.
“Floaters are created by material that has always been in the eye. There is no reason why the eye or immune system would recognize any of it as out of place or foreign in origin. There is no natural biological mechanism to clear floaters from the eye. By doing nothing, you can only hope that they will move to a less bothersome location. The advice to do nothing is to suggest that you should try to tolerate these floaters and accept your fate for the next 10-20 years or more.”
OPTION 2: YAG LASER ABLATION AND DESTRUCTION OF VITREOUS FLOATERS:
YAG Laser treatment has been around for about 20 years beginning with Dr. Fankhauser in Switzerland. Even after 2 decades, there are just a few ophthalmologists with any significant experience treating floaters. It is technically a very difficult procedure to perform. Not all floaters can be treated and the indication and ability to treat depends primarily on the location of the floaters as well as other optical characteristics of the eye. This is the procedure offered at our office and our area of particular expertise and interest. This topic will be covered extensively throughout this web site.
OPTION 3: FLOATER-ONLY VITRECTOMY (FOV, removal of most or all of the vitreous fluid):
A surgical vitrectomy involves general anesthesia or deep monitored sedation in a surgical center or hospital. A retinal surgeon will place three incisions into the whites of the eye and insert three instruments: 1) a fluid infusion to keep the eye from collapsing, 2) a fiber optic light source, and 3) a guillotine cutting/sucking instrument (a vitrector) to cut the vitreous and remove virtually all the vitreous material. The removed vitreous is replaced with a balanced, electrolyte salt water solution with is similar in chemical composition to the fluid in the front chamber of the eye. The replaced fluid will eventually be filtered out through the eye’s natural drainage system and is replaced with aqueous fluid. The vitrectomy enjoys a higher expectation of removing most if not all of the floaters, but with that higher expectation is a greater relative risk. The commonly noted risks of vitrectomy are cataract formation (lens clouding and opacification) within the first year. This is often quoted in a range of 20-100%. In addition there are more rare incidences of retinal detachment, eye pressure fluctuations, chronic retinal edema amongst others. The professional culture among retinal specialists who perform the procedure is reticence and reluctance to perform a vitrectomy for “just” floaters. Even if the patient has decided they want a vitrectomy, it is a difficult task sometimes finding someone willing to perform the procedure for what the professional community generally considers a harmless condition. This treatment may be a theoretical option rather than a realistic or practical option because of the general lack of availability in finding doctors willing to perform the procedure.
Vitrectomy vs. FOV Vitrectomy
For clarification, there really is no technical difference between a “vitrectomy” and a “Floater-Only Vitrectomy (FOV). The difference is not in the procedure or technique, but in the intent and indications for the surgery itself. Among retina specialists, the surgeons who typically perform the procedure, the sentiment and professional culture dictates that the vitrectomy be performed as part of, or bundled with another procedure. That other, primary procedure is usually done to fix some sort of pathology such as a retinal detachment, scar tissue, proliferative diabetic disease, etc. The vitreous is removed because it is a sticky and tenacious hindrance to getting at the actual “pathology”. The”FOV” designation simply indicates that the vitreous only was removed with out any other procedure or indication for treatment.
Video: VITRECTOMY FOR VITREOUS OPACITIES Retina specialists typically perform this procedure to treat diseases of the retina such as detachment, hemorrhage, scar tissue, membranes, etc. Some people have so much and such dense floaters that they are good candidates for the FOV procedure and the potential benefits will outweigh the risks. For some people with extensive floaters, or where the laser treatment has not been successful, it may indeed be an appropriate procedure.
I just found out that I have those floaters, in my left eye. They move pretty quickly. When I am not on my day job, I’m a photographer, I can still see how to shot a tack sharp photo. They don’t bother me that much. Of course I wish that I did not have the annoying things, and I wish that I could get rid of them. I don’t spend a lot of time thinking about them.
I just wish that there was a place a bit closer to me, where I could go and have them checked out.
My doctor told me that he has had them since he was 8 years old.
Of course, I’m glad that there is a treatment out there. This is a heck of a lot better than being told that there is nothing that can be done, because they are on the inside of the eyeball, and it is sealed.
Response: Thanks for contributing. The odds of your floaters being treatable depends a lot on your age. Please read about that elsewhere under the “age factors” menu section. It would be impossible to tell if your floaters are treatable by your description of them, unfortunately. I hope you found the web site informative. – Dr. Johnson