I am often contacted by potential patients prior to them coming out for an evaluation or examination. There are a few screening questions that I will ask to at least place them in some category as far as the potential treatability of that patient. The age grouping is probably the most important. Another question is whether they have had a local eye examination and if so, did the Doctor describe anything that sounded like a posterior vitreous detachment. Another line of questioning with highly variable answers is the question as to whether the local examining Doctor actually saw the floaters. This sounds like a very straightforward and simple question but I assure you that it is not.
I have yet to see or hear of an ophthalmology training program or medical textbook that emphasizes the diagnosis of simple eye floaters. There is plenty of time devoted to pathological conditions that can cause floaters such as proliferative diabetic retinopathy, vitreous hemorrhages , inflammation, etc. but generally, it appears that the standard of care is to simply rule out the pathology and then comfortably declare the diagnosis of floaters. This means that when your doctor told you that you have eye the floaters, they may or may not have actually seen the culprit floaters responsible for your symptoms – even though they competently made the diagnosis. How can that be? Is that even ethical?
fig. 1 The ability to see the fence in the foreground depends on the depth of focus, the aperture of the lens and the focal point.
Optics are a funny thing sometimes. The eye floater sufferer may or may not see their floater, or they may see it to varying degrees of distress depending on the ambient lighting, the size of the pupil, whether they are looking at a bright plain background or a busy distracting one, etc. similarly, the examining eye doctor may or may not see a prominent floater based on the instrumentation and lenses they are using as well as where their plane of focus lies. The ophthalmoscopes and examining lenses used in ophthalmology are designed to focus in the focal plane of the retina. Much like the example in figure 1 where the photographer is shooting through a chain-link fence.
So a patient presents to their local eye doctor’s office with the concern over their new “moving shadows” in their vision. The doctor, upon reading the complaint on the chart, is thinking “probably floaters” but is obligated to find or rule out any significant pathology of the retina or other structures of the eye. Using retina-examining lenses and scopes, they look right through the “chain link fence”, that is, right through and past the eye floaters. They simply may not see, or may not be particularly impressed by the floaters that they do see. It happens all the time. Thinking back to when I was a general ophthalmologist, I can not really remember any particularly impressive eye floaters and yet I’m sure I had many patients suffering them. I do not criticize the other doctors, but I do believe the profession itself and its dogma have generally missed the boat when it comes to recognizing the significance of eye floaters.
So when you think back to your frustration when you left the eye doctor’s office and were wondering why the doctor did not seem interested, it was more likely optical reasons rather than not caring about your conditions. – Dr. Johnson
I have floaters directly in my vision field in both eyes which have artificial lenses as a result of cataract surgery in my 40s. Currently 54. Have history of glaucoma and macular degeneration in my family. Does that rule out this type of procedure? How do your fees compare to typical posterior vitrectomy?(“oil change”) Dr Barnett here in Phoenix did both cataract procedures. I am intrigued by your procedure.
Welcome your response.
Thanks,
Ted
The laser procedure would not affect or be affected by macular degeneration. Depending on the type of floater (mass, density, and location) there is a small, but real chance of an eye pressure response after treatment. For someone that has borderline eye pressures (maybe a sign of a not-so-robust eye drainage system) or is already on eye pressure medication, the risk may be unacceptable, or may instead warrant a light and less aggressive first treatment to see if there is even a mild eye pressure response. The fees for a vitrectomy will include the doctors fee, anesthesiologist fees, surgical O.R. time, expendables used at time of surgery, etc. It could be several or more thousand dollars. That question is better directed to the retina specialist practice. – Dr. Johnson
i have floaters at least i hope this is what mine are .
i see alot of cell looking things floating around and they do make me feel emotionally
depressed most of the time doc says every things ok and doesn’t seem concerned.
they started about ten years when i was about 30ish but seem to have become more prominent now a days .i wish i didnt have to see these floatin things all the time.and have the clear vision i use to have.do u think that my floaters are treatable ?
i have quite a bit he said i syneresis of the lattice if this helps.
Response: I am often asked if I think floaters are treatable. Seems like a reasonable question especially considering the long distances people often have to travel to get to my office. Ultimately, each eye is different and there is no simple set of screening questions that I can ask that will ascertain whether someone’s floaters are treatable. In general, the younger you are, the less likely I can treat your floaters. Also, the more detail you can see WITHIN the substance of the floater shadow, the closer it likely is to your retina. So for instance, if you are seeing semi-translucent shadows that many have described as “crystal worms” AND you can also see designs within the shadows like cells or segments of the worm, then the vitreous condensations are sitting within 1mm of the retina – not treatable. In general, the treatable floaters are 3-4mms and further from the retina. The further they are, the softer and less-defined the outline of floaters. Also… If your eye doctor positively and easily saw the floaters in question, then it is probably larger and further away from the retina – and more likely treatable. All just rules of thumb which is about the best I can offer with the limited amount of information available to me. Regards, Dr. Johnson