Working With Your Doctor

GETTING YOUR EYE DOCTOR’S HELP IN EVALUATING YOUR EYE FLOATERS

If your eye doctor does not have experience treating eye floaters, then it is often a difficult (and sometimes awkward) task of asking them for their help. There are several reasons why:

• They may not believe that the YAG laser is a viable treatment option and will prefer to talk you out of the idea.
• They may feel that by participating in the evaluation of floaters may place them at some medico-legal exposure or risk.
• They may feel floaters are not a significant condition to warrant treatment.
• They may not be impressed with your floater mass or volume enough to warrant a treatment.
• By using the typical evaluation lenses and ophthalmoscopes, they may have looked right through your floaters and did not appreciate the quality of life and quality of vision issues they may be causing you.

Your eye doctor may be sympathetic to your problem and open-minded enough to assist you in determining the size and scope of your floaters prior to coming out to visit Doctor Johnson. We are developing the tools and language to help you, your doctor, and Dr. Johnson communicate with each other with the goal of standardizing the descriptions of floaters. This is the beginning of our efforts.

Click on this image to download a printable PDF document that you can take with you to your doctor. Ask them to describe your eye floater condition to the best of their ability.

STEP 1. PATIENT TO ASSESS THE SCOPE OF THE AREA OF VISION AFFECTED
We are looking to estimate the percentage area of the vision affected by the floater. The typical healthy eye is aware of vision about 90 degrees laterally, and about 60 degrees above, below, and across the nose (medially). The wide-angle image in this photograph is supposed to represent that field of vision. Regardless of where the floater(s) want to go to (peripheral vs. central), try to estimate the percentage of the surface area of vision affected by the floater(s). In extreme cases, a large floater could completely (even if just temporarily) occlude the vision.

Step 2. DOCTOR TO ESTIMATE WHERE THE FLOATERS(S) PRIMARILY RESIDE – ANTERO-POSTERIOR LOCATION
The globe of the eye here has been divided into 3 zones. The anterior (I), the middle (II), and the posterior (III). Although floaters move and shift from one area to another, they tend to reside in certain areas when the eye or head stops moving around.

Step 3. DOCTOR TO DESCRIBE THE TYPE OF FLOATER

COBWEBS / FIBROUS STRAND TYPE
This first group of floaters type is more common in young people and usually they are not associated with a posterior vitreous detachment. These floaters are likely an agglutination and clumping of the collagen fibers of the vitreous. They are more common in zone three in the posterior aspect of the vitreous. They tend to be quite thin and fibrous and dense in character.

WEISS RING DERIVED / POSTERIOR VITREOUS DETACHMENT
Posterior vitreous detachments occur in about 25% of 60 year olds and the incidence is higher as we age. They’re common in the fifth decade but relatively rare in the fourth decade and younger. As the vitreous cortex pulls off the posterior wall it will commonly pull off a particular density of fibrous vitreous cortex surrounding the optic nerve head. In the classic form, there is a ring-shaped floater more commonly, this ring will collapse on itself or remain a partial ring shape which is what we call a Weiss ring-derived floater. Almost universally associated with a posterior vitreous detachment are moving, undulating, semi transparent sheets of vitreous cortex. The vitreous cortex is not typically responsible for symptomatic shadows although under the right lighting conditions and with a perceptive patient, these may be seen as some movement much like a mirage. Commonly associated with a Weiss ring is a cloud-like dehydration and condensation of broader and more diffuse areas of the vitreous called syneresis clouds. These syneresis clouds are of variable density and can range from barely perceptible to nearly opaque. Like most floaters, they have a milky or creamy color appearance to the examining doctor, but since the patient is on the shadow side of the floater they will simply be dark or brownish. They may see it as a mucous-like mild blur or may completely block the visual field if it is large enough.

SYNERESIS CLOUD / DIFFUSE CONDENSATION CLOUD FLOATERS
These floaters are often difficult to see and are commonly the most frustrating and difficult to treat. The spot size of the focused laser energy is between 4-8/1000 of a millimeter and these clouds can be spread out over several millimeters diameter. They also tend to absorb the laser energy less efficiently than denser floater types.

These eye floaters can be treated, but less efficiently than the other types. These floaters are more likely to regress and re-form strands after initial treatment. They often require more overall treatment to get satisfactory results. That said, we have had some great successes but we feel it is everybody’s best interest to help set the expectations when we do see this type of eye floater.

OVERALL ASSESSMENT OF TREATABILITY WITH THE LASER
The evaluation for floaters and assessing the “treatability”consists of answering the following three basic, but important questions:
Can the doctor SEE the floater (not all floaters can be seen even with magnification. If “YES”, then…
Does the exam appearance of the floater CORRELATE or CORRESPOND to the patient’s view of the floater? If “YES”, then…
Is it safe or optically possible to treat with the laser? (Floater is at least 3 mm away from the retina and not too far out into the periphery). If “YES”, then…
The floater is likely to be treatable.

Ultimately, the decision to treat rests with Dr. Johnson after examination and discussion of the condition with the patient. The decision to treat is much more complex than the simple few criteria described above, and we understand the dilemma this places on potential patients and especially when they must travel long distances to come to our office.

We hope that the above illustrations and descriptions will serve as a communication tool that will help break down barriers of communication and help answer the question of “treatability” prior to the patient scheduling an appointment with Dr. Johnson.

A letter for your eye doctor Download a letter for your eye doctor to explain the purpose of the eye floater exam and some helpful hints.

---

Please do no use the comments section to leave personal contact information or detailed personal medical information. Keep it to comments, questions, or stories that will benefit other readers and floater sufferers. If you do have personal questions or requests, please go to the Email Dr. Johnson Page.