Persistent floaters that decrease vision can be removed. A vitrectomy, a retinal eye operation, can be used to successfully remove the vitreous and the “floaters” located within this gel-like tissue.
Most Floaters are From a PVD
Most new “spots” or “cob-webs” are due a posterior vitreous detachment (PVD). A vitreous detachment increases the risk of a retinal tear and/or retinal detachment. As we have discussed previously, a PVD is a common occurrence (especially as we get older). Patients should be examined when the symptoms of a PVD first appear and then 6 weeks after the symptoms started.
From a medical point of view, if a retinal tear has not occurred at the 6 week point, the patient may not need to return for another exam.
These Spots Can Be Annoying
Sometimes, the floaters are so numerous or so large that they are annoying, prevent normal function and may decrease vision. There is hope and there is help.
A Vitrectomy is the Only Solution
A vitrectomy can remove most of the vitreous, and thus, remove the vitreous opacities. The vision returns to “normal.”
Vitrectomy eye surgery is routinely performed by retinal specialists. The operation is usually performed for other reasons rather than just opacification or cloudiness of the vitreous. It can be used to repair retinal detachments, macular holes or remove epiretinal membranes, for instance.
Of course, there are risks of vitrectomy surgery. Though very rare, the biggest risks are blindness from infection or retinal detachment.
Some doctors advocate the use of a special laser (YAG laser) to reposition the vitreous within the eye. I personally don’t feel this is a wise choice as there is a chance of causing retinal tears, and possibly, retinal detachment.
What Does This Mean? It is true that most people learn to tolerate small changes in vision. In my practice, I rarely performed a vitrectomy for just floaters while I was in Baltimore. I operate on floaters much more often at my present locations.
Perhaps our tolerance for visual changes is different here.
The point is that, if needed, the surgery can be helpful. It is not a fancy operation, but rather a routine procedure and does not involve new technology.
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Dear Otacon,
Really nothing you can do to increase the absorption time of the gas.
Stay in touch.
r
Dear randy,
Eye is getting better day by day. İ started to see from the top of the eye. But i have a problem, original floaters seems to disappeared but i see hundreds of very black dots. They move very freely. They vibrate also if i slightly move my head or eye
Are these floaters inflamation cells? Or are they gas particles?
Thanks again…
Probably neither. I’d wait until all the gas is gone before worrying.
r
Dear randy,
Today is the 19 th day after facovitrectomy. Gas has completely dissolved. My eye is still dilated. Although it is not as much big as the first days of post surgey, it is still big. Light comes so strong that i can not open my eyes.
are these normal?
Thanks
Dear Otacon,
Probably a result of long acting dilating drops or you may be currently using dilating drops (common during the post-operative period). Ask you doc what he thinks is going on.
Randy
Thanks randy.
İ do not use dilating drops but i use fml liquifilm. İt includes fluorometholone. As i investigated from the internet, it may cause dilated pupil as a side effect. My doc says it will undilate. But sometimes the eye may remain dilated permanently after cataract surgery. İ am afraid of this.
I am a 62 year old male and am a professional portrait photographer in McLean, Va . I recently had a PVD episode of flashing lights and floaters invaded my right eye. The next day my vision totally changed. I had some webbing type vision and a horseshoe shaped floater that kept settling in front of my eye blurring my vision. This is akin to driving in a rainstorm but day and night, never ending. My optician referred me to Dr. Wong who had me come back a number of times to see if I had a retinal detachment or any lessoning of the floaters.
I had no detachment but the floaters didn’t lessen any. After reading about the low probability of problems, I opted for the Vitrectomy which I had only four days ago. Amazingly enough the floaters are long gone, my vision is perfect and the operation was painless.
I had a bandage on my eye for only a day and being floater free is a dream come true! I understand I have to wait a few weeks before the all clear sign can be given but I understand that chances of any problems are infinitesimal, one in thousands so I feel like all will be fine.
Dr Wong is an expert surgeon, caring and highly experienced. I feel great comfort in having him as my physician.
If you have any questions, please feel free to contact me through my site! http://www.JeffLubin.com.
Dear Jeff,
Thanks so much for your evaluation and trust. Good luck!
Randy
Hi Doctor Wong,
My left eye is seeing flashes & floaters for the pass 2 months. Had 3 eyes examined at one of the local eyes specialist center. The doctor said no detachment, the gel still stick well with the retinal. However, I’m freaking out cos the eye condition is keep changing.
The floaters is getting lesser. The flashes seems to be reduced times of apperance. Besides these, currently i experience a new thing on the left eye. When I bling my left eye, in a particular area i see small black spot & it disappear in seconds. Also from the same area, i feel dryness of my left eye. Whats wrong again?!
I’m getting confuse whether should go for another eye checkup with the same doctor again. Your advise will be much appreciated.
Thank you.
Dear Daphne,
The two complaints may be unrelated. Anytime you don’t understand one doctor….get another opinion!
Randy
Dr Wong:
Thanks for such a great website and being so compassionate and able to answer questions.
What are your thoughts on performing vitrectomy for a very large dense PVD immediately behind the lens in a 40 year old individual who works in a field requiring significant visual function (i.e. pilot, surgeon, etc)? The PVD is preventing one from performing their occupation.
I have lattice, and a history of bilateral retinal detachments, both repaired with scleral buckle and extensive laser retinopexy. The first buckle was performed on the left eye 15 years ago (asymptomatic retinal detachment seen on routine eye exam). The right eye which now has the severe PVD had successful scleral buckle 5 weeks ago. The PVD occurred 8 weeks ago, and apparently produced retinal tears. Of note, the PVD’s effect on my vision hasn’t improved in the 8 weeks. Laser held the tears for 2 weeks, but ultimately the buckle was required due to a peripheral detachment. It is hypothesized by surgeons that this right eye PVD may have been induced by suction during refractive surgery (LASIK) 2 months prior to the PVD, but this also is not certain, given the time interval between intervention and PVD. Interestingly, 3 days after the right eye PVD, a small PVD developed in the left eye, and this also required laser for tears.
Do you believe that in the RIGHT eye, the prior PVD and prior 360 deg laser retinopexy and a prior scleral buckle is PROTECTIVE from detachment during vitrectomy, or do the lattice and the history of tears actually increase my risk? What would you estimate the detachment risk to be, as well as other risks? If one has had a PVD, is it safe to assume it is complete? Or would some “peeling” of vitreous from the retina still be required and is this dangerous in someone with lattice? Any way to know if further PVD induction would likely be necessary prior to “going in”? Finally, how long after buckle surgery do you feel is safe to wait prior to vitrectomy?
Dear Craig,
1. Thanks for the compliments about the site. I hope more docs will follow suit….someday.
2. If the PVD is interrupting functioning at job or hobbies, and the opacity is responsible for the decreased vision, I’d recommend vitrectomy.
3. My general belief is that scleral buckles decrease the likelihood of subsequent retinal detachments once outside the recovery/post operative period.
4. If the lattice were treated correctly, probably safe to move forward, but I’d obviously recommend that you follow the advice of your doc. We all have different comfort zones in the way we practice.
5. A PVD probably takes several weeks to “complete,” but once completed…it won’t change.
6. I’d wait several months after scleral buckle surgery…the floaters might move and become less noticeable.
Randy
Am a Adult Onset , T1 Diabetic since 95′ at age 45, now 64. VG , BG’s but.
-I’ve had 3 Vitrus Eye hemmorages a few yrs ago
-The Reitna Speicalist I see had me just tolerate them, wear a Eye Patch and Let them Disove on their own and clear up. Each took about a Month
- After each one, they left some Floaters bedhind ,but he feel no need to clean them up and to tolerate them
- My biggest question is? If I get another Eye Hemmorage? Can They clean it up right away, instead of letting them disolve on their own and go thru all that Stress?
For I realize that the other Eye can have one as well and Can Become Totally Blind..
Thank you
Dennis in Wi.
Dear Dennis,
Did you get PRP after the bleeding?
Yes, a vitrectomy can be done shortly after bleeding if needed.
Randy
Dr. Wong:
It sounds like you characterize vitrectomy as a fairly routine procedure. If so, I am confused why all the eye specialists who I have seen refuse to recommend such an “extreme procedure” and tell me to “get used” to my extreme floaters. I have visited several specialists and have had my eyes throughly evaluated and I am told my eyes are “fine” (other than the floaters)
Unfortunately I cannot just “get used” to my floaters. I have dozens of long thin strings of “crystal” floaters of different sizes in both eyes that criss-cross when I move my eyes. I now have two in my direct field of vision in my right eye …extremely distracting. I can function in low light situations, but while in the office environment, such as being in a meeting room with UV lights, white walls, etc., looking at white paper and white plans, I almost am to the point of madness with the distractions.
I live in South Florida, but I willing to go to DC if that is what it takes to get my vision back.
Ted
Dear Ted,
I would be happy to see you.
I would need to agree that there are floaters bothering your vision. I do not always see “your” floaters on examination. They are not always visible to me, especially in younger individuals.
Let me know if this works for you.
Randy
Perhaps, the highest number of comments on any of your postings, Dr. Wong. This just only shows how much agony floaters cause, yet these patients have been time and time again ignored by the majority of the ophthalmic community. If the community had at least striven to do something to help these patients, I am sure today we would have a bit less invasive treatments for floaters. But no. Arrogance is the mother of all failures.
Dear Floatered,
Thanks for the insight and background. Hopefully this is a beginning for the floater community. Advances in technology have made vitrectomy much, much safer than 10-20 years ago!
Randy
Dr.Wong, I will plan on getting up there as soon as my schedule allows. Yes, I have been told that, other than the affected individual, it is difficult to see floaters. I was told during one examination that he could see at least 4 lined up in my right eye, but they are not very large to him. I have 3-4 more in my right eye peripheral which must be very close to my cornea because they are huge in my perspective. Hopefully you will be able to see them. Thank you for having this forum. Ted
Hopefully, Dr. Wong.
Thank you for being a source of hope for those who got vitrectomy for floaters done by you and for those who are still in contemplation mode.
Thank you.
Do you plan to publish some sort of a case series publication for floater vitrectomies sometime in future?
Look forward to meeting you.
Randy
Dear Floatered,
I think it’s a great idea and will keep in mind.
Thank you.
r
Dear Dr. Wong. I am 49 yrs old and had cataract surgery last year on both eyes. Everything was going great until I was recently struck in the right eye with a stray basketball. This resulted in a PVD in the right eye with many cloudy floaters.. My eye doctor has suggested vitrectomy as an available option. The question I have though is could this surgery disrupt the corrective lense placement of a successful cataract surgery? And could this surgery cause new cataracts to return? And would only the bothersome eye need surgery, or is it wise to do both eyes anyways? I used to be very nearsighted, but the cataract surgery corrected it. I would hate to disrupt that correctiveness in anyway. Thank you so much for your time!
Dear Terry,
The vitrectomy should not jeopardize your implants at all.
Randy
I am to have surgery to remove the vitreous from my left eye. They told me I would have to keep my head down to my feet for 7 to 14 days. Do they mean I will have to look down or will I have to move my head down towards my feet. My husband is on a feeding tube, and they said I would not be able to do it. Thank you for your reply
Dear Betty,
They probably mean that you should keep your head over, looking at the floor, with your face parallel to the ground…..
It must not be easy, but it will help save your vision.
All the best.
Randy
How much do you charge for FOV procedure?
Dear MP,
There are 3 basic charges for any surgery;
Hospital/Surgical Center
Anesthesiologist
Surgeon
Most of the time insurance will cover most of the costs. Please feel free to email me and I can forward to my surgical coordinators and we can check.
Randy
I have recently had double cataract replacement at the age of 44 after months of struggling with doctors telling me that cataracts were not the problem.
The surgery was a major sucess in terms of improving my vision and I am now left with trying to decide if something can be done to help with my floater problem which includes one that impedes my vision pretty seriously in my left eye.
I was told my cataract surgeon that the procedure to remove floaters is quite risky and he did not give me a referal.
I would like to know if having prior cataract surgery will have any impact on this surgery or if it is a contraindication under certain circumstances.
My vision is paramount to my profession and if done what is the standard healing time or time needed off work to recover.
Dear Tim,
You need another eye doctor.
Removing floaters is actually less risky (or at least at the same risk) than cataract surgery.
If you are having problems with floaters…don’t give up. Seek the help of a retinal specialist.
r
Dear Doctor,
I HAD VITRECTOMY IN BOTH EYES DUE TO RETINAL DETACHMENT , BUT WHY IS IT – THAT I STILL HAVE PLENTY OF FLOATERS & FLASHES-ONCE IN A WHILE? (ALTHOUGH NOT AS INTENSE BEFORE THE SURGERIES) AND AT TIMES I HAVE “LIGHTED FLOATERS’ – THAT COME AND GO. DO I NEED ANOTHER VITRECTOMY DOCTOR?
SUSAN
I am 66 years old and on Easter Sunday I had a small floater start in my good eye. I lost my other eye in 1967 due to scar tissue surrounding the optic nerve. This has gotten worse with a large piece floating around. How long does this normally take to clear up. My eye doctor stated that this is the 2nd largest one that he has seen. There is no damage to the retina. With just 1 eye, I am very concerned about having surgery. Do you have any suggestion? Thanks
Dear Susan,
You might indeed need another vitrectomy if the floaters are driving you crazy!
Randy
Dear Warren,
First things first. Make sure that there are no tears. It’s hard to say, but if the floater is simply due to opacification within the vitreous, then it may not leave…but it may move and occupy a different position in the eye causing less change to your vision and….no need for an operation!
Randy
Dear Doctor
About 4 weeks ago I experienced a PVS in my left eye causing a tremendous amount of floaters and little dots in my field of view along with flashing in the left side of the eye as I moved my eyes left to right. My Opthalmologist found 3 vitreol hemmoraiges but no tears in the retina. He also determined I had developed a Posterior Subcapsular Cataract in the eye. Today I was re-examined and so far I have not developed any retinal tears. The floaters continue to be a major distraction especially with development of the cataract. At least the dots have faded which he said were from blood cells that were released during the PVS. Like yourself my eye doctor performs many vitrectomies a month (over 30) and about 3 per month for floater removal. He recommends cataract surgery first and then a vitrectomy for the floaters. Is this the sequence you would follow or do you think it matters which surgery is performed first?
I am 38 and I had a vitrial detachment 4 years ago te floaters have not gone away but now I am told that I am also developing Cataracs. Do you recommend if I do the Cataracs surgery that I do a vitrectomy at the same time is that even possible?
Dear Jack,
I don’t think it really matter which is first. There are subtle differences in performing cataract surgery if a vitrectomy has been performed. Make sure the person doing the cataract surgery is used to performing surgery on retinal patients.
OVerall, not a big deal.
r
Dear Stawf,
I’d go with cataract surgery first, then vitrectomy, but only if the cataracts need to be removed now.
Otherwise, you can get the floaters removed with anticipation of cataract surgery.
r