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.
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=e4b4322d-8051-442a-81a9-41f7afdf39ce)
Dr “Randy” Wong, (My husband, Dr. Robert Andrew Buethe, is called “Randy” also!)
I enjoyed meeting and speaking with you today. After reading your informative website, I am even more comfortable with my decision to have my eyesight restored when you perform the surgery for my large floater. I will call your office tomorrow to schedule the surgery for as soon as possible. Thank you for all your time and training. Karen Buethe
Dear Karen,
I, too, enjoyed meeting you today. Thanks for the plaudits regarding the web site. I am very proud of this site.
I look forward to seeing you again.
Many thanks for taking the time to comment!
See you soon,
Randy
Randall,
I have waited long enough. I do now want to have the viitrectomy for my eyes. I am seeing some bit of deterioration in the total vision experience with these floaters. I do need to know how long it will take, should we do one eye at a time or both eyes at the same time, is the procedure covered through Medicare? Thanks for being patient with me. I do trust that you will do your best for my eyes. When would be the best time? How much time do I need for recovery? Finally, from a physics standpoint, is there any refractive index differential from what is in my eye now and the fluid that you will use to replace it? Do I need to have it replaced or refreshed at a later date?
Bill Johnson
5103 Redwing Dr
Alexandria VA 22312
703-354-6180
Mr. Johnson,
The operation will take less than 30 minutes. We will do one eye at a time, but perhaps as close as 2 weeks apart,or so. I’d like to play that by ear. There is no noticeable change in the index of refraction for water and the vitreous. The vitreous will be replaced by artificial saline on the day of the operation, but will be replaced by your natural fluid by the next day.
I will have the office call you today to schedule.
See you soon.
Randy
Dear Dr. Wong
I appreciate, so much, this informative website. I have been considering FOV surgery and was wondering what your patient satisfaction (as well as complication) rate is. How many patients have you performed FOVs for? I was also wondering if you induce PVD (for individuals who do not already have it) in order to get as many of the floaters as possible?
Thank You
Cheryl
Dear Cheryl,
The overall satisfaction rate with vitrectomy for floaters is 100%. I am pretty careful about screening patients to make sure that, absolutely, what they describe as floaters obscuring their vision is, indeed, due to floaters.
The surgery has a very, very low complication rate. The chance of infection inside the eye is less than that of cataract surgery (I usually cite numbers such as 1 chance in 10-15,000 for vitrectomy). There is about a 1% chance of the surgery causing a retinal tear.
Vitrectomy is pretty safe these days, especially with the use of 25 gauge instruments.
Almost always, a PVD has already occurred in patients with complaints of floaters. If not, a PVD is commonly induced.
Hope this was helpful. If you prefer, feel free to email me.
Randy
RWong@RetinaEyeDoctor.com
Dear Dr. Wong
nice explication in your website
i have some question you Dr.
I am 25 years old and I suffer of floaters for two years.
all reviewed that I pass on that wase floaters very small.
but me I see them very large and they become larger approximately every month and new is also formed.
I go twice in US for yag laser but too small to handle success.
I believe that the only thing has to do is the FOV?
How are the risk of having a cataract after the operation?
If I am a cataract its takes another operation?
and after the cataract operation do you think it’s pocible to have pieces of the cataract go in the new vitreous?
Please send me back some answers fast i realy need it.
Thank you Dr
Dear Kev,
I would agree that you should consider vitrectomy if the floaters are still bothersome. In most cases, especially with an experienced cataract surgeon, you shouldn’t have worries about the cataract “falling” into the vitreous if, and when, you need cataract surgery. Remember that many retinal patients develop cataracts. Make sure to pick a cataract surgeon used to working with patients who have had retinal surgery. They are not too hard to find.
While the cataract would be another operation, it can be planned and scheduled….if needed.
Good luck.
Randy
Just wondering if floater surgery and cataract surgery can’t be done at the same time, since I am developing cataracts, and possibly considering floater surgery in the near future.
Hello Dr. Wong,
It was nice to speak with you recently about the “floaters” in my one eye and the possibility of vitrectonomy to correct this. I am considering the surgery but have a couple questions: -if the vitreous is replaced by natural fluid within a day, is it safe to assume that the floaters will not return? -What is the purpose of the vitreous–simply lubrication of the eye? -Does the vitrectonomy reduce the chances of a retinal detachment in the eye in the future?
I look forward to your responses, as I am considering the surgery. One last question: can this procedure be performed in the office?
Thank you, Dr. Wong.
Stephanye
Dear Sue,
The technical answer is yes, it can be done at the same time, but I’d suggest you have separate procedures. First, and foremost, different surgeons with different skill sets should be doing the two different operations. This can also present certain complications in the operating room as it is a break from normal routine.
I would also suggest that if you are going to have both done; have the cataract surgery first. There are two reasons; 1. Cataract surgery might improve your vision enough so that you don’t need a vitrectomy, and 2. The cataract surgery will be slightly more complicated if there is no vitreous present. While many cataract surgeons are used to the slight difference in the two settings, why make it harder for the cataract surgeon?
Take care, thanks for asking. Great question.
r
Dear Staphanye,
Very intuitive. It is very safe to assume the floaters will not return. The vitreous is not regenerated. It is a vestigial tissue (something needed for embryonic development and that’s it) and is not needed once we are born. The only function of the vitreous, after development, is to possibly “plug” gaping wounds in the eye in severe trauma.
There are slight risks of retinal tears developing during any intraocular surgery, such as vitrectomy and cataract surgery. To answer your question, however, yes, removing the vitreous does decrease the likelihood of developing a retinal tear and, thus, a retinal detachment. Often a vitrectomy is performed in cases where patients have repeated retinal tears.
The procedure is performed in the operating room under sterile conditions and as an outpatient.
Nice to meet you. Hope this was helpful.
Randy
hello doctor,
after having a virectomy(floaters) and lets assume it was sucessful,are there any long term risks of any kind that one needs to know?
thank you
Hello Dr Wong,
I have recently developed a many small floaters and a few strands in each eye. Doctor said there was nothing evidently wrong. Even though my case is not nearly as bad as many here I was wondering, do you treat patients with just large floaters or do you also treat them with many small ones? It is like a snow globe for eyes and it has sent me into a great depression. Thank you for your time and for helping people who struggle with this.
Dear Harry,
I’d have to answer “no.” The immediate concerns are the risk of infection inside the eye and the chance of a retinal tear forming from the operation, but in the long run…pretty safe.
Good luck.
Randy
Dear Autry,
I personally never look nor regard the exact size and shape of the “floaters” that bother you. Big or small, as long as I’m convinced that you have floaters causing you angst and that you understand the few risks, you would be a great candidate for surgery.
There is no reason for depression as I believe, based upon your comment, that you can be helped.
Good luck. Hope this makes your day a bit brighter.
Randy
Dr Wong, your AWESOME!!!! There are not many doctors I have found who give hope and inspiration to people who’s lives have been so damaged and changed by eye floaters. Thank you for answering questions so quickly for all of us looking for a little ray of hope. God bless you!
Autry
One last question Dr Wong. It is stated that the onset of cataracts within a year is as high as a 50-60% chance. What would you rate the percentage of this in your own observation.
Dear Dr. Wong:
I stumbled across your website today while doing post vitrectomy research and would appreciate
your professional opinion.
I had a vitrectomy proceedure performed on both eyes. One in Oct 2010 and then Dec 201o to correct PVD and soupy floaters which greatly effected my vision. The procedure was conducted
using the 25ga 3 port process. Healing was rapid with no medical complications. However I have noticed a significant decrease in visual acuity within 2 to 5 weeks after surgery.
Prior to surgery my vision with glasses (looking between the floating debris) was pretty good. I could easily read street and road signs while driving and see images clearly on the TV screen. After about 2/4 weeks I noticed a decrease in sharpness and detail.
I had my eyes checked and purchased new glasses but the corrected vision is no way close to my former vision. I discussed this with my Retinal Specialist who stated that lenses in my eyes must have moved or changed position resulting in the loss of acuity. No other problems or complications
were observed except for a small cataract beginning in one eye. I am 60 years old.
Dr. Wong, Is this the likely cause? Your professional opinion is greatly appreciated.
Sincerely,
Vince
I had a vitrectomy Oct 14th of 2010, its been 4 months. I was highly myopic (-15) and had bad detachment (per surgeon). Cataract forming already (but it was expected). My question is regarding the vitreous, the good doctor says its needed for birth, but not life. Is it not also a “shock absorber” for the eye? Isn’t the eye more vulnerable to shock after a vitrectomy? Thank you
Hi Dr Wong,
Are you aware there is an Australian Dr Wong who is also practising in this field? Can you please help me with a query. What do you know about Lattice Degeneration? Is it all doom and gloom as Ive been led to believe? After laser treatment for this condition, which precipitates floaters, do you suggest a Vitrectomy? Please am hoping you will have some good news about this condition and that after laser treatment, it has a good outlook (pardon the pun!).
Thank you so very much. Awaiting your reply eagerly.
Dear Vince,
You did not have cataract surgery yet, correct?
My first thought is cataracts.
Randy
Dear RLK,
Your doc is right. The vitreous has no purpose, other than plugging a gaping wound of the eye after trauma, once we are born. I am unaware of any “shock absorber” functions.
Randy
Dr wong, I am a 35 year old that has had floaters for 14 years. I had gotten used to them but then seemed to get hit with a bunch in the last couple weeks that have been difficult to deal with. I especially have a hard time concentrating while using a computer. Is a virectomy something I should put off since it appears I will keep getting floaters in the future? I have nearsightedness but have no other eye issues. Do floaters settle down and sometimes leave a persons field of vision. It is the black floaters that are of most annoyance. I did see a dr and he ruled out a retinal tear. I appreciate your candor and would appreciate hearing from you. Thanks , ryan
Dr.Wong
Sorry for I have already developed epiretinal membranes and very bad floaters in my left eye. however my vision is still 20/20. the floater is getting worse and making me hard when reading and using computer….. I am wondering can I have a Vitrectomy to make both of them disappear?
Shuoyang Li
Hello Dr Wong
I am a Brazilian, 44 years old (sorry for english mistakes). In May/10 the first floaters appeared. I went to 2 retina/vitreous specialists:
The first doctor told me that I had a PVD in the right eye and this was the cause of the floaters and they would be going to disappear with time. He doesn’t do vitrectomy for floaters..
In November the floaters increased. Then I went to the second doctor, and after several exams he said that my left eye also had PVD, and my vision and retina are ok. The diagnosis is Vitreous Sineresis. He said to wait approximately 6 months and if the floaters will not disappear he is going to study a vitrectomy. Nowadays I have several floaters,(clumbs, clouds, etc) annoying me!
I have some questions:
- Beyond age, which other sineresis causes? Is any recommendation to delay it?
- Do the floaters really disappear with the time?
- About 25gauge vitrectomy, Are all the vitreous removed or only the floaters? How is the “post-operative”? How is the recover? Is it painful?
- Which is the cataract probability after vitrectomy?
- The clinic have the “Alcon – Constellation” – It is reliable ?
Thanks a lot!
Julio
Dear Ryan,
I see no reason why it needs to be delayed. They don’t really come back. Sometimes they go away and many times they don’t. 14 years is a pretty good indicator that they are not going any where.
r
If you have an ERM, both can be accomplished with one surgery; removal of the vitreous and ERM.
Randy
Dear Juio,
No recommendation to delay anything. “Constellation” is great. Nice machine.
Floaters can, but often do not, disappear with time.
During vitrectomy most of the vitreous is removed, especially the central portion with the floaters.
r
Dear Shelly,
Am not aware of an Australian with the same name. There are several of us.
Lattice degeneration can, but does not always, lead to retinal detachment. Laser treatment, if needed, should reduce the chance of a tear or hole forming.
It’s really not doom and gloom. Many people have it and never have issues.
r
Thank you Dr Wong. Could I have another question, according to my condition, which visual is still 20/20. What result can I expect?
Dr. Wong, I appreciate your repose and just have a couple further questions. What are the long term effects of someone my age having a vitrectomy? Does it increase the possibility of glaucoma later on and how serious are cataracts for someone my age? I’m 35 years old. Thank you. Ryan
Sorry, one more quick question. Would this affect my vision and could I still wear contacts after the procedure? Thanks again, ryan
Hi Dr. Wong,
I just want to know in cause of infection, is the vision is gonna be lost permanently or there is something that can be done to restore it??
thanksj
Dear John,
If one were to sustain an infection inside the eye, the result is usually permanent loss of vision. Blindness is a possibility, but the chances of this happening is quite low. To give you a comparison, patients undergoing cataract surgery have a higher chance of intraocular infection compared to patients undergoing retinal surgery.
Randy
Thank you so much Dr Wong.
Your reply is the most positive thing I have been told about my Lattice Degeneration. Your words: “Many people have it and never have issues” fills me with so much hope and joy! All Ive been told about it is all bad news and that in time it will cause blindness (even with many laser treatments Ive been told there is no guarantee it will help). I am only in my late 30s so this has been DEVESTATING for me. ;(
The fact that Im not a rare case because many others have it and that it can mean no issues and vision is fine, fills me with more joy than I can express. Thank you so much. God bless you for taking the time to reply and for your kind words of encouragement in my depression over this.
I am 30 years old. myopia -6.50, astigmatizm 0.75 in both eyes.
I have been suffering from floaters since 15 years. By the years, it increased a lot. There ara tons of floaters. My vision is very cloudy, lots of flashes, webs, black dots, halos and in pain.
I also have very small cataract in both eyes, that comes from the birth. The colors are somewhat strange. Living like this is a hell.
3 years ago, they did argon lazer to right eye. But there was not any retinal detachments. Now especially my right eye is in a very bad condition.
Last week, a specialist in Turkey offered me to do combined vitrectomy and cataract surgery. He said my retina is O.K.I have some questions to people who have already got fov and cataract together.
1)My vision is very cloudy, lots of flashes, webs, black dots, halos and in pain. Are all these caused from floaters, or cataract, or both? May they be worse after vitrectomy?
2) which IOL to use? multifocal or monofocal? what are their advantages and disadvantages?
3) my right eye visual field is narrow. when I look a point, ı dont see the sides. is this caused also from PVd.
4) I have tilted disc also:(. what are the effects of this?
thanks
glad to be of some use!
r
Dear Otacon,
Any thing that is “moving” is probably from the floaters as they lie within the vitreous. The vitreous “moves.”
Probably the floaters will more noticeable after cataract surgery due to the change in contrast.
Can’t advise you about the IOL: I don’t deal directly with them. I’d let you and your doctor decide.
Tilted discs are of no consequence with regard to either the floaters or the cataract.
Best of luck,
Randy
Dear Mr. Wong,
I am writing to you regarding me severe case of floaters. I have visited multiple surgeons, some of which are top notch in upstate new york, one is a professor at Syracuse University, unfortunately, I am unable to convince any of them to perform a floater only vitrectomy. They tell me my vitreous is health, I have a healthy eye (I believe them, no question) and would not consider a vitrectomy in my case.
My floaters have cause me to drop out of college and I am no longer able to drive and I take depression pills to try to deal with my situation somewhat. I no longer have any control of my life.
Is a Floater only Vitrectomy something you would do or even consider in my case?
I do not think I can bare another let down traveling from NY to VA.
thanks mr randy.
my vision in side is very dark and narrowing. But doctors did not see any retinal detachment and eye pressure is normal. are darkness caused from floaters? I only had argon laser from right eye, and my right eye is much worse.
I think I have the worst floaters in the world. They just blocked my vision. And what do you think about facovitrectomy?
Dear Dr. Wong;
I am 55 years old and have had very severe floaters in both eyes since I was 19. They are so annoying and present everywhere in my field of vision that I avoid doing so many things, including reading, hiking and anything that has to do with looking at stuff, Everytime I ask a doctor to perform a vitrectomy, they say my eyes are healthy, no problem. Then they say something like, “You don’t notice them when you’re out fishing and having fun, right?” Wrong. I notice them constantly every moment. My only relief from the eyestrain is sleep, and even they are present in most of my dreams. Finally, the ones in my left eye clumped together enough where the Dr. said, “Wow, you probably can’t see through that.” And I couldn’t, so he performed a vitrectomy on that eye. Now there are just very faint floaters in that eye that I remember seeing as a kid when I looked at the sky while sunbathing. They never bothered me as a kid, until age 19. At 19, when the big fuzzy floaters showed up, I had to quit skiing, because I’d get the shadows in my eyes from floaters confused with shadows in the snow due to moguls etc. I went to college, but spent much of my study time looking for a dark place to study and flicking my eyes to get the floaters out of the way. Anyway, the one operation on my left eye was successful, but he won’t do my right eye, because they haven’t clumped together in a big mass yet. Now I wear an eye patch at work to block the view out of the right eye with the big fuzzy floaters. How can I find a doctor that will perform a vitrectomy on that eye?
Hi Dr Wong. I am 56 years old and recently (1 month ago) had cataract surgery on my left eye. After 3 weeks, I developed a number of floaters in the repaired eye (a large spidery semi-circle and some clouds) as well as flashes when I looked to my extreme left. I immediately went back to my surgeon and he had his retinal specialist check me out, and he says that the retina looks fine. He attributes the flashes and floaters to an “excited vitreous” caused by the operation. That was a week ago, and while the flashes are getting somewhat less frequent, the floaters are stil there, and they appear to be even getting a little worse. Should I be worried? I feel self-conscious running back to my eye doctor again after a week…Butthese floaters are very annoying, ,and the flashes have me worried.
Dear John D.,
I can’t possibly know, without examining you, if you need a vitrectomy.
HOWEVER, if you and I agree that a vitrectomy might be of some benefit, then I could consider operating.
Please let me know if I can help further.
randy
Not a big proponent of combined phaco and vitrectomy. But that is my opinion. If your doctor(s) are comfortable performing both simultaneously, then go for it.
Without an exam, it’s tough to say for sure, but it seems likely that floaters could be a cause of your problem.
Let me know if I can help.
r
Dear Matthew,
Two options based upon your desire….
1. Where do you live?
2. Do you want to travel to Washington DC?
You may answer me privately if you want.
RWong@RetinaEyeDoctor.com
Take care. Hope to see you.
r
Dear Joe,
At best, keep the frequent appointments with your doctor.
If the floaters get dramatically worse, then make sure you tell him/her.
Overall, these should settle down, but it may take a few weeks.
Randy
Hi Dr. Wong.
Last October, I developed a severe case of floaters in both eyes. I went to see my eye doctor and he told me all was OK and to live with them. I have since seen a retinal doctor who has examined my eyes twice over the last 8 weeks. He also told me all was OK but to let him know if the floaters get worse. He also told me they may subside after 6 months. He told me I had no options for treatment and they continue to bother me.
Why do some doctors say that and you actually will perform a vitrectomy’s. This is a terrible way to live and I’m willing to take some risk to get my eyes better. Any suggestions?
Thanks:
Scott
Dear Scott,
I don’t have a great answer for you regarding doctors’ limitation of treatment. If floaters are indeed your problem, and you understand the risks of surgery, you should have surgery.
If you are willing to travel, I’d be happy to see you i consultation.
Randy
Dear randy’
This is the sixth day of post-op. Gas has not dissolved yet.my eye is bloody. According to doctor, it will take 20 days to dissolve.
what are your suggestions in order to speed up the healing process?
Thanks for your concern. You are so kind.