Vitreous Floaters: Evaluation and Treatment

What are Floaters? Randall V. Wong, M.D. Retina Specialist, Fairfax, VirginiaVitreous floaters are any spots or shapes which move back and forth with eye movement.  Floaters are very common and can arise from a variety of conditions.  New onset floaters should always be checked to ensure there is no tear in the retina or signs of other disease.

Floaters may be from blood, cells from underneath the retina, inflammation, asteroid hyalosis, from a PVD or from condensation/changes in the proteins within the vitreous.

What Causes Floaters?

Blood:  Floaters from blood most commonly occur as complications of a retinal tear, diabetic retinopathy or a retinal vascular problem.

Inflammation:  Another term is uveitis.  This is like having arthritis in the eye.  Cells from the immune system (white cells) actually migrate into the vitreous and clump.  Treatment of the inflammation doesn’t always resolve the floaters.

Asteroid Hyalosis is a special benign condition where white specs normally accumulate in the vitreous.  Very similar to driving through a snowstorm, these asteroid bodies often make examining the retina very difficult.  Miraculously, most people with asteroid hyalosis don’t complain of floaters, but on occasion, some do.

Posterior Vitreous DetachmentChange in vitreous proteins are probably the most common cause of floaters.  A PVD causes floaters or a “cobweb” moving through your vision as the proteins condense or change in clarity.

The floaters can disappear, become tolerable or annoy you to no end.  They can blur or decrease your vision and cause glare.

Vitrectomy (FOV) Removes Floaters

For the myriad of you in whom the floaters don’t disappear, you can get rid of them.  Vitrectomy surgery is the safest and best way to rid yourself of the floaters.  There are a few doctors who promote the YAG laser, but none are retina specialists.

With vitrectomy, the bulk of the vitreous is surgically removed.  We don’t need the vitreous.  It’s a vestigial tissue (i.e. a tissue we need during development, but serves no function once we are born.  Another example?  The appendix!).

The vitreous is similar to jelly fish…mostly water, but has some structure (that’s why you can catch a jelly fish with a net).  With vitrectomy eye surgery, the vitreous gel, and floaters, are simply replaced with 100% water, or saline.

My Doctor Can’t See the Floaters

It is my practice to consider vitrectomy if; 1) the floaters you see definitely move back and forth with eye movement, and 2) you understand the risks and benefits of surgery.  I don’t have to actually “see” your floaters.

The vitreous is usually optically clear to you, i.e. you shouldn’t see your own vitreous.  As a doctor, everything in your vitreous, however, should be visible to me.  Large floaters can easily be seen and identified to be the culprit, but this doesn’t occur that often.

More often, I can’t see the floaters because they are either too small for me to appreciate or I simply don’t know which one is causing the problem.

Anything moving back and forth with eye movement has to be located in the vitreous and no where else in the visual pathway.  I believe the issue with “seeing” the floater stems from the fact that using a laser to treat floaters requires a “target.”

With vitrectomy, this is not necessary.

What Does This Mean?

I don’t understand why patients suffering with floaters have been discounted.  There is a clear treatment available.  The risks of the surgery have changed since vitrectomy was first invented in the 1970′s.  The procedure has become much safer and is comparable to cataract surgery.

Because of the inability of physicians to knowledgeably council their patients, there are too many myths and rumors about vitreous floaters and the treatment.  I’ll be adding articles about risks and benefits of surgery, risks of cataract formation, etc. in the near future to help set the record straight.

Randall V. Wong, M.D. 
Ophthalmologist, Retina Specialist
Fairfax, Virginia

Comments

  1. Mary,

    If you need a vitrectomy to remove floaters (FOV);

    1. Surgery would not require a gas bubble, i.e. no need to keep your head face down
    2. My patients are back at full activity in 24-48 hours, there is no reason to limit activity.

    Hope this was helpful.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  2. Lewis,

    I will have Chrissy or Andrea reach out to you.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  3. Arnold,

    Certainly we do surgery under general surgery. If you require it and it’s best for you, no problem.

    I personally do not prescribe “benzo’s,” but your primary care might be willing too.

    Hang in there,

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  4. Sandy,

    How can I possibly tell without examining you?

    Get examined and don’t wait for the wedding.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  5. Hello,

    I am looking to see you about the possibility of FOVs. I live in Canada but prefer to visit you. Im not too sure about if insurance covers the procedure or not. Hopefully i can take a trip up.

  6. Dear Dr Wong

    Words cant express the gratitude I have for what you have done for me,Its been a long difficult road and now im finaly free from this horrible affliction because of your skill and expertise. I can admit withought a shred of doubt you gave me my life back that floaters stole from me,you are the most sympathetic doctor and a great human being,its such a strange wonderful feeling not having these horrible things in my eyes anymore,you went far out of your way for me and I will sincerely never forget that. I cant speak for those of you out there on how bad floaters bother you but if they are causing you depression and ruining your life,Doctor Wong can help, he saved my life.When I was told by numerous doctors to live with them,Doctor Wong made it clear that I dont have to,The minds of the majority of doctors needs to change they need to understand that floaters truly ruin peoples lives. once again thank you and please dont ever stop helping people,theres so many other people still suffering.

  7. Dear Ty,

    When you are ready, please email Chrissy or Andrea. They can help with insurance questions/issues.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  8. Dear Paul,

    Thanks for your confidence. I am very happy for you. Thanks for sharing your success with others. Please stay in touch.

    With Congratulations,

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  9. Hi Dr. Wong,

    I recently had a ‘core’ vitrectomy for floaters in the St. Louis, MO area. Everything has been great post-op for the past 3 months. However within the last 3 or 4 weeks I have been noticing a flashing phenomenon. I went to my surgeon for my three month checkup and she said everything looked fine and she was not sure what the phenomenon was from.

    Here is my description of the flashing:
    -I only notice this flashing phenomenon when looking at a well lit homogenous surface, such as a white wall, or black pavement, and shift my gaze quickly up-and-down or side-to-side.
    -It only occurs when I am looking at these plain surfaces and they are within about 5 feet.
    -The bright flashing occurs throughout the majority of my visual field.
    -I cannot see the flashing when my eyes are closed, or when it is dark outside

    I was concerned at first that I was experiencing traction, but because the flashing does not occur with my eyes closed or in dark conditions, I am pretty sure that it is not a neural phenomenon.

    Do you think this could be the ‘frill’ symptoms that people sometimes complain about?
    Have you ever seen anything like this? And was it able to resolve with time?

    Thank you very much,
    AJ

  10. Dear Dr.
    I am planning to visit you for a consult. Could you please tell me that you are now more in favour of inducing a PVD for removing floaters? I must say I really appreciate that you are willing to improve your techniques and change the mindset. It shows that you care and are flexible for the sake of improving.

    Is it true that recovery time is much longer with PVD induction? My only fear is the FRILL issue. Other than that I think you are the best Dr. to have floaters removed. Is the price of surgery different as i reckon that PVD induction takes more time and has more risks?

  11. AJ,

    I think this may resolve with time, as long as there is no tear in the retina. You’ve explored this possibility with your retina doctor.

    I don’t think it’s frill, or at least it is not the frill that I’ve experienced. It may be, in fact, be due to vitreous gently tugging on the retina. Having had most of the vitreous removed, you’ve got a change in vector forces/currents inside the eye.

    Hang in there. Best thing is… I bet you’ve got fewer floaters.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  12. dani,

    I am much more in favor of inducing a PVD than 1-2 years ago.

    There are two issues;

    1. Decreasing floaters
    2. “Frill”

    Frill is NOT a complication of vitrectomy, but rather a disappointment though the floaters are gone. I think the best approach is indeed a PVD.

    Price might only be affected if anesthesia time is increased.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  13. So Dr. What about the risks with your new technique? I guess the risks are higher now for a tear when you induce pvd in a young individual. So how are your results with this inducing pvd now?

  14. Dani,

    This is not a new technique. Vitrectomy was invented in the late 1970′s. Technology has just improved the safety quite a bit. Risks of retinal tears are about 1-2% at most.

    Thanks and Happy Holidays!

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  15. I am a 29 year old female suffering from moderate floaters for over a year. They awful to me and I was wondering what the best way is to contact you to decide if a trip up North is worthwhile. I visited Dr Karrikhoff last year and he said nothing could be done because he could barely see my floaters and they were too close to my retina.

    But I see them all the time. Except when very dim/dark. They have impacted my work and my love for the outdoors, etc.

    I would love to speak with you about options.

    Thanks in advance, Courtney

  16. Courtney,

    Sounds very likely that I’d be able to help. The best way to move forward would be through either Chrissy or Andrea. I’ll have one of theme contact you via email over the next few days.

    Look forward to meeting you!

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia 22030

    TotalRetina.com

  17. Im 25 an have been suffering from floaters for over a year now. I realize this is not as long as some people but I can honestly say I can’t live the rest of my life like this. Every doctor I approach does not seem to be concerned with this and says surgery is out of the question in regards to risk. Is this true? Also I find myself wondering how things would look seeing through water rather than this jelly material that is normally contained within the eye. Does it differ?

  18. Dear Dr. I did not mean the new technique as in the vitrectomy. I meant the fact that for you the FOV for floaters will be more and more done with INDUCING a PVD. This is also not a new technique in general. But it is your new Technique and approach for dealing with floaters. My question is are u comfortable with inducing PVD’s in young people and what are the risks in your eyes for RD. In the past you always had arguments against PVD induction and for CORE. I want to know what are the arguments now that made you turn 180degrees. You have my full respect for this turn and courage. I know it is because you want the best for your patients.

  19. Taylor,

    I’ve started a website for floater sufferers. Please visit and subscribe?

    http://www.vitrectomyforfloaters.com

    Here’s an article from there about the safety of vitrectomy or FOV.

    http://vitrectomyforfloaters.com/fov-vitrectomy-is-safe/

    All the best!

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  20. Dani,

    As you point out, I’m now more in favor of inducing a PVD, especially in young patients.

    I’ve had a few young patients in whom “frill” has really become a psychologic issue for them. Though the floaters are absent, the frill is bothering them even more. My best guess about frill is that their vitreous is indeed different, too. Thus, PVD is the best answer as it allows the most efficient removal of more vitreous.

    There are excellent techniques for creating a PVD to minimize the risk of retinal tears. My own experience is quite favorable with regard to minimizing the complications of retinal tears.

    I hope this was helpful.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  21. Dear Dr. Wong

    Could you please explain what does “frill” mean? I mean when for people after vitrectomy this frill disturbs more than floaters before? What are the chances of that frill? And how to reduce them?

    Regards, Kirill.

  22. Dear Kirill,

    “Frill” is not a clinical term but is used by certain patient describing an “edge” in their vision following vitrectomy. Curiously, it only develops in patients who’ve had FOV (vitrectomy for floaters) and NOT in patient who have undergone vitrectomy for other causes. In 23 years, I’ve never had a patient complain of “frill” after having vitrectomy for other reasons.

    You are right, many obsess over the “frill” though the floaters are removed. Moreover, this is viewed as failure though the floaters have been removed and the eye remains healthy.

    Chances of frill decrease with age. To me, as I said in a previous email to you, there may be two problems. The “frill” may only be realized after vitrectomy as there is now contrast between where the vitreous has been removed and remaining “abnormal” vitreous.

    Because of the above, I find myself inducing a PVD more often.

    Here’s the article, with video, of inducing a PVD

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030
    http://www.vitrectomyforfloaters.com

  23. Dear Doctor Wong
    i want to know that when you are performing fov and the you replace vitreous gel with saline solution
    in long run of life doesnt the saline make any problem or still it work the same vitreous please
    add more information about the saline after FOV . vitreous VS saline

    Thanks have great time sir

  24. Dear docot Wong

    could you please add more information relevant to vitreous VS Saline solution
    how it react in long run of life

    Thanks

  25. one more question sir the posibilty of retinal tear or retinal detachment is possible during surgery ? or after if after
    it occur maybe a month year or maybe not, it would be great if you add brief information about that ?
    Thanks Dear Doctor Wong

  26. darren chew says:

    Hi Dr wong,

    I am not from the states but i come to know about your practice through your youtube videos. I am extremely concern with issues regarding the retina since i have already experienced 2 torn parts of it.

    There are few questions which i hope you can answer to give me or rather the general population a sense of peace.

    1.) If i normally already have floaters, how do i know it is time that i have to see a eye specialist. When people say a shower, what does a shower constitute?

    2.) If i have a habit of moving my eyeballs up, down , left , right etc. constantly, does this movement causes the retina to tear since i have read somewhere that moving the eyeball causes the currents inside the vitreous to move. Hence, would it cause a tear?

    Thanks so much Dr wong

  27. shahzadah,

    During the vitrectomy, the vitreous is replaced by artificial saline. This is replaced by your own saline within 24-48 hours. There are no known complications of this.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  28. shahzadah,

    I am not aware of any difficulties with using artificial saline during an eye operation: cataract or retina.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  29. shahzadah,

    Retinal tears and possible during surgery. At the end of every case, your surgeon should look carefully for retinal tears that may have occurred during surgery. Retinal detachments resulting from a retinal tear usually occur soon after surgery.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  30. Darren,

    1. Normally we recommend that a sudden increase in the number of floaters or flashes should provoke an examination. If the floaters have been longstanding and you’ve had an exam, probably you’ve done everything you can.

    Be aware of NEW floaters.

    2. Your eyes are constantly moving when you are reading, walking or driving. These saccades are impossible to control. Also, tremendous movement occurs during REM sleep.

    So, no. Simply moving your eyes do not cause tears.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  31. shahzadah says:

    Dear Doctor Wong
    Thank you soo much you are helpful and a big hope for floater sufferers may god bless you and every wish you have come true . Keep practicing and help people the purpose you are born to this planet is to help people thanks sir for your time :)

  32. Hello!
    My 17 yo son was diagnosed with asteroid hyalosis today. For the last few weeks he’s complained about seeing “rain drops” and “heat waves” except when it’s dark.

    This is a very young age to start living with this condition. The eye doctor told him to ignore it and his brain would get used to it.

    What are your thoughts?

    Dana

  33. Shahzadah,

    Thank you for reading and your comments.

    Randy

  34. Dana,

    This is a tough case. Usually patients with asteroid hyalosis have no symptoms. The copious white “calcium soaps” suspended in the vitreous are sometimes so thick that it becomes difficult to see and examine the retina.

    It would be very difficult to determine if he has symptoms from the asteroid, but if he is “seeing things” he might benefit from a visit to a retina specialist. I personally would want to know if he can tell if the “rain drops” and “heat waves” seem to be moving with eye movement.

    If so, they are likely caused by the vitreous “swishing” to and fro.

    Where do you guys live?

    Randy

  35. Dear Dr. Wong,

    I am 37 years old. I am suffering from floaters too and I am interested on long term expectations after a FOV ?

    * What happens when the PVD happens in later years? Is there another vitrectomy needed
    to remove that loosley, wobbling bag then? Or is this bag barely visible?

    * Are there experiences how long does it take in that to develop a cataract with 37 years?

    * Is somebody still a candidate for premium IOLs after FOV?

    * Is the risk for developing a glaucoma much higher after vitrectomy because
    of increased intraocular oxygen level.

    thank you very much,
    I appreaciate it very much what you are doing in your “forum”,
    br Al

  36. Hi Doctor Wong,

    Thanks a great deal for the information you have on this site concerning floaters. I’m 33, my heavy floater onset came about 3 years ago and I was wondering if I would be a good candidate for the possibilities of treatment for them.

    I’m designer/photographer/visual effects artist and it’s greatly affected my profession/personal life during this period, I even moved my entire life from CA to the NY area because the visual noise from the skyscrapers help give me some relief.

    I saw 3 eye doctors, the first two didn’t care to sympathize with my condition, but the third did inform me they were caused by a clean, natural PVD in both eyes, so from what I’ve researched I hear that makes vitrectomies a lot easier, is that true?

    Thanks for any info!

  37. Al,

    * PVD happens once. If you’ve had vitrectomy and a PVD is not induced, it may or may not be visible. Most patients with PVD do not notice floaters.

    * No standard time. Everyone gets cataracts. Cataracts are like grey hair…usually occurring as we are older, but can happen easily in young people.

    *Yes, candidacy for FOV and Premium IOL are separate.

    *Glaucoma – no one knows for sure, there is no proof, just conjecture at this point. My personal bias is that it doesn’t happen, that is, I don’t seem see a lot of glaucoma develop in all my patients who’ve had vitrectomy – for all reason.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  38. Dave,

    Make sure to visit my new site http://www.VitrectomyForFloaters.com

    Performing a vitrectomy on a patient with PVD makes the operation the quickest and easiest. In addition, in my experience, if your floaters are related to a PVD, you’ll be very, very happy afterwards.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  39. I have many floaters of line shapes in my right eye, the doctors can not see them after dilating the
    pupils, so I wonder if they could be in the premacular bursa rather than in the viterous.
    If floaters exist in the premacular bursa area, could surgary still remove them?
    If there any way to make certain the location of the floaters? whether they exist in the viterous or
    premacular bursa?
    in addition, my right eye has experienced pain, swollen feelings, especially when I close my eyes,
    what is the cause of this?

    thank you

  40. Hi doctor Wong,

    Can you have the FOV surgery if you have lattice degeneration?

    Best regards,

    Moses

  41. Mario Cataldo says:

    Doctor Wong

    Thanks for your information

    how old are your young patients who complain of “frill”?

  42. Moses,

    Absolutely!

    Vitrectomy/FOV is not impacted by having lattice degneration….a normal finding in many patients.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  43. Mario,

    The couple of patients I have who have “frill” are about 25-30. It’s why I advocate inducing a PVD.

    All the best! Please visit my new site: vitrectomyforfloaters.com

    Thanks!

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  44. Jenny,

    As long as what you see move “to and fro” with your eye meovements, then a vitrectomy should be very helpful – premacular bursa or not. I’ll attach and article from my other site about the premacular bursa being a concern only for laser.

    Basically, with vitrectomy, the premacular bursa doesn’t matter.

    Pain and swelling – I can’t answer this without examining you….my regrets.

    All the best.

    Randy

    Randall Wong, M.D.
    Retina Specialist
    Fairfax, Virginia 22030

    http://www.VitrectomyForFloaters.com

  45. Fedor Nikolaev says:

    Hello. I have floaters in both eyes. Tried laser treatment but without good results… Planning to do FOV. Local doctors in my country aren’t sympathetic like you and doesn’t want to do it. Can I travel to US to have FOV with you? Also, interested in cost of operation for one eye.
    Except from floaters I have moderate dry eye and my cornea reacts very badly to anesthetic drops. Can this be a problem?

    P.S. I write here two days ago http://vitrectomyforfloaters.com/contact-us/ but still doesn’t receive an answer.

  46. Larry Berube says:

    Dr. Wong;
    thank you for your very informative website. Following new lens implants, the lining of both retinas began coming down but remain attached to a small part of the retina. The vision recovery from the implants was excellent. But, I am plagued by huge floaters that prevent me from doing close work and sometimes driving especially at night. I was told that doing a vitrectomy for floaters was not safe due to some lattice degeneration. They are extremely sight impairing when I move my eyes to and fro ( exe: driving and checking my mirrors). They are like pendulums swaying to and fro, caused by the vitreous lining on the retinas still partially attached to the retinas. Is a vitrectomy possible with this condition?

  47. Fedor,

    Sorry about delay. Did not get your message from the “contact us” page. Seems to be working.

    I can only respond when time allows. I hope you understand.

    I will have Chrissy email you separately regarding costs and scheduling appointments.

    Moderate dry eye should not be a problem. We won’t use anesthetic drops during the operation.

    Randy

  48. Michael Cipriano says:

    I am considering having this procedure done and am trying to determine which eye I should do first. My darker more annoying floaters are in my right eye and so I was leaning towards doing the right, but my vision is actually better in my right eye than my left. Eye doctors have told me that floaters are usually worse in the eye that is more nearsighted but for me that is not the case. Does this mean that my left eye will soon be even worse than my right? Or is it just a myth that you get more floaters in your most nearsighted eye?

  49. Larry,

    Vitrectomy is very safe with/without lattice degeneration. You are not getting good information. If there is any question about retinal detachment and lattice degeneration, laser treatment can be helpful either at the time of vitrectomy or beforehand.

    You can be helped!

    Randy

  50. Michael,

    Hard to say, but if the floaters are worse in your right….consider going with the right.

    No way to tell if the left eye will change.

    Randy

Trackbacks

  1. [...] am hosting my first webinar.  Two similar events to review the evaluation and management of floaters.   The webinars will be live and I plan to present the same material.  They are free and anyone [...]

  2. […] Floaters are anything (specks, dark spots) which move to and fro with your eye movement.  Floaters are located within the vitreous, the gel-like substance filling the eye, and cast shadows on to your retina. […]

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