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. Fagner Kisner says:

    Dr. Young, I’m Brazilian 31 years, many eye floaters right, I have no PVD, I follow your site to 2 years, and their website encouraged me to do the vitrectmomy, my surgery is scheduled for 4/28/14, the surgeon said that surgery is 98% reliable, but is worried that my surgeon will not induce a PVD will only remove the nucleus is located where the vitreous floaters, my fear is to stay with the “frill” and get even more depressed . He commented that not induce PVD to decrease the risk of dislocation and cataract, my question is what are the chances that I get the “frill” after the FOV, have until 27/04 to decide.

    Tank You Dr.

  2. Hi Dr Randall,

    If i have a very thin retina, would eye movements increase the chance of a tear? i am afraid since i have a habit of trying to catch my floaters and in the process, tend to jerk my eyeball back n forth. would this movements aggravate or provoke a tear?

    Thanks for ur clarification!

  3. Dear cindy,

    I don’t think you are hurting yourself. Remember that during REM sleep, your eyes beat back and forth rapidly and forcefully.

    Randy

  4. Fagner,

    How did surgery turn out?

    Randy

  5. Hey randy its been a while,things have been great up until a couple of days ago,I noticed some visual anomalies in my left eye,im no doctor but I think I might be getting a pvd,I know one of your patients had this problem and he ended up betting it removed,im going to see an opthamologist to see whats up,I just wanted to know your thoughts?

  6. Paul,

    It’s possible that you’re getting a PVD. What symptoms are you having?

    r

  7. I had flashes for a few days,and now I have floaters theyare semiattached,Idont have any tears,I got checked .I belive your assesment is right though.

  8. Paul,

    Glad to hear!

    Randy

  9. Nikolay says:

    Dear Dr. Wong,

    In one of the comments on this site, you mentioned a patient who was chronically infested with S. aureus, and got an eye infection after FOV. I’ve had S. aureus as long as I can remember, mostly in my throat, but also skin, etc. Does this mean I’m not a candidate for FOV? Do I have a significantly higher chance of losing the eye to infection?

  10. Nikolay,

    No, everyone has S. Aureus. This does not alter your candidacy for the operation.

    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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