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New Website for FOV and Webinar!

Vitrectomy for the removal of Floaters, Randall Wong, M.D.I have started a separate website for patients suffering from floaters and have scheduled two webinars to discuss the treatment of floaters.

There are many patients who have “floaters” which decrease their vision.  “FOV” means “Floater Only Vitrectomy” where a vitrectomy is performed to remove the vitreous, and hence, the disturbing floaters contained within.

Webinars:  FAQ’s about FOV

I have selected two separate dates to host the webinars and to discuss the more common questions and concerns regarding the treatment of floaters.  The information should be similar and have been scheduled at different times of the day and week to allow for as many time zones as possible.

You can register for either one or both.  They are free!  Just click to register.

“FAQ’s About FOV” (Webinar)


New Website:

I started a new website for patients suffering from floaters.

I do not want to bias this site ( with information and discussion about floaters and felt that it was time to start a separate site.  Also, there are numerous forums and chat rooms for patients suffering from floaters.

I wanted to start a place where constructive and accurate information about floaters and their treatment could be discussed.  I’ve never felt comfortable “invading” other sites, so I started my own website.

What Does this Mean?

I’m proud of everything we’ve achieved on this site,  I’d like to duplicate this type of community on as I understand the needs of the two communities will be different.

The website is technically up and running, but will require a bit more effort to get some quality content so it may stand on its own.

If you are interested in signing up for the webinars, they are free.  The webinars will present the same content and I expect the Q & A sessions to be similar.

See you there and on the new site!


What is the Vitreous?

A Posterior Vitreous Detachment May Cure VMT
The vitreous is a gel-like substance filling most of the eye.

The vitreous is the gel-like substance which fills most of the inside of your eye.  The vitreous is composed mainly of water and is very similar to a jelly-fish; i.e., a substance which is mainly water, but still has substance.

The vitreous fills the posterior chamber of the eye which is the space behind the iris and the lens.

Purpose of the Vitreous

The vitreous is a vestigial tissue.  Like the appendix, it serves no purpose.  Important for development, once we are born, there is no physiologic function.  We don’t need it.

When I examine patients, I am able to see your vitreous; however, your own vitreous is usually invisible to you.  In other words, light gets transmitted perfectly through your own eye and vitreous without casting shadows or creating any visible shapes.

It is normally optically clear.

Other than filling space, it serves no purpose.

Diseases of the Vitreous

There are no diseases of the vitreous.  Blood (vitreous hemorrhage) and inflammatory cells (vitritis) may accumulate in the vitreous, but these conditions arise secondary to other complications or diseases of the eye.

The vitreous can; however, cause a variety of problems.  In fact, almost every surgery performed by a retinal specialist involves the vitreous.  Below are common indications for retinal surgery and all involve the vitreous in a variety of ways.

Removing the Vitreous is Safe

When operating, I often perform a vitrectomy.  Vitrectomy surgery basically involves removing the vitreous and is a basic part of almost every retinal operation.  When performing an FOV (vitrectomy to remove floaters or blood), simply removing the vitreous is curative.  With other conditions, the vitreous needs to be removed to facilitate operating on the retinal surface.

Modern vitrectomy operations are now safer than modern cataract surgery.  25 gauge technology allows me to operate more safely and efficiently with more comfort to you and a rapid healing time.

What Does this Mean?

Without the vitreous, there would be far fewer retinal surgeries, if any at all.  The vitreous only causes problems.  In general, removing the vitreous is curative for the retinal diseases listed above.  This also explains why most of the diseases are unlikely to recur after an operation.

Luckily, with modern instrumentation, removal of the vitreous has become “routine” compared to even 5-10 years ago and my ability to restore your vision and prevent complications has never been better.



Webinar: The Evaluation and Treatment of Floaters

I 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 interested is welcome to register.

What is a Webinar?

Our webinar on floaters will be a live presentation, followed by real-time interactive discussion.  Specifically, I plan a short Power Point presentation followed by a question and answer (Q & A) session.  The whole event will last an hour.  I’ve scheduled two different times to accommodate as many different people and their schedules as possible.

This is a novel idea and I’d love as much participation as possible.  Please spread the word via your own links and communities.

Webinar for Floaters

Webinar for Floaters, Randall Wong, M.D.Why a Webinar?

I really hoped to do this via a Google Hangout, but it seems, at this time, the number of participants is limited.  I am probably overlooking something, but have decided to go with a webinar.

As with a blog, webinars are interactive. Unlike a blog, the interaction is live and in real-time.  I am looking forward to communicating in real time with so many of you who have sent in comments over the past few years and look forward to greeting many more you…online!

I chosen a subject, floaters, or vitreous opacification, which is very common.  Floaters are very common and can be from a variety of causes.  Floaters, depending upon the causes and/or visual goals, may or may not need to be treated.

We can discuss Ocriplasmin, Laser Treatment, FOV….whatever you want!

My point is that many, many of you may find relevance to this particular subject and presentation.

You Must Register

Simply  click on the links below and follow the directions.  Participation and registration are free.

Tuesday, February 5, 9 PM EST

Sunday, February 10, 3 PM EST

What Does This Mean?

Really trying to try a new way to interact with my online community.  This will allow me/us to interact with one another simultaneously, versus reading a thread on the blog.  This may prove to be very exciting, stimulating and informative!

See you there!

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


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

Vitrectomy for Floaters (FOV)

A vitrectomy is the basic operation used by a retina specialist for treatment of blood, epiretinal membranes, macular holes, retinal detachments and…floaters.

There is no difference between a vitrectomy for floaters (FOV) and a vitrectomy for removal of blood, macular pucker, etc.  In all cases, the vitreous must be removed to allow me to safely operate on the retina.

In the case of the FOV, once the vitreous is removed (and the floaters), the operation is complete.  In a way, it’s a partial operation.

3 Port 25 gauge Vitrectomy System

I use this type of system almost exclusively.  The “25 gauge” instrumentation requires small ports, or holes, to be made for passage of the instruments into the eye.  While this does dramatically reduce the operating time, it also significantly speeds the healing process as there is much less cutting on the ocular tissues.

The holes are self-sealing and do not require stitches.

Removal of the Vitreous Floaters

The instrument, a vitrector, rapidly “sucks and cuts” the vitreous hundreds of times/minute.  The vitreous is adherent to the retina.  Pulling on the vitreous could cause a retinal tear and then a retinal detachment.

This rapid succession of “sucking” and cutting makes it almost impossible to pull on the retina.

In many cases, the protein makeup of the vitreous has changed and the floaters, seen commonly as dark dots, move “to and fro” within the eye.  The vitreous is the only area in the eye where objects can move in this fashion.

Treatment of Floaters

FOV is the most viable treatment for floaters.  I recommend surgery if the opacities are bothersome, move to and fro and you understand the risks of surgery.  I prefer the floaters to have been present for several months.  After this time, they are unlikely to go away.

I do not perform laser for floaters and am not aware of any retina specialists who do.  I recommend against laser treatment as I believe the risks are too high for causing tears in the retina.

About the Video

I’ve been asked by several followers to publish such a video.  I thank “floateredeyes” for his patience in gently reminding me to get this done.

The movie was recorded directly from the operating microscope onto my laptop.  We used ONLY iMovie (the program and background sound).

What Does this Mean?

There are a significant number of patients suffering from floaters.  Too often, these patients are scolded and advised to “get used to them.”  Vitrectomy surgery is as safe, or safer, than cataract surgery and can be a viable option and life-changing.

Just as others want and need cataract surgery to improve vision, patients plagued with floaters can be helped.


Floater Only Vitrectomy: No Different than Cataract Surgery

Vitrectomy eye surgery can remove floaters.  So-called “floater only vitrectomy,” or “FOV” is a comparatively simple procedure compared to other operations a retinal surgeon can perform.

Floaters Can Reduce Vision

While these are common, most people are able to tolerate them over time.  There are, however, patients that have floaters so large and dense that the vision is reduced.  (Remember, the acute onset of floaters needs to be checked out to ensure that you don’t have a retinal tear!)

A vitrectomy is part of most surgery performed by a retinal specialist.  Usually, however, the vitrectomy is performed to allow repair of a macular hole, removal of an epiretinal membrane (video of vitrectomy and then removal of ERM) or to fix a retinal detachment.  The purpose the operation is to remove the vitreous, thus allowing surgery to be performed on the retina.

Floaters reside within the vitreous.  Thus, with FOV, these offending “spots” or “cob webs” are removed as the vitreous is removed.  The operation is then complete!

Vitrectomy for Floaters is Safe

Many physicians do not recommend this surgery, but would recommend cataract surgery.  This makes little sense.  The reasons include hesitation to operate on an otherwise healthy and normal eye, but for some reason this same reasoning does not apply to cataract surgery.

Risks of vitrectomy surgery include blindness from infection or retinal detachment.  These risks, however, are the same as having cataract surgery or any other eye surgery.  In fact, the risk of infection with this retinal operation is lower than cataract surgery.

Indications for Vitrectomy are the Same As Cataract

Patients interested in cataract surgery choose to do so when the vision is decreased and it interferes with their daily activities and hobbies.  Cataract surgery is performed to remove the cloudy lens and restore the vision.

Patients who have decreased vision from floaters can also have their vision restored, when they, too, experience decreased vision and understand the risks of surgery.

Alternatives to Vitrectomy

In my view, the only alternative is observation, that is, do nothing.  There are a few doctors who advertise the use of a laser to break up floaters, but it is usually not covered by insurance, nor are the performing doctors retina specialists.

What Does This Mean? There is hope for those who have decreased vision from floaters.

Most patients have been told, over and over again, that they just have to “live with it.”  As long as patients understand the possible complications and are sure that we are dealing with true floaters, the procedure is a possibility.  This summer alone I have had several patients travel from around the country seeking help.

For doctors that don’t agree with me, the decision to perform a “floater only vitrectomy” is no different that making the decision to perform cataract surgery.  Complications are few and can happen in either case, yet in both instances, the patient sees better.

So why suffer?


Eye Surgery Removes Floaters

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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Floaters, Are They Normal or due to Diabetic Retinopathy?

Floaters are generically defined as black spots in your vision.  They move to and fro with eye movement.  Most of the time they are small, tiny and black, but really can be large and translucent, too.  From a doctor’s standpoint, size does not matter.  New floaters can mean a retinal tear and the development of a retinal detachment.

Floaters can develop from a variety of causes such as a posterior vitreous detachment (PVD) or a retinal tear.  A posterior vitreous detachment (PVD) is a normal occurrence and happens more frequently as we age, with increased near-sightedness (eye slightly larger) and with trauma.  The vitreous is the “gel” that fills most of the eye.  With time it will separate from the surface of the retina and usually produces the sudden onset of new floaters  (For additional article on floaters/flashes, click here).

A PVD can cause a retinal tear.  It usually does not, but it can.  New floaters require a dilated eye exam to exclude a tear in the retina.  Patients are usually at highest risk for developing a tear following a posterior vitreous detachment for the first 6 weeks following symptoms.  Retinal tears can develop into a retinal detachment if not treated.

Occasionally, a vitreous hemorrhage can result from a retinal tear.  So, add this to the list of causes, too.

Floaters and Diabetic Retinopathy In a patient with diabetic retinopathy, new floaters can be related to a PVD or retinal tear just as any other person without diabetes.  New floaters; however, can also be related to the diabetic retinopathy and are caused by a vitreous hemorrhage.  Bleeding into the vitreous is caused by the presence of abnormal (aka neovascularization) blood vessels on the surface of the retina.  This signals the development of proliferative diabetic retinopathy.

What to you need to do? In any case, alert your doctor to your new symptoms.  It is recommended that you get a dilated eye exam to look for a posterior vitreous detachment (PVD), vitreous hemorrhage or retinal tear.


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

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Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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