ALL ABOUT VITREOUS EYE FLOATERS

VITREOUS FLOATERS DEFINED: Any change to the normally optically transparent vitreous body that is significant enough to cast a shadow onto the sensory retina AND be noticed by the sufferer at least some of the time.

BENIGN VITREOUS FLOATERS: are floaters that are not related to or caused by ocular or systemic disease or abnormal pathological events such as hemorrhage or foreign material. Benign floaters are NEVER a threat to the health of the eye no matter how dense and bothersome they may be. Although they may be large enough to obstruct central vision at times, they are not a cause of blindness.

PATHOLOGICAL VITREOUS FLOATERS: are associated with abnormalities and disease of the eye or body. They may be reactive, autoimmune, hemorrhagic, metabolic, genetic, parasitic or foreign material in origin. Of these, reactive inflammation and hemorrhage are the more common. We do not treat these types of floaters.

“Vitreous Floaters are very common and can range from barely perceptible to complete blockage of the central vision. Floaters can significantly affect the quality of vision and the quality of life for those suffering them.” – The Floater Doctor

CAUSES AND ASSOCIATIONS: The most common causes or associations with the onset of vitreous floaters are AGE, MYOPIA (near-sighted), TRAUMA, and UNKNOWN. There may be molecular and/or chemical changes that occur which begin the process.

POSTERIOR VITREOUS DETACHMENTS (PVD’s): are a common event that occurs in the vitreous space. The first event that occurs is thickening of the vitreous as collagen clumps as described above. As this fluid shifts, the pooled fluid space collapses and the posterior vitreous pulls away from the retina. This separation can be partial or complete. There is a thickened ring of vitreous where the optic nerve enters the eye. This ring, when suspended in the vitreous, casts a distinct shadow and is known as a Weiss Ring floater. It may be a ring, partial ring, or just an amorphous clump but it is typically denser and more fibrous than other types of eye floaters. Approximately 25% of 60 year-olds and 60% of 80 year-olds have had a posterior vitreous detachment. PVDs can occur at a younger age, but it is rarer.

DEVELOPMENT OF THE DIFFERENT TYPES OF EYE FLOATERS:
Vitreous floaters can also be random condensations of the vitreous and come in several varieties or in combinations. They can be small and distinct, stringy like cobwebs, diffusely hazy, or soft and cloudlike. Typically, there is a combination of types of floaters present.

The three most common types of vitreous degenerations are LIQUIFACTION, SHRINKAGE, and OPACIFICATION:

i. LIQUIFACTION (or SYNERESIS) is an aging process but is also associated or accelerated by nearsightedness (myopia), trauma, intraocular foreign material, and other obscure causes. On examination, the doctor may see a slight haziness to the vitreous, and it may swirl around with more mobility than normal vitreous gel.


ii. SHRINKAGE (also Posterior Vitreous Detachment = PVD) is the continuation of the process of liquefaction. As more clear fluid is extracted from the collagen network, the remaining vitreous will shrink and possibly separate from the surrounding wall that is the retina. This separation is commonly associated with shifting of fluid pockets as described above in the posterior vitreous detachment example.



iii. OPACIFICATION
is due to continued collapse, coalescence, and condensation of the collagen network. In some cases they may be quite mild or imperceptible except under very specific circumstances or they may be visually debilitating with fixed blockage of the central part of vision or anything in between.

PSYCHOSOCIAL IMPACT OF EYE FLOATERS:
No discussion of eye floaters would be complete with a discussion of the impact of floaters on the psychological health of the floater sufferer. Most of our patients are highly functional with excellent measured vision on the eye chart (even if we have to wait until the floaters move out of the way). Most would be able to pass any vision and eye health examination as their vision chart acuity, peripheral vision, color vision, contrast sensitivity, eye pressures, and anatomical structures are all normal. What isn’t tested is the subjective awareness and annoyance that eye floaters cause. Most people with floaters will pass any eye exam as normal and healthy. What isn’t ever tested for or recognized is annoyance, anxiety, depression, and sometimes despondency associated with eye floaters.

We have seen diffuse and seemingly significant floater complexes that didn’t seem to bother the patient much, and we have seen people put their life “on hold” for the most microscopic of floater debris that is undetectable by most examination techniques. Dr. Johnson has noted that “Floaters are seen through the filter of the sufferer’s personality”. Different personalities respond to the eye floaters differently and it is a travesty and a shame that our profession has continued to ignore, or flippantly disregard floaters as nothing to worry about.
Most eye doctor’s platitudes of reassurance such as “It will go away over time“, “Your brain will learn to ignore it“, or “It will eventually drop out of the way” help only in the short term to get the patient out the door. What about when they don’t go away, or the patient can not simply ignore them?

The Floater Doctor’s mission at Vitreous Floater Solutions is to treat what has previous been considered untreatable and to relieve patients of the constant, unrelenting burden caused by the vitreous degenerative condition that is eye floaters.

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