MY DOCTOR SAID MY FLOATERS ARE TOO CLOSE TO THE RETINA TO TREAT. IS THAT TRUE?

I will sometimes receive a message form an eye floaters suffering prospective patient who has undergone a thorough eye examination from their local, well-credentialed ophthalmologist and was told that their floater was not treatable due to its location. I have some thoughts and comments on this situation.

I will not address the even more common situation where the doctor says nothing can/should be done. That is worth its own discussion (oh, wait, I already wrote about that HERE). I am referring to the eye doctor who is at least aware of the use of the YAG laser to treat eye floaters as a legitimate option. They may take more time and put more effort into the evaluation of the patient’s complaints and show a bit more empathy for the patient.

There are a few important problems with their well-meaning declarations and pessimistic prognostications:

1. Most ophthalmologists are not familiar with the criteria for treatment with the YAG laser in treating eye floaters. They may be more than competent and in fact at the top of their game. There simply is no training course, continuing medical education classes, or articles that would educate the general ophthalmologist in this regard. There is no standardization, white paper guidelines, set of standard operating procedures, or cookbook approach to evaluating and treating floaters.

2.  The instrumentation and optical instruments normally used in a dilated eye examination are not really ideal for evaluating the extent, type, and position of the floaters withing the eye. The slit lamp biomicroscope is better designed for microscopic evaluation of the front structures of the eye (Cornea, iris, lens), and the binocular indirect ophthalmoscope is better for examination of the retina in the back of the eye. When the doctor switches from one to the other, he/she effectively skips right over the vitreous fluid. In addition, the typical examination ophthalmoscopes tend to ‘compress’ the visual image and might make floaters appear closer to the retina than they actually appear. The vitreous is best examined with a contact lens at the microscope with a lens that has a focal length specifically designed for examination in the middle of the eye where the vitreous and the floaters are located.

3. But what if your doctor sees a floaters in the middle of the eye, safely away from the retina and lens. That sounds favorable. All we know in this instance is that your doctor saw a density within the vitreous. He/She saw ‘something’, but we don’t know if what they saw is the actual culprit eye floater. The one or ones that are responsible for your symptoms.

You when it really come to summarizing your doctor’s declarations regarding the positions of your eye floaters and the potential for their safe and successful treatment with the YAG laser, I can not rely on your doctor’s examination. There is probably one exception: The instance where a patient over the age of 45-50 has a sudden onset of a main density or cluster of a floaters, that you examining doctor readily saw on examination AND further declared that you have experienced a posterior vitreous detachment (PVD) and that your eye floater has a name, the eponymous Weiss Ring Floater. With that descriptive cluster, I’d say there is about a 99% chance the floater floater can be treated.

In the absence of that circumstance, you, like almost everyone else will need a personal evaluation by Doctor Johnson in his Southern California office to best determine if you are a candidate for treatment. The good news, though, is that if he or she said you were not a candidate for treatment, they may be wrong and you may be able to get some relief from your eye floater.

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