A patient of mine recently told me that his visit with his local eye doctor the nurse or technician told him that “people with vitreous eye floaters are all perfectionists” and that they cannot be satisfied. This attitude may be shared by the physician and may be more common after they have performed surgery such as cataract surgery with placement of an artificial intraocular lens implant. Prior to recommending cataract surgery, the surgeon should be inquiring as to the patient’s blurry symptoms. It is not enough to simply have mildly cloudy lenses (mild cataracts) in the eye as there are other causes of are vision or more generally, or visual quality. Any disturbance of the cornea, tear film, retinal diseases, and some brain disturbances can cause blurred vision. One consistent feature of eye floaters is the patient’s subjective awareness of movement. Shadows or blurring due to intermittent obscuration disturbance that is dynamic and moving are due to floaters until proven otherwise. There is nothing in the visual pathways that can duplicate this dynamic moving shadow we phenomenon that is caused by vitreous eye floaters.

So I imagine then, the eye surgeons frustration after having performed a perfect surgery and the patient returns for follow-up with 20/20 vision and yet still complains of vision and quality issues. Instead of asking about the nature of the blurring or shadows, I think that the doctor and/or the staff simply blame the patient as being a perfectionist who cannot be satisfied despite the doctors immense talent and skill.

In the doctors defense, the typical eye examination instruments are not particularly designed well for efficient for the examination of the vitreous fluid and any eye floaters that may be contained within that fluid. There are few doctors that are as interested in finding the culprit eye floaters in their patients as me as I am supposed to be the expert in this area, and quite honestly there is a much bigger payoff for me to find and treat your floater than your local ophthalmologist. That said, sometimes I have really struggled to find the bothersome floater problem or perhaps have only seen part of it and have misjudged the entire extent of the problem. This is simply due to the optical challenge. This could be an issue  for fine and delicate microscopic filaments that are located posteriorly and very close to the retina (typically younger patients) or simply very soft and translucent or transparent cobweb-like floaters that don’t have much contrast to the surrounding fluid.

And really, is entirely fair to blame the patient for being perfectionist. Would you blame your surgeon for being a perfectionist? Would you blame the engineer that designs your airplane, your car’s braking system, or your attorney when reviewing the contract you are about to sign?Would you accuse your home inspection specialist of being a perfectionist when she or she finds major defects in the home you are about to purchase? It is an insult to the patient is suffering eye floaters to accuse them of being perfectionist. Ophthalmologists, optometrist, and medical technicians you are on notice!

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