TREATMENT OPTIONS FOR YOUR VITREOUS EYE FLOATERS

There are some floaters that are caused by pathological conditions such as autoimmune disorders, infections, diabetes, and hemorrhage. The treatment for these floaters is directed at the underlying disease or disorder and not within the scope of this practice or website. The remainder of floaters are generally benign. They are benign in the anatomical and “health” aspect, but not so benign when you consider the psychological effect floaters can have on the floater sufferer. They are not so benign when you factor in the sometimes devastating effect on the quality of vision and quality of life.

If we then consider the ‘non-pathological’ vitreous floaters, there are essentially 3 viable options available + 2 other options we will mention to complete the discussion:

1. DO NOTHING and LEARN TO LIVE WITH IT, or
2. LASER VITREOLYSIS USING A YAG LASER, or
3. COMPLETE SURGICAL REMOVAL OF ALL OF ALL OF THE VITREOUS
4. MEDICAL, INJECTION, OR ENZYMATIC TREATMENT,
5. NATURAL, ALTERNATIVE, or SUPPLEMENT THERAPY

OPTION 1: “DO NOTHING AND LEARN TO LIVE WITH IT
The ophthalmology and optometry training programs spend very little time on the subject of typical eye floaters. When a patient comes to the office complaining of onset shadows, The exam is directed toward making sure these conditions do not exist (“ruling them out”) and once the doctor is satisfied they are not the cause of the floaters, rarely anything with the patient.. There are many common phrases offered as reassurance: “You’ll get used to it”, “It will drop out of the way”, “It will eventually reabsorb”, and “Just ignore it”.

Floaters are created by material that has always been in the eye. There is no reason why the eye or immune system would recognize any of it as out of place or foreign in origin. There is no natural biological mechanism to clear floaters from the eye. By doing nothing, you can only hope that they will move to a less bothersome location. The advice to do nothing is to suggest that you should try to tolerate these floaters and accept your fate for the next 10-20 years or more.”

OPTION 2: YAG LASER ABLATION AND DESTRUCTION OF VITREOUS FLOATERS:
YAG Laser treatment has been around for about 20 years. Even after 2 decades, there are just a few ophthalmologists with any significant experience treating floaters. It is technically a very difficult procedure to perform. Not all floaters can be treated and the indication and ability to treat depends primarily on the location of the floaters as well as other optical characteristics of the eye. This is the procedure offered at our office and our area of particular expertise and interest. This topic will be covered extensively throughout this web site.

OPTION 3: FLOATER-ONLY VITRECTOMY (FOV):
A surgical vitrectomy involves general anesthesia or deep monitored sedation in a surgical center or hospital. A retinal surgeon will place three incisions into the whites of the eye and insert three instruments: 1) a fluid infusion to keep the eye from collapsing, 2) a fiber optic light source, and 3) a guillotine cutting/sucking instrument (a vitrector) to cut the vitreous and remove all the vitreous material. The removed vitreous is replaced with a electrolyte salt water solution which is similar in chemical composition to the fluid in the front chamber of the eye (the aqueous fluid). The replaced fluid will eventually be filtered out through the eye’s natural drainage system and is replaced with aqueous fluid. The vitrectomy enjoys a higher expectation of removing most if not all of the floaters, but with that higher expectation carries and a greater relative risk. The commonly noted risks of vitrectomy are cataract formation (lens clouding and opacification) within the first year. This is often quoted in a range of 20-100%. In addition there are more rare incidences of retinal detachment, eye pressure fluctuations, chronic retinal edema amongst others. Because of these risks the retina specialists who perform the procedure are generally reluctant to perform a vitrectomy “just” for floaters even if the patient desires one. This treatment may be a theoretical option rather than a realistic or practical option because of the general lack of availability in finding doctors willing to perform the procedure.

OPTION 4: MEDICAL, INJECTION, OR ENZYMATIC TREATMENT.
There has been some chatter and buzz in the floater-suffering community and with questions directed to me regarding a recently approved injectable medication called OCRIPLASMIN. This medication is injected directly into the vitreous to treat a condition called Vitreomacular Adhesion (VMA). This is a condition usually associated with aging where the vitreous is partially separated, but still adherent to the central and most important part of the retina called the macula. This failure of the vitreous to completely separate from the macula of the retina can cause traction resulting in edema (or swelling) of the macula, or an actual hole in the macula. Edema alone can diminish or distort visual acuity and a macula hole can cause an actual blind spot in the central vision. OCRIPLASMIN’s enzymatic protease action has activity on the fibronectin and laminin, components of the vitreoretinal interface. The purpose of the enzyme is to INDUCE A POSTERIOR VITREOUS DETACHMENT, and generally it is successful in doing so with a statistically significant reduction of macular edema and closure of some macular holes. One of the reported Adverse Effects (AE) of the injection is to creation of vitreous floaters which occurred in 17.6% of the patients compared to 8.6% of those receiving a placebo injection. There is no distinction as to the self-reported severity of the new floaters. Ocriplasmin has not been used to treat the microscopic floaters usually associated with younger people. In my practice, most of the larger and bothersome floaters that bring patients to me are caused by posterior vitreous detachment, that is where the posterior pictures has already of the retina. My concern with the possible use of Ocriplasmin in younger patients would be the side effects and complication of causing even worse eye floaters or maybe one of several other complications associated with administration of this medication such as pain (13.3%), photopsia (12%), blurred vision (8.8%), Retina or macula edema (9.5% combined), or reduced visual acuity (6.5%). My thoughts are that it would be too risky to inject this enzyme into the eye for the above reasons. As the saying goes, “Be careful for what you wish for”.

OPTION 5: NATURAL, ALTERNATIVE OR SUPPLEMENT THERAPY
We have created a separate web page addressing the use of natural, alternative, or supplementation course of therapy. The short version is that none of these that I’m aware of have shown to be effective using generally accepted scientific principles. More on this topic HERE.

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