WEISS RING FLOATERS – EVERYTHING THAT MAKES THEM SPECIAL

For much of my practice I assumed that Weiss Ring floaters should be capitalized  as if they were eponymously named after the first doctor to describe them, probably some Austrian, German, or Swiss eye doctor in the 19th century. I am probably wrong. The German word ‘weiss’ simply translates to “white” in English. Weiss ring may simply be descriptive. When you illuminate these floaters in the eye, they appear as white or light cream colored, dense, hyaline (from Greek, glass-like) densities.

Weiss ring floaters do not need to be a complete ring. They may be a partial ring, a dense clump, a semi-transparent sheet, or other, but they do still have some characteristic identifying features that distinguish them from other cloudy (synersesis type), or cob-web strand types of floaters.

Floaters are not formed over time, but instead they pre-exist. They are a particular density of the vitreous cortex that originates at or surrounding the optic nerve as the optic nerve enters the eye. Until they separate from the retina, they are not seen by the examining eye doctor and they are without any symptoms.

Normal eye without floaters
NORMAL EYE WITH CLEAR VITREOUS. The clear vitreous fluid takes up most of the volume of the eye. The vitreous is mostly (99% water with about 1% collagen proteins dispersed evenly and homogeneously throughout. These proteins make the vitreous a bit like dilute Jello: watery and ‘jiggly”.
Very early separation of the vitreous from the retina.
EARLY POSTERIOR VITREOUS DETACHMENT: The vitreous also has an outer layer, the vitreous cortex. It also consists of collagen proteins, but it is more organized.  The main vitreous fluid is like Jello, whereas the vitreous cortex is more like a sheet of transparent plastic. Here, the vitreous cortex is just beginning to separate from the retina. At the optic nerve area, there is a particular thickening of the vitreous cortex ‘sheet’. This ring-like thickening is the weiss ring.
The vitreous has completely separated, There is both a Weiss ring and some separate cloudy floater (syneresis) formation.
Here, the vitreous has mostly separated from the retina. It is a mostly ring-like structure that is integrally part of the (in fact, just a thickened part of) vitreous cortex ‘sheet’.  Given a little more time (days to a few weeks) the weiss ring will move more anterior (in this illustration, to the left) and will typically settle and stabilize in the mid-portion of the vitreous. In this illustration, there is also a hazy, cloudy and less-distinct, syneresis-type floater just to show that weiss rings are not necessarily all by themselves.

So here is the good news:

  • There can only be one posterior vitreous detachment (PVD) per eye. In addition, there can only be one weiss ring per eye.
  • Weiss rings typically settle into the middle portion of the vitreous chamber quite safely away from the retina and lens.
  • I have never seen a patient respond to the treatment of a weiss ring with an elevated eye pressure. I do not believe it is a potential complication of treatment – assuming that the weiss ring is the only entity being treated.
  • Weiss ring floaters are the most responsive to the YAG laser and the most efficiently treated ultimately yielding the best results, and…
  • Unlike the diffuse and cloudy syneresis floaters, weiss ring floaters do not have the tendency to reform and re-aggregate after treatment.

The downside:

  • Weiss ring floaters are rarely seen in younger patient, and younger patients rarely experience posterior vitreous detachments
  • Even if you have been told you have a PVD, or weiss ring, you may not. I have found that some doctors will describe the floaters as such, but they are not.

Since these dense, hyaline eye floaters are tethered and suspended as part of the vitreous cortex sheet, there is no expectation that they will just move out of the way regardless of what your well-qualified, and well-intentioned local eye care provider has suggested. The good news is that if you have had you eyes examined and they have reassured you that there is no retinal involvement (retinal hole, tear, or detachment), then there is no urgency or medical necessity to rush in and treat the eye floater. If you doctor has suggested waiting 6 months, then I will have no problem with that. Wait as long as you feel comfortable. There is NO loss of treatment advantage or loss of benefit by waiting. I will be ready when you are.

-Dr. Johnson

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