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The Smoke Screen Floater

(originally published Oct. 2012)

In studying the logics of an arguments:

Smoke Screen: An attempt to cloud or confuse the real issue with irrelevant facts, arguments or inventions.

What does this have to do with eye floaters? Well, I have created the term “smoke screen floater” to describe the phenomenon of the presence of minor and completely non-symptomatic vitreous condensations that can fool the professional examiner into thinking that what they are seeing is actually the culprit floater responsible for the patient’s symptoms.

Here is a not so hypothetical situation: a young person contacts me through my website or by e-mail. They tell me that they are seeing quite bothersome floaters of a specific shape or configuration, as well as movement behavior. This young potential patient may live thousands of miles away from our office here in Southern California. As they are doing their research and before considering the travel to our office, they understandably are trying to gather information in part to determine if they may have a treatable eye floater. One of the examination or background information bits that they offer is that their local eye doctor was able to see their floater.

At this point I start getting suspicious. In my experience with previous potential patients and floaters sufferers, I have found that I cannot rely on the other eye doctor’s evaluations of the floaters. This is not meant to suggest that they are not caring, well-educated, and totally competent doctors, it’s just that there is no standardized way of describing floaters and the reality is that they are used to looking through the floaters at the area of more interest to them, which is the retina. It is entirely possible to have some condensation of the vitreous located in the middle portion of the eye, which, as far as laser treatment is concerned, is a really good place to have it located. What I have just described may very well be a “smoke screen floater” or what I have previously described as a “red herring floater”. In our case, the smokescreen is unintentional and not part of any entity’s efforts to confuse the opposition, but it is still a confusing situation nevertheless. I have had some of these younger patients fly as far away as from Japan or from Moscow, because they had been encouraged by their local doctors and were told that the floaters that they have were truly in the middle part of the eye, where it should be treatable. I have the patient describe and draw their floaters in a detailed fashion and try to correlate it to what I see on examination of the eye. I will often find that they had some mild irregularities of the vitreous that were not responsible for their symptoms. Upon deeper and more careful examination, I find what the actual culprit floaters are and they are usually typical of younger patients with the floaters been located within 1 mm or so of the retina.

(a.) The transparent and diffuse hazy vitreous located in the middle portion of the eye. This is what the local eye doctor may see (b) The actual culprit floaters which are very small and microscopic and very close to the retina

Historically, it really took me the first couple years of treating floaters to finally come to be realistic conclusion that younger patients are just not ideal candidates for treatment with laser. There have been some notable exceptions, as there always will be with any distribution of populations, but they are exceptional.

If you are young, and suffering floaters, and your eye doctor told you that they were able to see the floaters, then you may be reading this because I directed you to post here. I have not closed my practice to younger patients and but I feel my obligation is to be honest with them and tell them in advance that statistically, they are not likely to be good candidates for treatment. That said, there may still be some value in getting the examination done here. And that is something really that the floaters sufferer has to answer for themselves. Many feel that their local ophthalmologist or optometrist has just really not put in the time or the effort to find and map out the problematic floaters. There still may be some unanswered questions that the patient has and may want a more definitive answer. If that is the case, we will still be glad to see you here in our office. It may at least eliminate the uncertainty of knowing whether or not you have a treatable condition. If it is and you choose to proceed with treatment, great. If it is not, it may help provide some bit of closure to the unanswered questions and ultimately you may have to still learn to live with your floaters. But at least you’ll know for sure if that is the case.

Only slightly off topic, this may be a good place to answer one more question you may have at this point. I am often asked by sufferers in their late 20s or 30s whether their floaters will be treatable by the laser and another 10 years or so. My answer is that it is the wrong question. The floaters that younger people have do not evolve into or become the floaters that older people have. There is no magic time frame were they mature and grow and move into more treatable position. The very small eye floaters that young people have, if they were to move just a couple of millimeters further away from the retina, would essentially disappear from sight or become significantly less bothersome. If the younger patient were to have a posterior vitreous detachment, it would likely pull these microscopic floaters away from the retina where were they would no longer be bothered by them. The good news is that most people who have a posterior vitreous detachment are essentially without symptoms of their floaters. So compared to the older patients who have a very bothersome floater present in their eye, I think younger patients have more potential for spontaneous improvement over time, again, not because their floaters would then become treatable by the laser. But because it they moved or shifted at all. They would naturally become less symptomatic just by the pure optics of the situation.

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