Vitreous Floaters

You may sometimes see small little specks or clouds moving around in your field of vision.  These are known as vitreous floaters or just floaters.  They are most easily seen when looking at a plain background, like at the sky or a lightly colored wall.  Floaters are defined as tiny clumps of gel or cells inside the vitreous in your eye.  The vitreous is the clear gel-like fluid that fills the inside of your eye.  Floaters are actually the “shadows” of these clumps of gel or cells that are being detected by your retina.

Even if you have a history of floaters, you should schedule an appointment with an ophthalmologist if you suddenly notice many new ones in your vision.

In some individuals, vitreous floaters can be so dense and relatively fixed as to permanently and significantly impair vision and, hence, quality of life.  One pervasive myth that continues to be circulated is that “nothing can be done for floaters.”  This myth is incorrect and does a disservice to those patients who suffer from moderate to severe vision impairment due to advanced collection of floaters and/or significant clouding of the vitreous gel.

In select patients, the vitreous can be safely removed using standard sutureless outpatient vitrectomy. Due to advances in surgical technique, removal of severe persistent floaters has become an effective option for those who are suffering from loss of vision due to long-standing reduction in the clarity of the vitreous gel. 

 

Sutureless Vitrectomy Surgery

vitreous floatersBasic techniques for approaching the inner layers of the eye for surgical purposes were developed over 40 years ago. While many refinements have come about since that time, only within the past few years have instruments and techniques evolved allowing for truly minimally invasive surgery in the posterior segment of the eye. Many surgical specialties have benefited from development of small-incision approaches; which bring about less surgical trauma and contribute to better outcomes with more rapid recovery. Recent polling data from the American Society of Retina Specialists suggest that approximately 60% of retinal surgeons in the United States employ sutureless surgery for most or all of their vitrectomy cases.

Dr. King has been employing this surgical technique exclusively in all cases of vitreous surgery for over ten years. Sutureless vitrectomy surgery shortens procedure time, allows for minimal postoperative discomfort, and hastens vision recovery compared to the older methods using incisions with larger instruments that require suturing of the eye.

Vitreous Floaters FAQ

I have had “floaters” for years but they only bother me on occasion. Should I consider having a procedure to remove them?

Most likely the answer is no.  While surgery is very safe and effective in virtually all cases, surgical removal of floaters that are only occasionally noticeable are best left alone.  No surgical procedure is 100% risk-free.

I have heard of doctors using laser treatment for floaters. There are several I have found on the internet. How successful is that treatment?

There is little or no scientific evidence that this form of treatment has any lasting beneficial effect whatsoever.

I learned from my eye doctor that vitrectomy almost always creates a premature cataract. My floaters are very bothersome but I don’t want to have cataracts form after the procedure. What should I do?

In all but a very few cases we recommend that patients who have not had previous cataract/implant surgery postpone vitrectomy indefinitely for this very reason.

I am under the care of a retina specialist. Since having cataract surgery, I feel like my floaters are very bad and affect my lifestyle on a daily basis. Why won’t he agree to remove my vitreous?

Even though retinal surgeons have had years of collective experience with this surgical technique, there remains a wide gap of acceptance among practitioners.  No two surgeons are alike in his/her philosophy or confidence when it comes to surgical decision making.  The fact remains, however, that there have been numerous highly respected publications over the years confirming the safety and overall superb outcomes of vitreous removal surgery.  As a result, floater removal – for the right patient- is rapidly becoming a more mainstream and less controversial option.

I’d love to live a life with clear vision. My floaters are a constant source of frustration. If I have them removed will they come back? Also, what is the vitreous replaced with?

The vitreous is not unlike a wisdom tooth or an appendix, in a way.  If it is negatively affecting your life it can be removed.  It actually serves no purpose whatsoever beyond age five.  What goes back in is basically IV fluid- a clear fluid that is slowly infused as the vitreous is removed.  That fluid comes in to balance with the other clear liquid inside the eye.  The floaters never return… just as your appendix doesn’t come back after it is removed.

I used to have floaters that I could identify as specks and spots that would briefly cloud my central vision. Now that I’ve had cataract surgery I mostly feel as though I’m looking through smoke all the time….more like a foggy windshield wiper moving in and out of my vision. Could this be a problem in my vitreous?

Quiet likely, as we age – and especially following cataract surgery- the vitreous will liquefy and become condensed.  This process is known a syneresis.  Examination of the dilated eye by your doctor will determine if this is the problem.  This is the most common combination of symptoms and findings that lead to successful outcomes with vitrectomy. 

I have been told that vitrectomy for floaters is very dangerous. Can surgery cause blindness?

Any surgery has potential risks.  In our practice’s lengthy experience, complications such as infection, retinal  tears and retinal detachment are exceedingly rare.  We have performed over 500 incision-less surgeries for vitreous opacities over a ten year span.  Retinal detachment has occurred in 2 patients, both of whom were extremely nearsighted.  Only one of those two failed to regain full vision after further surgery.  In all, the complication rate associated with the vitrectomy surgery for floaters is very similar to that of cataract surgery.

Does insurance usually cover vitrectomy surgery and will your office file my claims?

Most insurance plans do cover the surgery.  Our surgical team will contact your insurance provider to verify coverage and inform you of any co-insurance or deductible that you would be responsible for.  This will be done prior to your procedure. 

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