Observation
Most floaters will go away over a period of several months. There is generally no urgency to remove floaters. It is very reasonable to wait several months prior to considering any intervention for floaters.
Step 1 – Learn the basics about floaters
Step 2 – Learn about the surgery and what to expect
Step 3 – Learn about the other options
Step 4 – Learn about the potential risks of the procedure
Step 5 – Learn to maximize your results
The eye can be thought of as similar to a camera, with two main parts, a lens and a film. In addition, there is a gel called the vitreous that is located in front of the retina and is very firmly adherent to it. The vitreous is optically transparent in most people.The film layer is called the retina and lines the back wall of the eye. However, some people may develop opacities within the vitreous.
There are two main mechanisms by which people may develop floaters: Vitreous syneresis and posterior vitreous detachment. Both of these conditions result in parts of the vitreous no longer being transparent. The parts of the vitreous that are not transparent cast a shadow on the retina when light hits it. Patients perceive the shadow as a black spot of varying shape which moves when the eye moves.
Vitreous syneresis refers to the development of opacities within the vitreous. These vitreous opacities may not be bothersome, or may be severe enough that they decrease the ability to read or drive.
Posterior vitreous detachment refers to the separation of the vitreous from the back of the eye towards the front. This causes patients to be able to see the back face of the vitreous. Patients frequently perceive this as a black object which is shaped like a spiderweb or circle. These floaters tend to improve over time. However, it may persist in a small percentage of patients.
A floater removal is performed with a pars plana vitrectomy. This is an outpatient surgical procedure. It may be performed under under twilight (monitored anesthesia care) or general anesthesia.
The retina specialist places 3 small ports that are less than 1mm in size through the white of the eye and into the vitreous cavity. Fluid is infused into the vitreous cavity while the surgeon uses a vitrectomy probe to carefully removes the vitreous. The retinal surgeon confirms that all all of the gel has been safely removed from the back of the eye. The surgeon then carefully evaluates the eye to confirm there are no retinal tears. An eye patch and eye shield are placed on the eye.
Most floaters will go away over a period of several months. There is generally no urgency to remove floaters. It is very reasonable to wait several months prior to considering any intervention for floaters.
The retina specialists who recommends the treatment will discuss the risks, benefits, and alternatives to the procedure. It is up to the judgement of the physician to weigh the benefit of the procedure to the potential risks. It is only once the decision is made that the benefits outweigh the potential risks is the procedure offered to the patient.
Pars plana vitrectomy typically results in the complete resolution of vitreous floaters.
The most significant risk of pars plana vitrectomy is worsening of a pre-existing cataract.
Additional risks of the surgery include retinal detachment and infection.
Symptoms of retinal detachment include the sudden onset of many new floaters, new onset flashing lights, or noting a progressive decrease in the peripheral vision (like a curtain coming down at a play). This is urgent and the treating physician should be made aware the same day.
There is a small risk of infection following the procedure. If this is going to occur, it typically occurs 3-5 days following the procedure. Symptoms include redness around the eye that gets worse not better, extreme light sensitivity, and worsening pain. This is a medical emergency and requires immediate treatment by a retina specialist.
Patients who still have their nature lens will experience progression of their cataract following vitrectomy surgery. Approximately 90% of patients who are 50 years or older will require cataract surgery within 2 years.
All surgeries are associated with a number of other uncommon, but possible problems. Potential complications of pars plana vitrectomy include high eye pressure, bleeding within the eye, development of new retinal tears, and the need for further procedures.
It is important to use eye drops as prescribed by your retina specialist. Patients should ask if they need to continue to use prescription eye drops they were using prior to surgery(such as for glaucoma).
Peripheral vision – The peripheral vision should gradually become clearer. If the peripheral vision becomes dark and starts to become larger, this is a sign of a retinal detachment.
The vision is typically very blurry the day following surgery. The vision thereafter will continue to improve.
Infection – The eye should continue feeling better following surgery. Infection is characterized by a combination of severe eye pain, profound light sensitivity, and a decrease in vision. This must be treated emergently.
This information is being provided to you for educational purposes only. Accessing or using this information does not constitute the practice of medicine nor does it establish a physician-patient relationship. This information does not replace a consultation with your eye care specialist. This information should be used at your own risk. The authors and Eye Know More do not assume any responsibility for harm incurred by the viewers. All information on the website is copyrighted and is the property of Eye Know More. Unauthorized redistribution of Eye Know More’s proprietary information constitutes a copyright violation.
