Vitrectomy eye surgery can remove floaters. So-called “floater only vitrectomy,” or “FOV” is a comparatively simple procedure compared to other operations a retinal surgeon can perform.
Floaters Can Reduce Vision
While these are common, most people are able to tolerate them over time. There are, however, patients that have floaters so large and dense that the vision is reduced. (Remember, the acute onset of floaters needs to be checked out to ensure that you don’t have a retinal tear!)
A vitrectomy is part of most surgery performed by a retinal specialist. Usually, however, the vitrectomy is performed to allow repair of a macular hole, removal of an epiretinal membrane (video of vitrectomy and then removal of ERM) or to fix a retinal detachment. The purpose the operation is to remove the vitreous, thus allowing surgery to be performed on the retina.
Floaters reside within the vitreous. Thus, with FOV, these offending “spots” or “cob webs” are removed as the vitreous is removed. The operation is then complete!
Vitrectomy for Floaters is Safe
Many physicians do not recommend this surgery, but would recommend cataract surgery. This makes little sense. The reasons include hesitation to operate on an otherwise healthy and normal eye, but for some reason this same reasoning does not apply to cataract surgery.
Risks of vitrectomy surgery include blindness from infection or retinal detachment. These risks, however, are the same as having cataract surgery or any other eye surgery. In fact, the risk of infection with this retinal operation is lower than cataract surgery.
Indications for Vitrectomy are the Same As Cataract
Patients interested in cataract surgery choose to do so when the vision is decreased and it interferes with their daily activities and hobbies. Cataract surgery is performed to remove the cloudy lens and restore the vision.
Patients who have decreased vision from floaters can also have their vision restored, when they, too, experience decreased vision and understand the risks of surgery.
Alternatives to Vitrectomy
In my view, the only alternative is observation, that is, do nothing. There are a few doctors who advertise the use of a laser to break up floaters, but it is usually not covered by insurance, nor are the performing doctors retina specialists.
What Does This Mean? There is hope for those who have decreased vision from floaters.
Most patients have been told, over and over again, that they just have to “live with it.” As long as patients understand the possible complications and are sure that we are dealing with true floaters, the procedure is a possibility. This summer alone I have had several patients travel from around the country seeking help.
For doctors that don’t agree with me, the decision to perform a “floater only vitrectomy” is no different that making the decision to perform cataract surgery. Complications are few and can happen in either case, yet in both instances, the patient sees better.
So why suffer?
270 replies on “Floater Only Vitrectomy: No Different than Cataract Surgery”
I have had two separate visits to Dr Johnson who uses the YAG laser for floater treatments. My second visit was to clean up some remaining strands and dots. As a result, I am now left with another large floater in my left eye that interferes significantly with my vision as the fogginess blurs by vision. I am very frustrated and I ha ve incurred two trips to California from Florida and have not seen any significant improvement only setbacks. I would appreciate getting further information on the FOV procedure and the related risks. Are there physicians in Florida as well that share your thoughts and opinions about this procedure. Thanks for response in advance. Gary
Not to my knowledge, but there are so few that have a site. I’ll keep my ears open.
Where in FL?
Dear Doctor Wong,
Thank you for writing this entry into your blog. You and I have communicated on the possibility of you performing a FoV on my eyes. Have went to several ophthalmologist in New York. Non of them were willing to perform the surgery, one Ophthalmologist told me to name my floaters and treat them as pets. Another one told me that the risks of a FoV were greater than hear surgery, when I told what I knew about the risks of a FoV he replied “I’m the expert and you are not” and then dismissed me.
In sum, as you guessed and suggested in your blog, the techniques and technology has apparently surpassed the former and greater risks of a vitrectomy.
I wish to get these floaters removed so I can return to a “normal lifestyle, play football, basketball, finish my education. Not have to struggle to read and wear sunglasses (in some cases double pair of sun glasses) where ever I go.
It feels like I am looking out of a window screen or a black veil.
See you this week.
Have a good weekend.
Look forward to seeing you!
Is there any treatment available for post-op vision loss following scleral buckle/vitrectomy surgery? Is any research being done to investigate the potential to treat retinal damage?
Really need more information as to the actual cause of the vision loss. Do you mean from the retinal detachment itself?
It’s always encouraging to discover “enlightened” doctors when it comes to floaters. After being treated like dirt by the whole retinal community in my city (Calgary, AB, Canada) for several years, I finally found a more or less sympathetic doctor in another city who is amenable to at least discussing the possibility of FOV. We need more doctors like this who understand that floaters can cause marked decreases in visual acuity and quality of life. I hope to see my doctor in the next couple of years once I save enough money to travel. Ten years of cobweb vision is enough for me!
I’ve never thought of cataract surgery being analogous to floater surgery, but it makes perfect sense. Thanks for bringing this viewpoint to the table, Dr. Wong. It’s much appreciated in the floater community.
Thanks for the kind words. Just sharing my perspective…based on facts!
Good luck to you.
Dear Dr. Wong,
The fact that 99% of ophthalmologists, including general and retinal specialists, will not suggest one to have a floater only vitrectomy, except in cases where visual acuity is decreased, what is your opinion about this culture of denial in the ophthalmic community? Lack of awareness of the recent progress in vitrectomy technique or lack of empathy with patients? Or the belief that acute emergencies such as endophthalmitis are urgent while floaters rarely, if ever, have effect on life?
My floaters have ruined my life. I was always a bright and intelligent student in college. Loved reading, and reading, and reading, both academic and non-academic stuff. Here I am today, enclosed in a closed room, taking time off from last year of college. And I have decided to become a retinal specialist, if I can, in future.
I wish one day I can get rid of floaters and become a retinal specialist to help people like myself.
I hope that things turn around for you and that floaters are really the blame for your difficulties.
Hang in there!
Best of luck.
Eye doctors make FOV sound like a ticket for blindness. My life is ruined by floaters even though they do not blind me but all doctors call me crazy for wanting surgery. What exactly are the risks for total blindness? I know retinal detachments can happen but if they are repaired in time can the patient still see? I would to know the risk of losing useful vision.
Severe floaters have got to be the most underestimated disease in the world. Maybe because everyone has them to some degree. I got tired just by writing this post. I think every successful FOV is a live saving operation. Why aren’t there more doctors doing this kind of surgery? Isn’t it enough that we suffer so much, why do we have to endure ignorance from doctors?
There are definitely people who have decreased vision from the floaters. Why more doctors don’t pay attention is unknown to me. On the other hand, the same exact complaints of loss of vision will usually lead to cataract surgery.
The risks of a vitrectomy are blindness from infection (I estimate a chance of 1:10,000 to 1:15,000) or retinal detachment (about 1-2%). The risk of retinal detachment is about the same as cataract surgery, whereas the risk of infection is actually lower.
I never realised that there was such a procedure to get rid of floaters. I have always had to put up with them (as I was advised) although they are an occasional life interference.
Do you know of any ophthalmologists in the UK likely to perform this procedure? Thanks.
Sorry, don’t know anyone over there at all.
But if you come here for a visit…………
Best of luck!
What makes someone a good candidate for FOV? How old should a patient be before you would consider doing a FOV?
Dear Dr. Nelson,
In my opinion, a person who is clearly not happy with his/her vision, has symptoms clearly related to “floaters,” and who understands and accepts the risks is a “good candidate.”
With regard to age, are you asking with regard to liability or is there a clinical concern?
BTW – nice looking website.
Dear Dr Wong,
thanks for posting this article. I am a floater sufferer that does not have reduced visual acuity but rather am psychologically dusturbed by them. So much so that they have made me anxious and depressed and obviously have had a detrimental effect on my mental health. In your view is vitrectomy an option for patients such as myself?
As long as I would agree that floaters are present and a vitrectomy would remove the floaters….it could significantly impact your psychological state.
Thanks for your web site. It was a good counter-view to another web site that tries to sell a non-surgical cure for floaters without saying what that cure is (sounds like snake oil to me). The other web site makes the FoV surgery sound extremely risky, but your web site is much more in line with what my doctor is telling me. I am planning to have the surgery with Southern Vitreoretinal Associates in Florida as soon as the approvals are all done (http://www.svaretina.com/practice_overview.html). This is not something my doctor and I have rushed into; the decision has been made after months of observation, or as in your words “do nothing”. My doctor told me about all the risks, but said the greatest risk is for my developing cataracts to get worse. That sounded like good news to me because I will be glad to have my developing cataracts removed. Anyway, your web site helped me make the decision to go ahead with the FoV. Wish me luck!
Thank you for your very kind support of my site. Best of all….good luck!!!
I was just wondering if you personally do this procedure? If so how many F.O.V.s have you performed in your career and also what has been the prognosis among your patients?
Yes, I perform vitrectomies routinely. I don’t keep track of the exact number of each different case type, as a vitrectomy is part of almost every operation I perform. In most cases, a vitrectomy is necessary to gain access to safely operate on the retinal surface, repair a retinal detachment, etc.
In the case of FOV, only the vitreous is removed…and we are done. I have performed thousands over the past 20 years.
Complications are very unusual. The most feared are infection and retinal detachment.
I estimate the chance of blinding infection to be less than 1:10,000 and the chance of a retinal detachment less than 1%.
So, the prognosis is very, very good with regard to successful surgery.
Dear Dr Wong,
I am scheduled for cataract surgery and a vitrectom to remove floaters in 4 weeks. I am 65 and in good health. My vision is over 20/600 in both eyes (nearsighted all my life) and I am having problems with increasing halos around lights as well as a generally increasing haze in my vision. I suspect that my night vision will deteriorate to a point where I will not feel comfortable driving in a few years. I do have a problem with floaters with several being dark spots in my vision but I would stop short with characterizing my issues today as extreme (i.e. I am sure that I could continue for a few years or longer without surgery but I am truly anxious to see better). Without any additional detailed medical input, can you possibly offer support for my upcoming surgeries…or not. In otherwords, based upon your experience, am I taking an unnecessary risk. I might add that I have been reading a number of information sources and your site seems to be more positive in your patient orientation I have seen todate.
Thank you for your kind words regarding the site. I am proud of it.
Regarding your surgery;
1. Is the same doc doing both cataract and removal of floaters?
2. Glare and halos are commonly associated with cataracts.
3. There is no guarantee that your night vision will decrease, that is, it could remain normal.
Randy: I have clinical concerns about young patients getting cataracts sooner after a vitrectomy. Liability is always a concern with any surgery.. Do you have a special consent for FOV? Regardless, when properly selected, patients are extremely happy with the results from a FOV in my experience, especially monocular patients, which give the surgeon the greatest pause, but the patient the greatest benefit.
Sorry for the delay. Took a few days “off.”
I do not have a specific consent for Floater Only Vitrectomy…I feel the risks and benefits of any retinal surgery are the same. I do specifically mention the chance of blindness due to infection or retinal detachment.
Please stay in touch.
Hi Dr. Wong,
Will you please tell us about your technique for performing FOV? What gauge instrumentation do you use? Do you use Kenalog? Subconjuntival antibiotics? How often do your patients report post-op debris and, if they experience it, what is the debris, inflammation floaters? If so, how long does it take to go away?
I prefer 25 gauge systems for most of my vitrectomies and I do not routinely use Kenalog for FOV. I almost always use subconjunctival antibiotics. Rarely are there complaints of post-op debris.
I’ve had a slight amount of floaters my whole life… but over the last 9 months they have become horrible.
I dread going outside, and sunglasses is always a must. The floaters don’t usually interfere in generally dark areas, but if there is a decent amount of light, they are extremely noticeable in both of my eyes.
I am 21.
Do you think FOV would be a good option for my situation?
As long as you understand the risks of surgery and your doctor agrees that your problems are caused by floaters…you should consider treatment for the floaters if they are bothering you to this degree.
Stay in touch.
Thanks for your responses so far.
In your view are cataracts a 100% certainty after FOV and do you induce PVD?
I had a nice discussion today about this very issue, the likelihood of cataracts. While we are all destined to get cataracts, in my experience cataracts are not certain shortly after vitrectomy…for whatever reason. I do not try to induce a PVD. It can only ask for trouble…especially the younger you are.
Thanks for your response Randy – If PVD is not induced would that not mean the possibility of further floaters being formed down the line? It seems some Retinal Surgeons insist that PVD is a must whilst others would prefer not to do it. in your experience what kind of problems could result from the PVD being induced?
Also – I read that decreasing the oxygen in the fluid that is inserted in the eye could potentially reduce the chances of cataract – is this something you are familiar with?
Inducing a PVD can cause a tear. No reason to tempt fate.
The biggest factor I know about cataract formation in this setting is length of time of operation, but you are not going to find that listed anywhere. A smart surgeon is not going to list how fast they operate…but that is your biggest risk factor.
I am 31 yrs old and i have developed floaters in both my eyes and they are destroying my life… i am unable to get over them. i have 2 questions pl provide answer for both of them.
1) i read on one of the forums that floaters caused by some small injury or ‘jerk’ can be cured by medicines over time, is this true?
2) i live in india if i decide to come to america and get this surgery done, how much will it cost me for the Fov.
1. Never heard of this. I don’t think it’s true.
2. Regarding price; there are 3 fees
a. Surgeon’s fee
If you are serious, please email me and I can pass you email on to our administrator.
Before I go to great expense to travel to see a surgeon who does FOV, I hope you can tell me whether severe dry eye would make someone a bad candidate – in which case I can save my money and not go.
I take prednisolone drops 4x a day every day for the inflammation. It helps to some extent, but I still have chronic conjunctivitis, blepharitis and significant punctate keratitis. I also have a history of corneal ulcer from the dry eye and I understand quite a lot of damage to the surface of my eye. My dry eye does not respond much to any of the usual treatments and so it is not a matter of “bringing it under control” for surgery. I was wondering if the surgery would be likely to worsen my inflammation, and it may be difficult to control as I already take plenty of steroids which only help somewhat.
On the positive side, I will probably end up with early cataracts from the steroids anyway, so the risk of cataracts from FOV is not a concern for me.
1. Why do you have the dry eye? Is it associated with a syndrome or eye problem?
2. You didn’t mention any symptoms, why do you think you need FOV?
3. I don’t think surgery will worsen any inflammation, but to be sure, it depends upon answer #1.
Look forward to hearing from you.
I am confused about “inducing a PVD”
My understanding is that the argument for inducing PVD is that if one has FOV, if one develops a PVD later, floaters will return.
The argument against this is that induction of PVD can raise the incidence of detachment during surgery.
Is this correct?
My question is: 1) If one has PVD already as the cause of the symptomatic floaters, is the PVD complete or is there a possibility that the PVD needs to be further induced “to get it all”. I understand your reluctance to do this, but if one already had bilateral PVD, is it always complete?
2) I have even told that vitrectomy can cause possible worsening in astigmatism. Why is this? Is this permanent?
3) What do you estimate the risk of cataract is in a 40 year old following vitrectomy and after how long?
4) Finally, how soon can people return to work following surgery?
1. Usually, when present, a PVD is complete.
2. No. Not sure how this would occur.
3. Everyone eventually gets cataracts with/without vitrectomy. To answer your question, the chance after FOV is probably very, very slight. We think one culprit in advancing cataract formation after retina surgery might be the length of surgery. In my experience, this does not occur with any regular frequency.
4. In my experience, in one to two days.
As you don’t recommend mechanical induction of a PVD, what are your thoughts of gentler chemical induction? Specifically using Ocriplasmin which is soon to be approved by the FDA?
Honestly, I don’t know enough about Ocriplasmin, but in theory, sounds like a winner from the standpoint of creating vitreo/retinal separation. In that regard, a chemical PVD sounds great and potentially avoids the pitfalls of physically inducing a PVD……but could there be complications from implementing/injecting the drug, too?
We’ll have to see. Thanks for the comment!
First, great website!
You told, that you do not induce a PVD because there is no reason to tempt fate. I am 34 years old and do also not have a PVD yet. In case of a FOV you would “only” remove the inner of the vitreous “ball”, but you try not to remove the membrane of the vitreous ball, right ?
I read some articles regarding the oxygen which is increased in the inner of the eye after vitrectomy.
I also read about microplasmin investigations, that after inducing PVD the oxygen level immediately was increased near the lense.
Q1: Have I interprete it right, that you avoid to remove the vitreous membrane by not inducing PVD?
Q2: Is the reason that cataract is not developing in next time perhaps also, that the membrane keeps oxygen within the eyeball at a low level ?
Q3: In case the membrane keeps intact, is without the inner of the vitreous a natural PVD is to expect or is this then more or less dangerous regarding tears?
Thanks for your effort here,
A1. Yes. I simply do not want to cause vitreous separation from the surface of the retina.
A2. No one really knows. There is also the likelihood that there are other causes…such as light exposure during an extensively long operation.
A3. Not sure, but I would think less likely.
Dear Dr. Wong,
only another question.
How close is it possible to remove vitreous in respect to the vitreous membrane which is connected to the retina? Here I guess is the area of most annoying floaters, right? Do I have to visualize what you are doing here similar like cut the gras of a garden? Then a key skill of the doctor is here to have a steady hand and a good view to the tip !??
Thanks again and have a nice weekend,
Really don’t have to get too close. In my experience the largest and most bothersome opacities are located in the center of the vitreous and interrupt central, visual pathway.
so I have “floaters” in both eyes and are equally bothersome. when you perform a FOV procedure can both eyes be operated @ the same time? also if I were to have you perform this procedure I would most likely have to fly in as I live in MN. would there be a “waiting period” after the surgery due to flight pressure? do mosts insurance plans consider this an elective procedure therefore not covering it? Ive read that when the vitreous is removed it is replaced with a salt solution that is similar in composition but eventually is replaced with natural fluid. is this true? if thats the case then why doesnt the eye have a natural drainage in order to rid itself of debris? ive also read about a certain enzyme that is in the process of being developed that when injected into the eye would dissolve and injest any foreign debris. have you heard anything about this as well? sorry for all the questions?
Flight pressure has no bearing on surgery. Often patients will call ahead and schedule surgery. We will see you in the office a few days before the scheduled date. If for some reason, we can simply cancel surgery if needed.
The vitreous is mostly “water.” The vitreous is “replaced” by 100% saline solution that is identical to the fluid component of the vitreous. This artificial saline is replaced by your eye within 24 hours.
No idea why there is no natural clearing mechanism for debris.
The new enzyme might be Ocriplasmin (microplasmin enzyme). My reading tells me that it is under FDA review, that is, not available for us at this time.
The Ocriplasmin is anticipated to chemically cause a PVD, but will not get rid of existing floaters. Many hope this will obviate the need to create, or induce, a PVD during surgery. This might be possible chemically. Inducing a PVD with surgery is risky business…in my mind it increases the chance of retinal tear and retinal detachment.
i have floaters in both eyes so needless to say i am considering an fov. After a little research i have some questions i need to ask?
1)If pvd is present , then is there a need for inducing it.
2)at the moment i am posted in asia, so if i decide to come to you good doc, will there be a problem for me flying back(long flight) with an air bubble in my eye. 3)How much time will i have to spend in US for u to safely assume that the procedure went well.(time being not an issue)
P.S..i wish all the doctors were as patient in answering questions as u are.
1. No need to induce a PVD if one is already present.
2. I don’t think you need an air bubble in the eye. I don’t do that for straight vitrectomies. Therefore, you may fly.
3. In a perfect world, I’d like to see you at least a week after surgery, but many patient go home after a day or two.
All the best,
can a FOW be performed on both eyes at the same time? also I was curious to know as how do you know when all the old vitreous is extracted when performing the surgery? can any debris that appears in the field of vision be visible to the naked eye after the fluid is removed from the eye?
No. Usual practice is to operate on two eyes within a week or two if needed, but not on the same day.
Usually, I can see the vitreous. At times, I can infuse a dye to mix with the vitreous.
Not sure about your last question, I don’t understand it.
sorry for the confusion about my last question randy. what I meant was after the old vitreous is removed from the eye is it possible to look at the fluid and see the debris that was causing the “floaters” when it was still inside? does this help” thanks!
Following a vitrectomy the “old” fluid is collected, but it is highly diluted with water. Also the vitreous has now been fragmented into microscopic pieces.
The fluid inside the eye is quite clear.
Did this answer your question?
Dear Dr. Wong,
I was just wondering if my comments got deleted? If so, may I know the reason?
No. I have “approved” all 3 of your comments.
1. 2/16/12 and I responded
2. to which you responded on 2/20
3. and today’s.
Are they no longer visible?
They should be with “Eye Surgery Removes Floaters”
I don’t think I’ve ever deleted anything once published…..at least on purpose.
Let me know. I still have record of them being published.
Thanks for following.
Dear Dr. Wong,
Sorry for the confusion. They indeed are visible in the post that you made. For some reason, I was searching for them in this post! Good lord.
Thank you. 🙂
Dear Dr. Wong, First and foremost thanks for providing such valuable information for us suffering from eye floaters, it is indeed both informational and refreshing, and second, I live outside of Philadelphia, and am not aware of any retina specialists or opthomologists who perform FOV surgery, if you know of any, can you please let me know, and if not is it possible to make an appointment with you in Fairfax Virginia, and will my insurance cover the surgery? I’m almost 50 now, and I want to see clearly again and you seem like the right candidate for the surgery, may I leave you my personal information so you can contact me, and get the precise information, Thank you so much, you are such a Blessing…….
Sorry, not aware. Not too many docs care to write about anything let alone vitrectomy.
Feel free to call either office and make an appointment with me. I believe this is covered by insurance.
Look forward to meeting you.
If you’d like us to call you, send me an email with your contact information.
I realize that you are over 1100 miles from minnesota so i was just wondering if there were any specialists in the twin cities metro area that also specialize in FOWs and are as willing to perform this procedure as you are? seeing as how compasionate you are to those like me who suffer with this condition I would rather put my trust in some like you but the inconvienence of the long distance makes me wonder if there are others that would be willing to help. thanks for your cooperation!
My adult son has scheduled an FOV. Your posts are very comforting as drs in this city have the standard horrified reaction. Why is there so much disparity of opinions in the medical community?
Dear A Mom,
Don’t know, but the conservative approach is too conservative. Doesn’t make sense, does it?
Hope your son does well.
Thanks for writing.
Dear M..D. Wong,
I’m a 25 years old boy from germany and I got floaters in 2011. Big clouds and black dots on both eyes. I had 3 vitrectomys on the right eye and most of the stuff is gone. But 4 small black dots stayed in this eye and I see allways hundreds of litte bright dots on white walls and when I look at the sky. What could it be? The surgeon says he couldn’t induce PVD completely because I’m too young and the retina can detached. And he left some vitreous in the near of the lense that I don’t get a cataract in the next months. Now, what are the small lightpoints when I read words on a white paper and look at the grey sky? Could it be blood ceLls? What can I do? Is it possible to get 100 % floaterfree after fov? Thank you and best wishes. And, my last question: When I get the 4th surgery – should I do a combined FOV with IOL to get rid of all floaters?
When looking at the sky/white paper you could be seeing floaters, but other possibilities include entoptic phenomena from white blood cells, they are characteristically seen in situations as you describe…seen only when looking at bright and white backgrounds. These can be normal if this is indeed your issue.
How about cataract? If you have a cataract, then removal would allow your retina surgeon to more comfortably remove the floaters near the lens. I’d wait until you have a cataract before assuming you’d get surgery.
Hello Dr Wong,
I am 32 and experienced an onset of floaters in both eyes after lasik. The ones in my right eye are a bit off to the periphery and I can live with them.
But I have one in my left eye that floats in my field of vision and drives me nuts. I tried YAG laser surgery with Dr. Karickoff in Falls Church but he rejected me because he felt the floaters were too small and too close to the retina for the laser. I’m considering getting a second opinion from another laser surgeon named Dr. Scott Geller in Florida because he’s more experienced. But I just came across your procedure and it seems promising. I have two questions.
1) To your knowledge, what is the effectiveness of YAG laser compared to your procedure for younger patients with smaller floaters near the retina?…what
would be your professional recommendation for someone considering either of the two procedures?
2) If you’ve had lasik, could fov(if successful) potentially revert your vision back to pre-lasik acuity?
ps: thank you for this blog btw…it’s a shame more doctors don’t communicate with the public like this.
Thanks for you reaching out. You are not alone in this “journey.”
To answer your questions, I will simply state that YAG laser is not performed by any retina specialists and there are 3 doctors promoting YAG laser for the treatment of lasers.
I believe that FOV is the only way to resolve your issues. FOV is probably the only way to go and it’s as safe or safer than cataract surgery. It directly addresses your problem.
Stay well. Keep in touch.
Hello Dr Wong
Thank you so much for maintaining this informative blog post! I wanted to get your opinion on my situation.
I am a 45 year old male, at San Francisco, CA. After years of being myopic (since age 5) I had a very successful cataract surgery on both eyes in the Summer of 2011 (IOL toric lens). I have been seeing 20-20 since then without glasses, altho’ I need reading glasses for computer work. I have had PVD on my right eye for several years, and I have got used to floaters.
A few days back, I developed a significant PVD on my left eye, which also caused a retinal tear, that was treated with laser by my local retina specialist. That PVD has generated a large number of floaters – and most of them I can live with, except one – this is a very well-defined inter-twined single set of black strands, in the center of my vision, causing serious distraction while driving or working, and even headache when I am on my reading glasses.
My question to you – is there any procedure to remove just this single set of strands instead of the entire vitreous as is done with Vitrectomy? Also, is Floaters-only-Vitrectomy (FOV) a different procedure than standard Vitrectomy? Another website indicates that it takes only 15-30 mins for FOV, while standard Vitrectomy takes 2-4 hours, but it is not very clear on the details.
Sincerely, and thanks again,
You are correct, FOV should be the same as vitrectomy for any other condition.
2-4 hours? Don’t know what they are talking about.
If the floater is bothering you…consider a vitrectomy …the central vitreous should be removed and should take no more than 10-15 minutes.
All the best.
Just a quick follow up question. You’ve mentioned the central vitreous numerous times because I presume that’s where the largest and most bothersome floaters are for most people. But I assume that some of the smaller floaters that streak across every once in a while live in the periphery of the vitreous closer to the retina. Is that correct? And would that require removing the entire vitreous to get at those, instead of the central part?
Yes and no.
The closer the floaters are to the retina, the less likely they are actually going to bother you.
My guess is that most of the floaters would be removed with a simple vitrectomy. For me to conjecture otherwise without examining you would be irresponsible.
Dr. Wong can confirm what I will suggest. I am a med student and am haunted by floaters myself, and have been research retina and vitreous for the last 2 years (yea, that is much more exposure to ophtho than an avg med student will ever get in med school).
Central vitreous (or core vitreous) is the vitreous jell around the equator of the eye (center of the eye). It can be easily removed as it is not adhered to the retina and is in the center. On the other hand, peripheral vitreous refers to vitreous that is adherent to retina and this can be anterior or posterior (keep in mind that peripheral retina refers to retina that is anterior to equator and near ora serrata or in other words away from fovea centralis).
Core vitrectomy (also non-PVD induced vitrectomy) can take most of the vitreous out (normal vitreous is about 3-4 mL) and along with it will take most of floaters out IF they are in the center. This vitrectomy is safer as it does not remove vitreous hyaloid membrane from retina. However, you might still have some floaters left because not all of the vitreous is removed, or you could have natural (but abnormal since ccentral vitreous has been removed) PVD occur years later. My friend developed PVD 4 months after his core FOV.
on May 08 is the ARVO2012 in Fort Lauderdale. One topic will be “Sutureless Small Gauge Vitrectomy for Relief of Symptomatic Vitreous Floaters”
The results and conclusions are telling the same thing like you already told in your article. The procedure itself is apparently quite safe, right? Or do I misinterpret this?
Your webpage is so informative. As a member of the “floater community” I am extremly thankful that you take time to answer all these questions conerning floaters treatment, also from persons who are not your patients. I also have a question. I live in Belgium and consider the undergoing an FOV with one of the retinal specialists here. His technic involves 365 laser coagulation of the peripheral retina at the end the surgery to prevent RD. I know that there is some controversy concerning added value of this procedure. What’s your opinion about it? Is it safe for the eye to undergo such laser treatment. Thanks in advance! Przemek
While there is nothing wrong with the 360 laser, I am not sure that it isn’t overkill. It is definitely safe as this is commonly used to treat some diabetic patients. I usually don’t perform this type of laser on straight forward vitrectomy patients.
How is it possible that many people (like me) see huge floaters, but for the the doctor everything appears as chrystal clear? I was told that in these cases they are extremely close to the retina within 1-2 mm.
My theory is that if they are in fact really close to the retina, floaters wouild move up instead of moving down when the eyes arent moving because everything is projected upside down on the retina. When they are moving down in the vision they have to be further away from the retina before the point where the lightbeams cross eachother. I might be saying nonsense here 🙂
Not sure the direction of the floaters is related to the how close they are to the retina.
Dear Dr. Wong,
if someone has a 360 degree extensive lattice, is it possible after FOV that his/her retina can come off 360 degrees from lattice lesions and collapse on itself in the form of a severely complicated retinal detachment that has come off its entirely from the vitreous base?
needless to say, I am very confused at the moment (emotions taking over rational mind) since my friend has developed retinal detachments (needing 2 vits and now scleral buckle) after his FOV last year summer.
Huh? Sounds like bilateral Giant Retinal Tears.
Hard to know if the retinal detachments are indeed related to the FOV.
Sorry I can’t really help more.
I’m looking at options for a large floater I have in my left eye right now. I am just 24 years old, but I have had a floater in my left eye that is extremely long now. I’ve had it for about 3 years now and went to a doctor to make sure my eye was otherwise healthy and it was. I can live with 90% of the floater, but there is one section of it where I think several strands have become caught up on each other (as best I can tell) creating a dark mass that I see all day every day, hanging around my vision and causing me a lot of anxiety and stress. It’s very difficult to read unless I’m in perfect lighting conditions and I get anxious just thinking about going outside.
If I could just get rid of this one section of the floater that is so dark, I’d be an immensely happier person.
Is it possible for a doctor to use a YAG laser to eliminate just the mass, or to at least break it up so it’s not overlapping and being so dark? Would this be safer?
Your situation is all too common…you can’t see as you’d like and you want a change.
Your options are vitrectomy vs. YAG laser. I am not aware of any retinal surgeons who use the YAG yet am aware of only a handful or doctors advocating the YAG. My criticism of the YAG is the frequency of retinal tears created by the procedure, that is, I wonder how safe it really may be, whereas the risks of vitrectomy are at least better defined.
Dear Dr. I am from the Netherlands. I am thinking to come over and let you do my FOV. As I am a dentist I wondered if a cataract will follow. Will I be able to do my daily practice? I can cope with the floaters in the other Eye. I only have this big think in my right one.
Important question for me: do you always induce PVD? And if not, what kind of increased chances will one get in having a natural PVD (uncontrolled) after this so-called core vit. ?
It is unlikely that the cataract will follow any faster than if the FOV were not done.
I do not always induce a PVD, in fact, I try not to induce a PVD. I don’t think it is safe nor wise. I think that removing most of the vitreous greatly prolongs the chance of a PVD, that is, I think it decreases the chances of it occurring or at least it will happen much later in life. Just my feelings.
Hope to meet you.
Thanks so much for taking the time to help us suffering from floaters. I saw a specialist in my area and she diagnosed me with having a PVD. This was after I woke up one morning with lines a dots ans squiggles everywhere in both eyes.
Is it safer to have a FOV after a PVD? It’s been almost a month and a half and my floaters are driving me nuts. Is there a rough price estimate for what a FOV surgery would cost? do thin line floaters ever dissolve?
In my opinion, yes, safer after PVD.
If the floaters are driving you nuts and you understand the risks, I see no reason why you can’t be helped. The thin line floaters sometimes become less noticeable, but usually do not disappear completely.
With regard to price, I would encourage you to call Chrissy at my Fairfax Office 703.273.2398.
Dear Dr. Randy,
In one of your videos’ comments section, someone asked you about saline/aqueous after FOV causing retinal detachment. You mentioned that it is not possible for the less viscous saline/aqueous to cause retinal detachment unless there is some traction from remaining vitreous on the retina which causes a hole or a tear.
I was wondering what about rhegmtogenous retinal detachment? If someone has atrophic holes due to lattice, and all the vitreous has been removed meaning no traction, can the saline/aqueous still seep through these holes and result in rhegmatogenous retinal detachment? I think yes. So it basically means eyes with previous holes or tears, despite being treated with laser, are going to have a RD by the very fact that fluid can seep into the RPE through “cracks and holes” in the sensory retina.
What do you think?
Not so sure I agree. With the vitreous “gone” the forces to “pull” or detach the retina are greatly reduced if not completely erased.
There are areas of the retina, such as the macula, where a macular hole does NOT lead to retinal detachment.
Dear Dr Randy just wonder went PVD take place the viterous should move away from the back toward the front of the eye thus creating a hollow space and what fill up that hollow space?Also will the PVD after moving toward the len get to sink to the bottom of the eye? And if that happen the floaters will be less noticable since it is further from the retina?Also after FOV plug are used to seal the incision so when do the plug be removed?Tks
The vitreous does move forward in cases of PVD. The void is simply filled with 100% water vs. vitreous which is >90% water. Floaters may either be more noticeable or less noticeable…there is no golden rule. In my view, awareness of floater is related to size, shape and location. Often, the more anterior floaters cause the most problems.
In 25 gauge surgery, no plugs are used after the vitrectomy. Wounds or incisions are small and self-seal.
Hi Dr. Wong,
thanks for the info. I’m 25 and have lots of floaters in both eyes. They truly are detriment to my quality of life. I’m not sure I’m ready t have the surgery at this point in my life, but was wondering if you have any ideas as to what can cause extreme amount of floaters? I have my theories but was curious if you had any?
Most of the time, the floaters are due to changes in the vitreous where the “once optically clear” vitreous proteins may denature and become more noticeable. Other causes include blood, asteroid hyalosis or inflammation.
I developed a lot of floaters in both my eyes in the last 5 months.
I am 22 and myopic (-4) with astigmatism (-1.5) in both eyes.
I also have lattice (snail track degeneration) in both my eyes and had done a laser 8 years ago for the same.
Can i undergo FOV for my floaters? are there higher risks due to snail track degeneration and laser performed?
I wouldn’t think either put you at higher risk for retinal detachment.
Dear Dr. Randy,
I understand that you have a very busy schedule. I was just wondering if you got a chance to develop a video on Floater only vitrectomy for patient education? I understand that FOV is not much different from a regular vitrectomy but having a video dedicated only to these would educate patients and other doctors a bit more.
On youtube, there is only one professionally done video of FOV by Dr. Cohen. Why do not you take the next step and be the second one? 🙂
Thanks for the idea and encouragement. I am anxiously waiting my “coworkers” to finish the editing.
Now that school is out…I expect to get them up very, very soon….but you know that.
Thanks for your patience.
Hi Dr. Randy
Since my PVD developed my floaters went from being stiff and hardly moved to now zooming around. It’s almost like shaking a snow globe and everything scatters around when my eyes move. Then as soon as my eyes stop, the floaters gently fall to the bottom of my eye. Does the Vitreous every completely liquify? Wouldn’t this help dissolve or eliminate floaters if they are in complete liquid?
I heard of Microplasmin being a possible solution for floaters. Is that true?
Not sure if Microplasmin will do anything for patients with floaters. It chemically induces a PVD. It does nothing to “dissolve” floaters. So, it may indeed make them worse?
[…] is no difference between a vitrectomy for floaters (FOV) and a vitrectomy for removal of blood, macular pucker, etc. In all cases, the vitreous must be […]
hi doctor randy..i am from macedonia and i have 32 years.i have floaters and light spots 4 years ..i want to ask…….does world medicine make some try to find another cure for floaters or there is only vitrectomy…thanks
There is really only vitrectomy. YAG laser is practice by very few doctors here in the U.S. Retina specialists, like myself, feel that it is too dangerous to the retina as it can cause tears and then retinal detachment.
All the best.
I think on behalf of everyone posting and reading your blog, thank you for being so accessible and knowledgeable. I have been following your blog for months and will be taking the next step shortly to schedule a vitrectomy due to floaters with you and your office. I understand the prognosis for successful surgery is high, however, my main question, is have you seen any real vision threatening or permanent damage in any of your patients who have undergone this surgery with you and once the surgery is done what is the standard recovery time to get back to normal, back to work, workout, etc?
Thanks, Dr. Wong.
Thanks for the support!
I have had one suspected infection (endophthalmitis) in 20 years. This occurred in a patient chronically infected systemically.
I would anticipate return to normal activity within 24-48 hours including, work, workout.
Look forward to meeting you.
Dear Dr Randy,
I’m very myopic (-7.5) does this make FOV more risky in terms of retinal detachment? Also, is this more of a problem if I need cataract surgery following FOV in the future? Can I also ask, what is vision like following an FOV, is it exactly the same as before just minus the floaters?
-7.5 is not horrible and should not affect your chances of retinal detachment. Cataract surgery following FOV, in most cases, is not a problem. In most cases, vision returns as before ….minus floaters and cataract!
I had a vitrectomy for floaters performed approx 4 years ago. I am starting to notice more glare during the day from lights in one of my eyes so I am thinking early stages of cataract. Is there any difference or precautuions when performing cataract surgery on a vitrectomized eye?
Yes, there are some subtle differences performing cataract surgery on a vitrectomized eye.
The vitreous can give a cushion like effect or buoyant like effect on supporting the lens/cataract. Most experienced cataract surgeons are aware of this and does not pose a problem.
How do you know? Specifically address this with your retinal surgeon…or…
I’d pick a cataract surgeon in a practice that has a retinal specialist.
I have become concerned recently that exposure to near infrared (800-1000nm) may be responsible for the development of some of the floaters that have been recently bothering me. I got on this track of thinking after reading that the vitreous body absorbs light in this region, and that the heating effects of such light can cause the denaturation of proteins. I am trying to determine the brightness of these LEDs. What is your opinion on this? Could the absorption of Infrared light in these ocular structures be to blame?
Thanks so much
You are way ahead of me on this. Interesting concept, but I simply have no opinion, yet don’t discount your theory.
I am 23 years old and have had floaters for about 4 months, which resulted from a PRK surgery I had in February of 2012 . They have consistently been “growing” and getting worse. My eyes were only myopic by -1 with a slight astigmatism, so it is mind boggling that a supposedly “safe” procedure has had this horrific result on my vision. I tried to golf yesterday and found that I couldn’t find even find the ball in the air after I hit. I can still read and drive and function( although I am easily distracted and disturbed by the amount of floaters in my eyes), yet I can no longer enjoy being outside and doing the things I used to enjoy so much. I have seen 2 retinal specialists here in Texas who both can see the floaters yet say that they will fade or settle with time and that there is nothing to be done about them. I have a couple of questions for you and I really would like to speak with you on the phone if you can find the time in your busy schedule.
Will the changes in my cornea from the PRK have any implications on a potential Vitrectomy, including the possibility of a cataract developing?
Should I wait at least a year after first noticing the floaters to consider this procedure?
From your statistics it seems like a no brainer to eventually go for a vitrectomy, but what are the odds that it will result in reduction of vision quality or other visual phenomena?
How many FOV’s have you performed and what would you say the success rate among patients is?
I would greatly appreciate a response, as this condition has plagued my mind over the past few months and is very disheartening.
First of all, I support your position.
I think that 4-6 months is enough time to determine if the floaters are likely to fade or to see if you’ve become more tolerant.
Regardless, you are the patient. If they are bothering you so much (and it sounds like they are), then something must be considered.
1. PRK: no, in my opinion PRK will not influence the surgery nor pose any complications to a vitrectomy.
2. Wait a year: see above
3 To give you a number; less than 1% chance (infection is probably around 1:10,000, retinal detachment is around 1%, cataract formation is impossible to rate (everyone gets cataracts) but go with 1% as an immediate result of surgery).
4. I don’t know about the actual number of FOV’s, but thousands of vitrectomies for a variety of reasons including floaters.
I have had visually impairing vitreous oppacities for 2 years. They have become more mobile..and are increasing. I have not driven for those 2 years because my vision gets too blurred out..as the oppacities cross my central vision. I have been too a retinal specialist in Melbourne, Australaia. He explained the risks. He was unwilling to do the surgery as my vitreous is still strongly attached tol the retina…and said that this would make the surgery more risky.
He said imay try Microplasmin in the future too hopefully drop the central vision floaters out of view. If this did not work..he said he may then do the vitrectomy. But i am worried that when the time domes, he will say no.
I cannott even go too visit my daughters..which hurts very much.
My eye floaters are classed as mild. But i am seeing them as a large mass.
I wish the medical community would take this more seriously. A lot of people are suffering greatly. Many of us do not have the normal floater experience..yet are labelled in the former.
I am not sure if microplasmin will really be the answer. While it may indeed cause the floaters to “move,” they could also make them worse/more crowded.
I’d keep searching until you find a doctor more sympathetic to your problems. Too bad you aren’t a little bit closer.
Dear Dr Wong,
I am a 26 year old male who has an increasing number of floaters in both eyes. I have seen my ophthalmologist twice in the past few years regarding them and both times given a clean bill of retinal health. I am nearsighted, and I have not seen any white spots or curtains either. I do however smoke marijuana and was concerned with its effects on the eyes. I have heard that reduced ocular pressure is not a positive thing for eyes in general. Is this a possible source of my floaters? What are your thoughts on cannabis use and retinal health, floaters etc. Thanks!
Not aware of any association between floaters and cannabis nor any relationship to retinal health.
I had a pvd in the right eye and soon after experienced a big round black floater that bounces around quite freely-has a mind of its own. i have had the left eye also with a new dot same as the right but fainter. it goes left and right but does not bounce around freely. the vitreous is more attached. the right eye also has a glare-like smudge that goes from right to left and back again when my eyes move right to left. i am seeing the vitreous membrane, which has possibly collapsed-or in any case is moving freely. this symptom is more disheartening than the spot because it ALWAYS happens. the dot can move out of my feild of vision sometimes.
so- my question is this. if i were to get a FOV whose to say that the removal of more vitreous wouldnt make the appearance of the vitreous membrane more noticeable? that would certainly not be a good outcome for me.
I don’t think that it is possible. The vitreous is anchored to the side of the retina and removing the central portion (aka core vitrectomy) should clear the central path.
The peripheral vitreous can’t move centrally to replace the surgically removed vitreous.
Dear Dr Wong,
I have high myopic eyes (-15) and my eye doctor confirmed I had recently PVD (partial only) on left eye but with no retinal detachment. I went to him because of a quite large floater had suddenly appeared 10 days ago.
In parallel, I’m followed by a retina expert as I coincidently had a submacular hemorrhage (likely due to valsalva maneuver) on right eye two months ago. VA has decreased on right eye, although that is already in recovery process.
My question is on FOV for left eye (although I wouldn’t decide anything before at least 6-12 months, to assess full recovery on right eye, and also leave time to left eye floater to fade). My retina doctor says there is a high risk of retinal detachment as I’m higly myopic in case we try to do anything (e.g. vitrectomy) on left eye. In spite of the PVD I had there already, as he claims ‘highly myopic people never have complete PVD’.
Based on this information, what would be your statement on a possible FOV on left eye?
When I asked my retina doctor if/when the floater would fade, he clearly said he wouldn’t, which is in contradiction with what I’ve seen in most publication. What would you think about this too?
Many thanks for your feedback.
with best regards
I don’t believe an FOV significantly increases your risk of retinal detachment. Your biggest risk is the severe myopia. One might argue that removing the vitreous actually decreases your risk of retinal tears/retinal detachment in the future….Without the vitrreous, what can tear your retina.
In short, I don’t find this to be a contraindication.
Most floaters don’t really fade, they just become less bothersome.
Dear dr Wong
Had passed cataract l+r eyes several years ago, few month later a lot of new floaters started to “visit” my eye sight. 2 years ago I (against experts opinions )took the risk to pass a vitrectomy in the R eye (the worsed eye). the results have been very good! all clear but for two very small circles that “pay a visit” once or twice a week . THE eye SPESCIALIST WHO operated on me does not like to operate on the L eye as the Floaters distarbance is only “half bad”. Is the fact that I had cataract operations done already change the risk rate of the VFO ? Why are eye doctors in general (my eye doctor told me “have u gone crazy” (in Hebrew of course) against VFO if risk is so low.?
Dear Mr.Moshe Tchelet,
Cataract surgery does not increase the risks of FOV, in fact, one of the “risks” of vitrectomy is cataract formation…so in a way cataract surgery prevents one complication.
I have no idea why eye doctors in general advise against FOV. Years back, vitrectomy was new…perhaps that’s the reason?
I visited your office earlier in the summer. I am scheduled for a FOV in Sept. my question is about the general vs. local when in surgery.
If I have trepidation about being semi-conscious or higher, can I elect a full general anesthesia for the surgery? I have read that you prefer the sedated vs. knock-out route for your surgeries. Is that a personal choice to operate in that fashion or is it based from patient experience results?
Also, for any of the blog readers who have had a FOV while sedated vs. general can you relate your experiences during surgery?
Looking forward to looking without floaters!
Dear CB lv,
Operating in patients with light sedation is both my preference and is based upon patients’ results.
The procedure lasts only 10-20 minutes. That’s pretty quick. In most cases, general anesthesia is overkill and increases the chances of side effects. It takes much longer to recover.
If you really want general anesthesia…no problem with me as long as you are cleared to have it by the anesthesia department (they will discuss with you just prior to surgery). Every patient must be cleared for general anyway.
Look forward to seeing you.
hi i have had pvds in both eyes leaving me with weiss circles and other floaters in both eyes this as happened in last 2 plus years with still some flashing at bottom of eyes on waking .consultant also as done laser at front of both eyes during this time due to raised presure ie 22 to 24 i have narrow angled glucoma it seems at last vist he said i now have start of cataracts in both eyes and he wishes to replace lens sooner rater than later to help presure .and i have dry eye, previous to pvds i had no trouble with my eyes at all and my visits to opticians always showed low pressure , my question is have pvds caused all my problems and could i still have a vit surgery to remove jelly
thank you susan
No. PVD’s have nothing to do with your present situation. Yes., you can still have a vitrectomy.
Hi Doctor Wong, greetings from Asia. thanks for setting up this blog. I greatly enjoyed your very positive outlook tempered with straight talk. I’m currently suffering from some new floaters but your FOV procedure/advocacy has truly taken a load off my mind. Can you please have Chrissy email me your approximate costs for FOV, I’m sorry for posting this is in your comments section but i cant seem to find a direct email. Thanks in advance.
Dear New floater,
Expect an email from Chrissy shortly!
Hang in there!
Dear Dr. Randall,
i am 38, living far away in Portugal. I am an ex contacts wearer ( 10 years ). Got a shower of floaters i both eyes since last December. Had some form of conjunctivitis ( blepharo-conjunctivitis the ophthalmologist called it ) Did the treatment, one month of several medications and lubricants. Had and still have a great deal of light sensitivity, better now after the treatment but not quite 100% yet.
Been reading extensively about some way to take the floaters away. FOV seems to be my only choice atm. My eye doctor told me right away i should NOT operate for this even though it is life changing ( for the worst ) I had no tear or trauma, my doctor tells me maybe i had a PVD, no confirmation on that. Eyes are myopic ( -2.75 BOTH ) but otherwise healthy she says.
Question: why so many people are reporting wavy/distorted vision after the FOV procedure? And cataracts? Leaks and loss of pressure? Even glaucoma !!! Are they unavoidable side effects? Or only a very small possibility??
Question: Do you think maybe in 5 to 10 years some new solutions will surface for floater removal or are we pretty much stuck to what there is now ??
Thank you for being so nice and reassuring to us all. People are killing them-selves over floaters and the medical community is in the dark ages regarding this HUGE health problem. No research to be found anywhere is very depressing to say the least.
I can only tell you that in my experience, from all reasons for vitrectomy, that distorted vision, cataracts, leaks and glaucoma would be very unusual. Certainly anything can happen, but after 20 years of performing vitrectomy, these are not usual complications following vitrectomy.
Keep in mind…everyone gets cataracts.
I don’t believe that things will change much in the next 5-10 years. Ocriplasmin, in my opinion, may make things worse…just because a PVD is created, it doesn’t meant floaters will disappear.
I’ve been like most of us Floater sufferers, scanning the web for all the data we can for a FOV. I have found many are saying that a non-PVD FOV is only a temporary solution and that the PVD will happen anyway so get it done all in one.
I belive you have said that an induced PVD is not really needed in a FOV. I am curious why so many folks would say a PVD is a better option – in your opinon.
1. Most people with a PVD do NOT notice floaters.
2. After vitrectomy, a PVD might occur way forward in the future. Floaters may not recur at all.
3. Regarding PVD: don’t really know. I would contend that after a vitrectomy, a PVD is less likely to occur…or at the very least won’t happen until much older. This may be hype in the Internet community. Doesn’t make sense to me to worry about an event (PVD) that may not cause new floaters.
Thank you Dr. Randall, very much.
I’m sure you understand why we, the floater sufferers, drill you with so many questions.
We are left hopeless by the medical community as they seem to have been trained to tell the patients to either “live with it” or go mad. Then someone like yourself breaks all of these taboos and actually take your time to ease our minds and people regain hope again.
People like you are the reason that hope i s alive as well as faith in Human kind.
I am very far from the US and my fears are mostly regarding post-op complications that may arise and not dealt with in the best manner here in my country.
Anyway, i am working on saving enough to travel to your office and get this done.
It will be hard, considering the added travel costs and having 2 eyes to be “worked” on and can only op one at a time, but still…only a matter of money and health has no price.
Thank you for being so professional and Human.
You are welcome and thank you for your kind comments. By the way, my biggest concern post-operatively is the chance of developing infection inside the eye, called endopthalmitis…a potentially blinding infection. It is very, very rare with vitrectomy and usually develops within a few days of surgery.
Hoping we meet someday.
Thanks for answering my questions.
I’ll be seeing you at 0730 9/14.
Somehting I have just thought of How long should I wait before wearing contacts again?
Dear Dr. Randall,
Thank YOU for being such a good person and such a professional doctor. Life saver, literally.
We WILL meet for sure, no doubt about that. Looking forward to it.
Just 2 quick questions if you don’t mind:
How long between ops considering both eyes have floaters?
Is my chronic blepharitis a set back?
Need to know this so i can plan for my future trip to the US for the procedures.
I’d prefer 1-2 weeks in between surgery. Chronic blepharitis does non alter my decision and I do not consider it an issue that would influence surgery.
Dear Dr. Wong. Thank you for this website and forum. It has given me some hope.
I am 40 years old and have relatively healthy 20/20 eyes (don’t believe i have a pvd)accept for some really irritating eye strands of floaters with areas that have globs of cells in my left eye that have continuously gotten worse over the years and have taken quality and happiness from my life. Thank you in advance for taking the time to answer these very serious questions for me.
1). For cases like mine- What do you remove in the vitreous? Just the center?
2) If I have floaters near the retina…will that not make me a candidate?
3) how many cases in your 20 years similiar to mine have developed infection or detachment?
4)And how long usually have you seen people with a case similiar to mine develop cataracts?
6)Would I expect to have my normal 20/20 vision within a couple of days or is there a longer healing process to the vision? Or does it never return to my your prior vision?
7) Does it affect the pressure in the eye?
8)For all of the FOY patients that you have had…what % would you say are happy that they did this surgery?
** I WOULD LOVE TO HEAR FROM THE PATIENTS THAT HAVE DONE A FOY AND GET THEIR IMPRESSION POST OPERATIVE…ESPECIALLY IN A BLOG LIKE THIS…..IS THIS POSSIBLE?
1. I try to remove most, if not all, of the posterior vitreous, including that part closest to the retina.
2. Floaters near the retina are only a problem if considering nd:yag laser…which is a procedure I don’t offer. By removing the posterior most portion, PVD or Not, I can remove floaters really close to the surface of the retina.
3. 1 person with a possible infection. He was chronically infected with S. aureus any way. Detachments occur, but not too often with 25 gauge surgery.
4. Cataracts are tough to answer as everyone gets them. If you have a cataract at the time of surgery, I’ll tell you that vitrectomy may hasten the formation, but not always.
6. You should expect return to “normal” vision within 1-2 days.
7. No effect on pressure.
8. As close to 100% as I dare to state without your becoming skeptical!
Sorry Dr. Randall…Not WONG….!
Day 4 post op.
I had my FOV with Dr. Wong (Randy) on the 14th of Sept.
I can honestly say I am pleased beyond measure! The staff at Woodburn surgical center are some of the nicest and most dedicated staff I have come across. The pre-op was spot on, they made me feel very comfortable.
The procedure I had was a Core Vitrectomy in my right eye. I had disruptive floaters, in that they truly disrupted my day-to-day activities. From driving, working, reading even talking with people- their faces would become smeared or blocked by the floaters.
I am floater free in my right eye and it is an amazing thing. I have caught myself hunting for the floaters that were once there, just out of habit, this is a very freeing experience to no longer have the obscuration of my vision!
Randy truly made my day!
The post-op when well and when the bandage was removed on the 15th I had clear vision, similar to what one has after being dilated. The dilation was for me, a very long lasting one, it has gone as of this morning, that’s 4 days of being dilated, but it was worth every moment just to be floater free.
As an aside, I believe my vision in my right eye has improved somewhat, I say this since I wear glasses and through the right lens it seems as if it is a bit too strong now. That will be a bonus if I can confirm that one!!
The entire experience has been a very good one. I learned of Capital Eye Consultants(CEC) through a friend of mine that had a cataract removed by Dr. Ballinger. When I called to CEC I was told that Dr. Wong is the retinal Dr. and that he would be the one for me to talk with and work with.
I am a computer professional of over 25 years so when I started doing research on CEC and Dr. Wong and found that Dr. Wong has what I think of as extensive understanding and knowledge of internet concepts and worth I thought – cool.
Randy’s blog, his website, the references to him from multiple Vitrectomy and retinal sites is very numerous. This guy knows what he is doing. It is quite simple to become an “internet SME” (subject matter expert) today and there are plenty of charlatans out there making you believe so – not the case with Dr. Wong.
For a Dr. to understand and leverage the mass communications capabilities of the internet and disseminate and yes bi-directionally communicate to both patients and those seeking answers whom he does not even know, is a feat in itself.
He established empathy, credibility and total understanding of what we as “floater victims” go through on a day to day basis. I know that the other non-floater individuals who visit his site(s) for macular or retinal issues must feel the same as I do. Randy is changing the way we as potential patients interact with Doctors.” This (as a car commercial tagged lined) Changes everything”
To Dr. Wong and all of the team that worked on my surgery day thank you for helping me start recovering my quality of life.
You are very kind. I am very happy for you and encourage “our” followers to push for resolution, too.
Too many suffer from floaters and their complaints are discounted, but if they couldn’t see due to cataracts….it would be a no brainer.
Thanks for sharing!
i’m very happy for you, your words accounting your experience have made very aware of what i might expect when i embark my own FOV adventure with this wonderful person, Dr. Randall Wong.
I truly hope all continues to go well for you and all the others like you.
Have a beautiful life my friend,
P.s. Thank you Dr.Randall, for Charles and for us all.
Dear Miguel (and Charles),
This is a very, very new way to relate to one another.
I applaud and appreciate both of your willingness to be transparent!
Thank you for your answer Dr. WOng. I really appreciate it and thank you for your patience with my ongoing questions. Just some follow up questions:
1) Approximately how many FOY’s have you performed on otherwise ‘healthy” eyes that don’t necessarily have a PVD?
2)How many retinal detachments have you encountered in this group? Any beyond repair detachments?
3)Do they usually have less or more complications than other types of eyes?
4)If one develops cataracts after a vitrectomy….will they still be able to get a lense that will be able to focus and not require special glasses–I know that there are a couple of types of lenses(forgive me for my lack of understanding with cataract surgery and options)
4a)And is cataract surgery just as successful as those who have not had a vitrectomy?
5)Do you find that all of these cases similiar to mine develop cataracts within the first year?
6) You also state that you remove most of the Posterior part of the vitreous….Is there a special technique that you use to try not to force a PVD or a detachment?
7) I was curious when CHARLES above stated that his eye is still dilated..Is this normal? And i know from experience when my eyes are dilated that i don’t really see my floaters…
Thank you again.
Charles here, on your no. 7 question. I would think that each individual will have varying times of dilation. Let me clarify my dilation statement further. My dilation was not a full wide open dilation for 4 days, it progressed back to normal state within those four days.
I use pretty strong drops to keep you dilated after surgery…I have recently decreased the strength in patients undergoing FOV.
P.S. Thanks Charles!
I hope you are able to come the the US and get your eye problems resolved soon.
Con mucho gusto mi amigo!
1. I read all comments but I still don’t understand the exact difference between a FOV and a ‘full’ vitrectomy?
2. I had a relatively minor retinal detachment which was preceded by a 5-week long period where initially I had small flashes in my eye, and then over 5 weeks the number of blob like floaters increased steadily. I kept telling my eye doctor I felt there was something wrong and he kept telling me I was in process of having a PVD and that my retina was fine and don’t worry about it, and then furthermore there was nothing I could do about huge # of floaters in my eye. Well sure enough at 5 weeks I experienced a retinal detachment in the periphery of my left retina. The doctor (told me AFTER emergency surgery that I was born with lattice degeneration which makes me more likely to have a detachment in BOTH my eyes. I’m not sure why the bastard (excuse my French) didn’t tell me about the lattice in the first place. I feel that if I would have had a preventative vitrectomy before retinal detachment that I could have avoided the detachment and the emergency surgery. Is this true? Should I have a ‘preventative’ vitrectomy on my other good eye (right eye) considering it has a lot of lattice degeneration (although the retina is flatter in this eye which is good) but I also HAVE been experiencing more floaters appearing in my right eye (good eye) 3 weeks after vitrectomy and buckle surgery on my left eye! Doctor tells me I am not having a PVD in my right eye but I think he is full of crap.
3. Why did my surgeon fill my eye with gas bubble after retina surgery rather than use saline? It seems to me saline would have been the better choice for quicker recovery (and I would have avoided having to keep a head down position for a week).
4. If you have a FOV what’s to say a future PVD wouldn’t occur in same eye? It seems to me you might as well have a full vitrectomy and reduce chance of future floaters to zero?
5. Now that left eye has undergone vitrectomy and scleral buckle, the surgeon told me I am extremely unlikely to suffer a future retinal detachment in that eye. Is this true?
6. My right eye is flatter than my left eye giving me less stress on edges of right retina (which is good), nonetheless the surgeon said there’s a medium chance I could have a retinal detachment in my right eye too given the lattice degeneration. Is this also true and what might my odds be? It really worried me that I’m seeing a few new blob like floaters in my right eye. Doctors says no PVD and retina looks fine. But my thinking is that I should have a ‘preventative’ vitrectomy in that eye because I really want to get rid of current floaters, and remove the full vitreous to prevent future floaters and most importantly reduce my chances of a retinal detachment to as close to ZERO as possible in my “good” right eye. Please advise?
Sorry for all the questions but I’m a bit concerned and I think they’re good questions.
1. There really is no technical difference between the two terms. Another way to look at it; FOV is the “lay person’s” term for a vitrectomy performed to remove ONLY floaters. Vitrectomy can be performed for many other reasons.
2. Standard of care is NOT to perform vitrectomy for lattice…with holes or without. Lattice may be present in up to 10% of the population. If anything, you may want to talk about preventative laser treatment to the areas of lattice. I doubt a vitrectomy is really necessary.
3. Gas keeps your retina attached while the laser/cryo performed to the detachment starts to take hold. If only saline were used, you had a very, very likelihood of detaching right after surgery.
4. See #1. Also, by removing the bulk of the vitrectomy, in theory, PVD is less likely to occur. If it does, less likely to notice floaters.
6. It is possible to have the vitrectomy for the floaters and at the same time, laser for the lattice. This should get your chances of detachment as close to zero as possible.
How’d I do?
Hello Dr. Randall,
I still have faith in Human Kind, never lost it. We are all related and should try to be the best we can to each other and set an example for our kids.
I hope you are well and everything is great.
Thank you once again for the respect you continue to show for us.
Hello Dr. Wong,
I would first like to thank you for your blog and the sympathy you continually show towards those affected by floaters. (I didn’t realize the emotional toll they caused since becoming one myself). Sometimes just knowing that there are caring specialists out there that are willing to alleviate our symptoms is enough to help with my morale.
I am a fairly new floater/flashes sufferer, I’ve had floaters for a little less than a year and they do not seem to subside and have actually increased a little. I am 22, do not have PVD, not myopic (close to 20/20 both eyes) and my floaters are very visibly distinct. I had a few questions about your procedure and the nature of these opacities.
1) My floaters are very distinct so am I correct in assuming that they are casting shadows very close to the retina?
2) Therefore would a FOV alleviate my situation or would I still need a core vitrectomy? And also, do you perform Core Vitrectomy for young people with floaters or solely FOV?
3) By having a PVD induced PPV and having healthy eyes increase the rate of retinal tears as a result of the strong adhesion of the vitreous to the retina?
3) What is the rate of vitreous syneresis. I’m sure it differs greatly by patient but what should I be expecting? (I think the unknown is my biggest concern)
4) I have started to see a sort of greyish veil in the right periphery of my vision, it’s very mobile, I’m just curious to ask what that may be? I have also have strings, dots, and crystal worm types (as of right now).
5) If I were to get surgery for my floaters in the next year and knowing the risk of cataract down the line. Is it reasonable to assume that I should start putting money aside to invest in Accommodating IOLs for cataract in my 30s?
Thanks again for your patience and I hope I haven’t been a burden. Researching the eye has been a hobby of mine for the last couple months. I really commend your work and I’ve watched your FOV video many times ,its so cool! I agree with you that microplasmin doesn’t seem like the ‘big-ticket’ solution right now but could it work adjunct to FOV by easing traction? Also, what do you see in the future of eye surgery instrumentation, if you could lead me to some reviews or papers I would love to read them!
Thanks again for you patience!
Regards from Canada,
1. No. They can be anywhere in the vitreous. But overall, it doesn’t matter if close to the retina or not…only those using laser recommend against these. A vitrectomy will remove them.
2. FOV = Core Vitrectomy.
FOV is the lay person’s term for core vitrectomy. A vitrectomy is performed for a variety of reasons; retinal detachment, macular holes, epiretinal membranes, etc. When performed for only floaters…..FOV.
3. Inducing is not a great idea. Increases chances of tears.
3. Vitreous syneresis is basically a lifelong process. If you are asking when a PVD develops, statistically after age 50 or so.
4. I have no clue. You should get examined. Could be benign or retinal detachment.
5. Not necessarily.
Thanks for the comments. Glad someone agrees with my view on microplasmin!
Thanks kindly for taking the time to read and answer all my questions! I really appreciate your candor and the effort you put in easing our woes!
I apologize for my typo for question 2. What I meant to ask was if you perform PVD induced Vitrectomy? (of course considering the risks as you answered in q 3)
I ask because I have read that in young floater sufferers there is a chance that these opacities are actually in the pre-macular bursa? Therefore, I am under the assumption that a Core Vitrectomy would not eliminate them?
And I will schedule and appt. asap for that veil. Thanks!
Hi; I need you hepl me please; my email is email@example.com
I need know how is the price for the sugery for opacities in the vitreo.
I am a Spanish engineer and opacities are holding me every day
i have stable; -6,75 I and -6,5 D
Please send me a email with information
Chrissy should be in touch with you within the next 48 hours.
Look forward to meeting you!
I can do Vitrectomy after Lasik? What is the price of FOV?
Yes, vitrectomy can be performed after Lasik.
I will have Chrissy communicate with you regarding price. It is usually covered by insurance in the U.S.
I hope I didn’t interrupt a separate thread 🙂
I have already had cataract surgery, can the procedure yo remove floaters still be performed if need be? Thank ou.
Yes. Absolutely. Cataract surgery just makes the procedure easier.
So i had a visit with DR. karachikoff (who does laser surgery for FLoaters)- I am just going mad with these floaters. basically told me that what he can see are just tiny dots that are near retina and there is nothing that he can do for me. (To me they are huge and are not all bunched together)- so not sure what he saw.
I than asked him how he feels about a vitrectomy. Basically told me that there is not a Retinal surgeon in this country who would operate on me. I told him that there is a surgeon who would possibly…And he said no way..I than mentioned your name and he said ..I know DR. Wong. Did he examine you? I said no..than he said that I MISSPOKE and that DR. WOng would not perform it on you if he ever examined you.
Can you comment on this…He basically is trying to destroy any hope for me..which i think is crazy given he is such an advocate of getting help for floaters.
1. Karickhoff offers YAG laser for treatment of floaters. In that regard, he MUST see the floaters so he can attempt to break up the larger ones. Smaller ones are tougher to treat…especially those close to the retina. This is not an issue with vitrectomy surgery…a huge misconception.
2. I don’t know why he would assume he knows how I’d practice. If your “floaters” move to and fro with eye movement and you understand the risks…then you could proceed.
3. Maybe you need to come for an exam?
Look forward to meeting you.
Had my FOV with Dr. Wong in September. Status update. Everything is still very good. I had an vision check today after letting my eye settle for a couple months.
The interesting thing is that my myopia went from -5.5 to a -7. Not sure if that is a normal thing or not, perhaps it’ll lower as time passes. If not, I am fine with clear vision at a -7 in one eye. Otherwise all is good.
I am looking forward to getting my left eye done in the first couple of weeks in Dec. So you may be seeing me soon Doc!
So glad you are doing well!
Thanks for contributing!
Congratulations Charles, happy to hear your doing well.
Have you noticed anything “weird” at all in your vision? Or would you say it’s perfect?
Also, maybe the difference in viscosity from vitreous to aqueous has changed the shape of the eyeball and making it more oblong in shape is giving you more diopteries ?? Well i’m no doctor but this is what came to mind. I’m sure you can easily correct for that bro,
Peace and good luck with the other eye, say goodbye to your little “friends” for good.
Thanks for contributing.
My eyesight is clear and spot on. The only change has been the increase in power. With my new contact I can see very well and I am looking forward to having a floater free life in both eyes very soon.
Miguel, if you can get here to see Dr Wong, I think you will be very happy with the results.
Cheers and to Dr Wong and his family and staff have a Happy Thanksgiving!
Glad you are doing well.
Thanks for contributing. It’s very helpful for those who follow you.
I have had a pvd in my left eye since August, 2011. My vision in that eye has gotten blurrier as time goes on with intermittent light flashes. The neuro-opthalmologist who last examined me in October, 2012 said, “I can clearly see the pvd and it’s flopping all over in there. It must be driving you nuts!” I can see that from this side. It’s like looking through a dirty, translucent half-deflated balloon. I think the pvd is at least partially attached yet because even though it “floats” it always stays in my field of vision. I believe I need a vitrectomy, but it would only be worth having if the pvd was removed at the time of the vitrectomy. There are other small floaters in my eye, but nothing as bothersome as the pvd itself. Can the pvd be safely removed during a vitrectomy? I have read on your website that you like to perform vitrectomies that do not produce a pvd. In my case the pvd has already happened and is itself causing the blur. Are there increased risks doing what I ask? I also have a cataract in the same eye that I would like to have removed during the same surgery if possible since it would mean one less recovery to go through. Would that be a problem?
Thank you for your time… Bob
With regard to the PVD/floaters, your situation is the easiest.
I can not do cataract surgery at the same time, however, and I doubt you’ll find any solution for having “one” surgery.
I would recommend you get cataract surgery if you have a known cataract, the possibly followed by vitrectomy.
Let me know if I can help.
Hi Dr. Wong,
I’m coming to see you early next year for floaters in my right eye. They’re causing quite a bit of discomfort mentally and physically. My question is about inducing PVD. Isn’t inducing a PVD during vitrectomy the only way to guarantee that floaters will not reoccur? If floaters continue to worsen over time, wouldn’t removing the source of those floaters be the best thing to do? There are a few people of the floater forum that have had floaters reoccur after an FOV without PVD inducement. Please let me know your thoughts on this Dr. Wong. I look forward to your reply and to meeting with you in February.
Technically speaking, no. Inducing a PVD makes it more likely that all the floaters are removed, but floaters can remain after surgery for a variety of reasons and not solely because a PVD was not induced.
Floaters might recur if they are due to inflammation (uveitis), bleeding or some of them were simply missed.
In my opinion, inducing a PVD is too risky with regard to causing a retinal tear.
Also, there is some misguided concern regarding a PVD;
1. PVD’s happen naturally to everyone.
2. PVD’s can, but USUALLY DO NOT cause floaters.
3. When I perform a vitrectomy, I view the vitreous as an onion. I’ll remove most of the central part of the onion and operate almost to the “paper” covering of the onion. If a PVD were to occur, it may not occur for 10-30 years and with the bulk of the vitreous removed, there is simply less vitreous to cause floaters. Last, removing the bulk of the vitreous, in theory, will make it less likely, or more difficult, for a PVD to occur.
See you in February!
Thank you for your reply. I’d like some clarification about the surgery. Would the pvd be removed during the vitrectomy? How is it removed if it is still attached at least at certain points? Does removing it have any increased risks over FOV without a pvd?
Once again..thank you for your time… Bob
A posterior vitreous detachment, or PVD, indicates that the posterior, or back portion of the vitreous has separated from the surface of the vitreous. A PVD is a normal event occurring in everyone, eventually. The anterior portion, or front part of the vitreous, does not separate from the retina and remains adherent.
The misguided and over concern about a PVD is that when it occurs naturally, floaters ALWAYS occur. This is simply not true. Most people who have had a PVD don’t even know it!
A PVD, however, makes removal of the vitreous easier and faster. So, yes, a PVD is really an anatomic configuration of the vitreous.
Here I am post-op by 11 days all I can say is I am so glad I went to see Dr. Wong!
I had my right eye done on 9/14/2012 and my left on 12/7/2012. Both surgeries went well. On my right eye, I was completely unaware of any work being done on my right eye. The left eye, I was out for the majority of the operation. It seemed as if I became aware at the close of the operation. To me, I recall seeing the “Great White Light” and my floaters spinning away up the tool. Now, remember I was in a very happy state at the time and I could have seen only what I thought were these things. Nonetheless, the patch went on and I was up and out.
Some observations, with my right eye, if you recall from my earlier post was dilated for about 4 full days. My right eye, however was not. In fact it had almost completely recovered to a normal state on the Saturday office visit with Dr. Wong.
The post-op procedures have been followed and now I am going to see Dr. Wong tomorrow for my 10 Day follow up.
Having one eye done and one still with floaters in the other for three months was ok .So, I thought I could live with only one eye corrected – so to speak. It was acceptable to a point. There were times that it was very bothersome in that a cloudiness and ofcouse the floaters moving to and fro distracted me. I kept doing a comparison between eyes. Closing one and then the other to check the differences.
Well, I had compared enough and went in for the second operation.
The difference now with both eyes corrected is astounding! No more clouding-milky vision with threads and globs – all gone! When looking out at the sky – nothing, when looking up on cloudless cold night skies – nothing. After a lifetime of floaters that gradually became so bad that I had to take control of them and my life, I am finally free.
The skies sparkle again, no more “was that a bug?”, no more obscuration of words, faces or feeling nervous about driving or motorcycling because of floaters.
Truly, words cannot fully convey the beauty of clear vision restored.
I know that this is a serious operation and like any other it does carry risks. That is why one must choose the surgeon very carefully – I am very fortunate to have had the good circumstance to be referred to Capital Eye Consultants by a flying buddy back in the summer that ultimately led me to meet and then engage Dr. Wong to correct my floaters.
If those of you who are considering this procedure do not get too caught up in the internet blogs and reports that are all doom and gloom, instead look for the successful and wonderful recovery stories that are out there. Just like our TV media the internet sensationalizes the worse popular sides of any story, why? They get advertising revenue when you hit their page. The more hits the more they make and that drives the page position in your search engine. So go look past page three or four in the results you may find happy stories there.
To wrap up: Dr. Wong with his internet outreach and his skill and ability in surgery are without a doubt are at the top of the heap. I have no reservation in referring or recommending Dr. Wong and if you have the opportunity to employ him you will too.
Remember that we are to go boldly not blindly, where no one has gone before!
Cheers and Happy Holidays to you all!
You’ve had a life changing year!
Thank you for sharing your experience with others.
All the best for the new year.
I’m from Russia. Insurance is not provided for me. what is the approximate price FOV on two eyes? Will FOV successfully? Excuse me for my accent.
Sergey, 21 (after Lasik)
You should receive an email from Chrissy shortly.
Dear doctor R.
I have floaters a few months ago in both eyes. I am 43 years old woman.I went to see 3 opthalmologists and all of them said there is nothing need to do about floaters. every other things in my eyes look fine, retina look healthy, no PVD, good lense,eye pressure level is noral in both eyes. I feel quite irritation at my eyelid so she suggested me to use artificial tear. Floaters bother me and is very annoying. It distracts me to focus in work quite often. I see some small grey lines. I felt like my world is almost end and my happiness in life has been decreased.
she said my floater occured from changing of gel to liquid, not from PVD.
I hope my situation get better or I can get over/ignore it …My questions.
1. if in some case, it worth to take risk to go ahead with virectomy ( which remove all vitreous as I understood and if in the case that eye develop cataract later, is cataract surgery and lens replacement can be performed ? how the lens can be stable in the eye if the vitreous had been removed and only saline is in there.
2. How many % of cataract development after virectomy in patients younger than 50 yrs old?
3. Can I get the cost and is the insurance cover the expense?…PS..
I am from Thailand and seeking more information about this. Kindly send information to my email.
1. Vitrectomy surgery is quite safe. Compared to cataract surgery, the chance of infection is less and the chance of retinal detachment is about 1-2% – about the same.
2. Cataract surgery after vitrectomy, performed for a myriad of reasons (hemorrhage, retinal detachment, etc.) is quite routine and the lens rests safely in an eye with only saline.
3. Chance of cataract is very small if no pre-existing cataract at time of FOV.
4. I’ll have Chrissy email you details.
Happy New Year.
First I would like to sincerely thank you for the forums you run and your willingness to communicate with patients- it is truly an incredible source of optimism and consolation for so many people who suffer floaters and are weary of the advice given by too many doctors. I wanted to ask you what is the typical age of the patients you treat with FOV and what you would say is an appropriate age at which you would be people to perform the vitrectomy without added risk. I would say my floaters are tolerable at best in the present and would be very interested in the surgery, but I was curious if you think it would be in my and other younger people’s best interest to wait further into the future for less risky potential treatments that may emerge in time. Again I thank you so much for what you do for all of us who suffer from this condition and your advice helps to improve the lives of thousands.
I operate on both younger and older patients.
I don’t think there is a better or worse age to operate.
If you’ve been plagued by floaters for months/years, understand the risks (comparable to cataract surgery), then vitrectomy is a viable option.
I don’t think there will be any new developments in the near future. Also, not sure Ocriplasmin will change anything.
All the best and thank you for your comments!
Hi Dr. Wong-
I am 39 and myopic (-7.00) in both eyes. I had a cycling injury that left me with a black eye and subsequent PVD and floaters in my left eye. Within five months of that happening, I also had a PVD in my right eye–no reason as to why by my Doctor with the exception that they usually happen in close timeframes to one another.
My questions are thus:
1. I have been told that I have lattice degeneration on my retinas–does this make the procedure more at risk for RD or tear?
2. Is the fact that I am highly myopic more of an “at risk” condition?
3. Lastly, from what I read, you don’t induce PVD, but for those cases where PVD has already happened, does that change your protocol to removing all of the vitreous?
I appreciate you taking the time to answer. It seems that many Docs ignore the quality of life issue that these things cause. Also, even though many doctors state that this is part of aging, I refuse to beleive that this is normal for someone not yet 40–hence, my diligence in finding a solution.
1. No. Actually a vitrectomy will make it less likely that you’ll tear from the lattice, but to answer your question…no.
2. -7.00 is myopic, but not too dramatic. I wouldn’t consider you “high risk” or “at risk.” There is too much hype over myopia and retinal detachment. Yes, there is a correlation, but your chances of detachment are still 1-5% for instance.
3. PVD makes operation easier and quicker.
Happy New Year and thanks for the plaudits.
I’ve been interested in vitrectomy for quite some time but I’ve had a rather difficult time finding any difinitive answers to a couple questions. I was wondering what is the success rate for FOV (all removed with no immediate complications), the long term complications and the percentage of patients who develop them, the typical implications on vision if they exist (prescription change, perception distortion etc), and lastly the general satisfaction with the results of FOV and the satisfaction that is reported by your patients. Also, I was curious as to why most doctors are so vocally against vitrectomy for floaters; you seem so optimistic about the use of the surgery and offer little discouragement and while I absolutely do not doubt your practice and the results in the least, I have to ask about the discrepancy. I apologize for bombarding you with questions but you are truly the only doctor I have ever heard of who is so open and interested in communicating with the public and I thank from the bottom of my heart for what you do.
Okay, here goes….
1. Success rate re: immediate complications
I’ll estimate about >99%. I’ve had one case where the eye pressure was low for greater than one day. Not sure it caused any long term problems though. I’ve had one case of infection in 20 years and this was in a patient/diabetic patient where vitrectomy was performed for complications of diabetic retinopathy. This patient had chronic systemic infection though.
2. Long term complications: Not sure what you mean….
The two most concerning complications from any eye surgery, vitrectomy or otherwise, are blindness from infection and retinal detachment. Both could cause permanent loss of vision or blindness. The chance of developing endophthalmitis (infection inside the eye) for vitrectomy (vitrectomy for floaters, vitrectomy for ERM, vitrectomy for macular hole, vitrectomy for diabetic retinopathy, vitrectomy for retinal detachment, etc.) is somewhere between 1/10,000 and 1/15,000.
The chance of endophthalmitis in cataract surgery is 1/2000 (Yes, you are reading correctly, cataract surgery is riskier).
The chance of developing a retinal tear from vitrectomy is 1-2%. Not all retinal tears will develop retinal detachment…so the rate of retinal detachment is probably around <1%. This is comparable to cataract surgery.
3. Cataract formation is controversial. The official dictum is that vitrectomy hastens pre-existing cataract formation, that is, if you have a cataract at the time of vitrectomy surgery, you'll likely get a cataract sooner in that eye than your other eye. See below.
Keep in mind;
a. Everyone gets cataracts...everyone.
b. Cataract surgery is the most common surgery performed in developed countries and, in the U.S., enjoys a >99.8% technical success rate, that is, very, very safe.
c. There are NO studies on cataract formation in patients who undergo FOV (technically this is the same operation as vitrectomy for any other cause, but the operation is much shorter and no gas is injected at the end of the surgery, the studies revealing cataract formation after vitrectomy include all types of vitrectomy….and very few, if any, FOV – because noone does them).
4. Discrepancy – Most eye doctors that you’ll see are not retinal specialists and they are simply repeating what they’ve heard from one generation of docs to the next. Vitrectomy was developed in the 1970’s and became quickly adopted in the 1980’s due to its novel approach and ability to help people who would otherwise go blind. Yes, the complications were much higher than now.
30 years later, the technology has changed making the operations much easier, quicker and, most importantly, safer.
I support vitrectomy for floaters, or any other condition, if you understand the risks as stated above. These stats are facts. Most docs just aren’t aware of them. There is a huge rift in knowledge between retina specialists and non-retinal specialists. Most “eye doctors” simply just are unaware.
Hope this helped you.
Thanks for asking.
Thanks for answering my questions. I did have three other questions that came up while awaiting your response:
1. I have “tracer” flashes along the periphery of my eyes, the left one especially, which is very noticeable at night when driving, changing lanes, etc. After a vitrectomy, wouldn’t these flashes go away if the vitreous which was pulling is now gone?
2. Of everyone who meets with you, surely, a percentage do not opt for surgery. Do you have a “gut feel” as to why they are willing to live with it?
Last, do you know what limitations one has after cataract surgery? I mean, I will be 40 at year-end, but can’t imagine having the eyesight and light-sensitivity of an 80 year old person that has had cataract surgery. (Several relatives come to mind!) if I did have early onset cataracts. . Any thoughts regarding this and the acuity provided by IOL’s?
One other thought…I have had myopia since age 15, and I’ve relied a contacts/glasses since then. I can’t help but think I could do LASIK to rid myself of my -7.00 contacts and then having a vitrectomy for clear, no-contacts perfect vision…thoughts on that?
Regards and Happy New Year.
1. Flashes, if related to traction/pulling on the retina, usually go away anyway…but especially with a vitrectomy.
2. Some patients can’t stand the thought of surgery to their eye. They’d rather have decreased vision and the floaters. Most elect for surgery however by the time they come in for a visit….they’ve already decided surgery is a viable option for them.
3. Limitations after cataract surgery…usually none. Most patients have excellent (20/20) vision following cataract surgery. I don’t know why you think there is any compromise with vision after cataract surgery with implants.
4. LASIK may be an option to make you less near-sighted.
Hope this was helpful!
Hi Dr. Wong. I’m sure you’ve been asked this question a hundred times- why do you as a specialist chose to perform non-PVD induced vitrectomy for the treatment of floaters? I personally lack significant knowledge of the condition and treatment greater than what I’ve learned from forums, discussions and most of all, your website and videos (thank God for this site and your incredible generosity and empathy) but I know you must a reason for preferring this method. Pardon my ignorance but practically everything I have read seems to indicate that non-PVD induced vitrectomy is essentially a gateway for residual floaters and other problems in the future, a tremendous risk for someone choosing the operation to correct that sole condition.
Also, I have read a lot about the use of sutures in vitrectonmy and was hoping you could explain the difference between a suture and suture-less operation and their results.
Lastly, I am a little curious about the general logistics of how the process is handled- for patients who do not live near your treatment center in Virginia, do most people stay at a local hotel and travel by themselves when you feel the eye has healed significantly or are you pretty laid out and have to stay in town for awhile?
Thank you so much for your time and I wish you a fantastic New Year!
Thank you for your comments.
1. I’d prefer everyone had a PVD. A PVD allows for more rapid and complete removal of most of the vitreous.
A. PVD however;
i. Does not always cause floaters, in fact, most do not! So, if a PVD were to occur, it might not even give you floaters. Also, see below. You might love to be floater free for 30-40 years even if every PVD did cause floaters.
ii. A PVD may not occur for another 30-40 years (let’s assume you are now 30 years old).
iii. The vitreous is similar to an onion. I can remove almost all of the vitreous down to the thin paper like coating of the onion. This allows me to get within a mm or so of the retina, thus removing all possible floaters. Also, by debulking the vitreous, I believe it much less likely that a PVD will occur.
B. Inducing a PVD, especially in a young person, increases the chances of a tear developing during the operation. While the risk of a tear developing during vitrectomy is somewhere around 1-2%, I try and minimize the chances of complications of retinal detachment.
2. Here’s an article I wrote about 25 gauge vitrectomy. Hope it helps. I think it may answer your questions, but if not, feel free to post another comment.
3. Most arrive on Thursday for pre-scheduled surgery on Friday. I like to see you on Saturday and would like you to follow up with your own doctor at home. I’ll have Chrissy email you separately about the logistics. We have a few hotels that are very patient friendly and will offer a pretty nice discount.
Hope this was helpful.
Thank for your reply, Dr. Wong!
Last couple questions, I promise. Another symptom of my eye troubles has been a dramatic increase in my sensitivity to light and what I believe has been dubbed ‘visual snow’. Despite never having abused drugs of any kind, I find myself suffering from most if not all of the major symptoms of HPPD, a condition I discovered through the many hours of research I have logged on my visual troubles. I was wondering if you had any experience with conditions similar to this? It is my understanding that they are often seen in patients who have developed floaters, but I have not read anything regarding the effects of a vitrectomy on light sensitivity etc so perhaps you may shed some light on that I hope.
Secondly, I know I have already raised the question but I now have a more serious interest in the procedure so I was hoping to ask more. I believe in possibility of vitrectomy but unfortunately I have heard nothing but horror stories regarding its use on the young. I am 19 year old student who has been experiencing floaters for the last 2-3 years of my life and desire nothing more than a second chance at normal vision, but I have heard much about the inevitable complications that may arise cataracts, periphery/frill floaters etc. I’m not entirely sure what Im expecting you to say to quell my fear more than you already have but what I have heard from my own opthomologist and the Dr I saw at Bascom Palmer was they would never think of performing a vitrectomy on someone my age unless there was a medical emergency with risk of blindness. Have you ever operated on someone my age or similar?
Lastly I have read throughout the web of the many surgeons who tout their abilities to cure floaters. I have been far and away most impressed with your website and knowledge through this discussion, but I was simply curious as to your opinions regardding the other major specialists out there (Patel, Mackool, Charles etc) as well as the people who claim a cure through YAG laser. Thank you so much again Dr Wong for everything!
1. Light sensitivity…not sure it’s related. That’s why you probably haven’t found anything.
2. With regard to your fears. Examine the facts. Vitrectomy is safer than cataract surgery with regard to infection and probably has the same risk of retinal detachment. The question really then becomes, why would the same doctors who are skeptical about vitrectomy in a patient with floaters readily operate on the same patient if the cure were cataracts? It just doesn’t make sense.
Cataract risk in vitrectomy for floaters is, at best, controversial. The recent research says cataract formation is hastened by vitrectomy (but these are vitrectomy cases performed for all kinds of problems, e.g. retinal detachment, and not just floaters). Can’t honestly say cataracts always happen after FOV if noone performs them.
3. What about Patel/Mackool/Charles bothers you?
I was curious regarding the potential of FOV for the development of cataracts. I’ve read quite extensively your own and other’s opinion on the impact of vitrectomy on the formation of cataracts and have accepted the inevitable fate that eventually everyone will develop them and FOV may only hasten the process. Regarding the actual treatment of cataracts, it is my understanding that having had a vitrectomy has no impact on the results of cataract surgery- is that correct? I know this may exceed the scope of this website or your practice but what can one expect post-cataract surgery; do accommodating lenses effectively recreate the perception of natural lenses or is there a notable discrepancy between the two? I find this to be a particularly hard risk to accept because of my age, even though I would think life with glasses would greatly outweigh the life I now have.
Also I have heard myopia is a significant factor in the development of floaters and in the process of treating them via invasive surgery- what classifies as noteworthy myopia, doctor, as I am -1.50 and -1.75 with minor astigmatism? Are either of those conditions a problem?
Last question. Under what conditions do you personally refuse to treat a patient for floaters? I’ve read many peoples’ concerns voiced to you on this website, and you have deemed most of the conditions presented as a non-issue regarding your operation, but I have to believe there are situations in which vitrectomy would not be viable option- is age ever a problem? glaucoma? etc.
On a personal note, I’ve been informed I have a choroidal nevus on my right retina I believe, and while I anticipate it would not be a problem for vitrectomy, I am not certain what its presence means for this procedure and for my general eye health. I would tremendously appreciate anything really on the subject you may offer me.
I know your support of vitrectomy for the treatment of benign floaters has garnered attention and skepticism amongst doctors and patients alike; however, I agree there is incredible merit and value to the practice and I applaud you. The health care system in our country is in dire straights, and doctors like yourself are truly the greatest hope we have. I anxiously await hearing from you.
Vitrectomy has litte impact on cataract surgery.
I don’t know that much about accommodating IOL’s because I don’t perform them, but my colleagues claim great success with them.
Neither the small degree of myopia nor astigmatism would affect vitrectomy.
If I don’t think a person is actually suffering from floaters and I don’t think the procedure will be helpful, but if you clearly state that whatever you see moves back and forth with eye movement…it can only be floaters within the vitreous.
Age is not a problem…nor glaucoma.
Choroidal nevus is not an issue either.
Thanks for your kind comments.
Dear Doctor, I’m a engineer and floaters are bothering me all time and for me is difficult to do my every day job
Could you tell to Cristy if she can send the cost of the surgery.
Dr. Carlos Couder Castañeda
Thank you for your help
I will have Chrissy contact you.
I had cataract surgery on both eyes this past year. The right eye after the YAG treatment has a very large floater, making it difficult to read or do computer work, ie. when I hold my head downward the floater covers the area of vision. Would there be a possibility of removing the floater?
You can be helped.
Thank you- I dont know how you possibly manage all the questions but its much appreciated!
I have been seriously considering the procedure, and I find myself constantly pondering what the source of my affliction has been.. I understand many people cite stress as an agressor while others recommend exercise or medication to relieve the floater’s prominence in one’s perception. I know many people who, like myself, suffer from floaters however are not driven to the brink of insanity/surgery and learn to cope quite well. This leads me to question what it is that makes the select few of us perceive floaters as such a larger nuisance than others do. Do you ever advise people to pursue lifestyle changes or any other measures before considering FOV?
Also, what have your experiences been with halo/starburst effects both pre and post op? Have you ever seen FOV have any impact on these odd phenomena of vision? I know you and most other surgeons consider retinal detachment, cataract and infection the primary risks involved, but what about those that arise when everything goes well. Ive read horror stories of wavy distorted vision, blind-spots, hypotony, secondary floaters worst than the original etc. and it seems to me these unknowns are worse than the three knowns. What is your opinion? On a side note, many people question the use of Kenalog- would you mind explaining its function and your use of the drug if you do so.
As always, I greatly appreciate your time, knowledge and expertise, and await your response. Thank you Doctor
1. You are welcome. I don’t know how I manage sometimes either!
2. I do not advise lifestyle changes because the FOV/vitrectomy is very safe and easy to perform. There is way too much bad information out there about the procedure.
3. Halo/starbursts may be related to the PVD/floaters, but I’d have to examine you.
4. The horror stories probably do exist, but overall the procedure is about 98-99% safe and successful.
5. Kenalog for what purpose…removing the vitreous?
6. Am considering a webinar in the next few weeks re: Floaters, would you find that useful?
Dear doctor. Does nystagmus may have affect on development of floaters.
No, I don’t believe so.
Hey Randy hope all is well! Just hopped on here to see how things were going. Looks like you are quite busy! To everyone reading, my name is Chris and I posted my Vitrectomy experience with Dr.Wong in July of 2012. It is now January 2013 and everything is fantastic. If you are contemplating this procedure and/or worried about having this done, Randy is the best. I am debating having my other eye done (which is not as floater filled as the operated on eye) however due to the outcome of the first procedure would not hesitate in a second to see Randy again.
Thanks for the support. Glad to hear you continue to do well.
I am thinking of a webinar in the next few weeks. Would you be available to participate?
Hi doctor, my left eye is myopia（-10.00) and my intraocular pressure is about 22-23mmhg
Is it suitable for me to have FOV? Does it belong to high risk to do this surgery, for example, ocular pressure elevated after surgery?
No reason why you can’t.
BTW – thinking of scheduling a webinar for floater afflicted patients.
Would this be of interest to you?
Hi mr Wong!
I have floaters in my eyes.Its degenaritve of vitreous,as you know/I have myopia and astigmatism also.
I know you do surgery for it-FOV.
Can you help me also?
I have some questions
The big problem-i have chronically blepharitoconyuctivitus.
Can you do operation my eye or its dangerous about infection?
Please help me.
Answered this in the other post.
Webinar on Floaters scheduled for February. Follow links to register!
I think the webinar is a great idea- there is an unbelievable amount of confusion and unsubstantiated opinion in the realm of floaters/vitrectomy as I’m sure you encounter all the time. Perhaps you should consider recording it or making a FAQ section to cut down on the monotony and relax? Either way your dedication is awesome and we all appreciate it tremendously.
Anyways with regard to Kenalog, I had only heard the name in a few horror stories, and maybe it was used only for a unique circumstance as I havent encountered it again. The reason I had inquired about lifestyle is that in a routine ophthalmologist visit, I had explained my situation with floaters as well as an increase in sensitivity to light in certain circumstances. His reply was that the floaters in my eye were insignificant and the only reason I was bothered by them was my hypersensitivity and that I should cut gluten, caffeine, nitrates etc, wear sunglasses inside and embrace my ‘gift’. It was not a pleasant visit.
Thanks again and I look forward to the webinar!
Sign up for Webinar: Evaluation and Treatment of Floaters
Kenalog is sometimes used to “see” the vitreous during the operation. I don’t use it, but prefer Brilliant Blue….no reports of toxicity.
Find another doctor!
Looking forward to the webinar.
I would be more than happy to participate from Dallas, Texas. Let me know the details. My personal email should be attached to this post.
Sign up Webinar: Evaluation and Management of Floaters
Look forward to your participation.
can you do vitrectomy on someone with moderate nystagmus? how do you remove the last layer of gel fromt=retina with shaking. is it better to put a nystagmus patient under
Yes. The eye won’t be able to move with the local anesthesia.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Hello Dr. Wong
i am a 17 year old young man who suffered from flashes of light and a lot of floaters….
Lately, i was hit in my my head before these symptoms start appear
but i am not sure that the blow is the reason
but at the same time i’ve got the blow i was taking an eye drops for inflammation and it contains cortisone
i used it for a week and i’am sure that the eye drops is the main reason for the floaters and flashes…because the hit was very weak to make my condition reach to that extend.. !
i went to a doctor and he affirmed that the eye drops is not the cause !
If you please help me figure out my case…
Thanks in advance
See my other comment.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
I’ve forgot doctor….my eye has became very dry after flashes and floaters appear and i take an eye drops called Systane Ultra and it doesn’t treat my eye
one of my friends was subjected to full vitrectomy on her left eye to remove a floater. After the operation eye and vision condition is almost perfect, but there are some black dots (much small than floaters but still noticable). Her doctor says it’s some air got inside during the opearion and with time it will go out. Her doctor has made already 3 “washing” procedures, but not all bubbles are gone. Do you you faced with such condition during your practice? How to avoid this?
If it were air, it should be absorbed within 24-48 hours or so.
Not after 3 operations.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
I’m a little late in reply, but the webinars were very good. I know that the folks, who are contemplating the surgery, now feel better informed about the choice they have.
As a patient that has done both eyes, I can tell you that for me and most it is safe, effective and recovery is quick. I have no regrets whatsoever in having this procedure done last year.
I have written in earlier posts about my experience as have others, please go back and read through them you’ll find a wealth of information and answers to the question you are probably thinking of asking.
Dr. Wong, Randy, will answer your questions and does so when he gets time away from helping people like me. It’s pretty amazing that a Dr. of his caliber takes the time to honestly listen and inform people like me who have been searching years for a solution to the clumps and strings in our vision that there is a solution and it’s very safe.
Thanks again Randy!
BTW the redesigned site is well done.
Dear Charles B,
Thank you very much for your kind words. As you know, I feel this is a very important way for doctors to reach out.
Thank you for your participation here on the website, the webinar and other places. I, too (finally!), like the re-design.
As you pointed out, all of this takes a tremendous amount of time, especially if done correctly.
Thank you for your help and thank everyone else for your patience.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Hello dr. I’m speaking from Argentina and I wanted to ask if you do vitrectomies to minors.
What sizes of instruments generally used?
Does the kenalog in all operations?
Do you use sutures?
With that fills the eye?
What are the statistics of success?
I have 13 years and I have hundreds of floats for some like myself this meses.Me vitrectomy with you.
Would be traveling to the U.S. later this year.
Many thanks and sorry for the translation (I speak Spanish)
A vitrectomy on minors is no problem as long as the parents give consent (permission) to do so.
I prefer 25 gauge instruments almost all the time, but the reasons depend upon the case.
I do not use Kenalog all the time. Once in a while.
See remark about 25 gauge….no sutures if 25 gauge. Sutures if 20 gauge.
Saline fills the eye.
High rate of success….but for what reason are we operating, I assume floaters? If so, at least 98%
Look forward to meeting you.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
what is your phone number?
Please do give us a call.
Ask for Chrissy.
Hey Dr. Wong – Thanks again for the webinar a while back, very informative. Had a couple additional questions. Have had issues with dry eye in the past, is that a big concern in doing a vitrectomy? Also – my local Dr. said that when he does a vitrectomy for floaters he will typically give a little tug to see if the vitreous easily comes off and if it does not he will not try to induce a detachment. Is that something you typically do as well? Thanks again, appreciate it. Ryan
1. Dry eye is more an issue with laser vision correction. Not sure it’s a worry with vitrectomy.
2. I won’t tug. No reason. I disagree.
Hi Dr Wong,
After a lot of reading and watching your webinars, I’m very interested in coming for a consult and (hopefully) surgery, but I’m in college and don’t have insurance. Do you have a rough estimate for hospital and surgery fees? I’m hoping to have this completely done and be recovered by the end of summer. Is this realistic?
My local doc said he would not do the surgery. He thinks I am too young and the risks are too great (although he does note the floater problem). He said if I were older he would consider it (frustrating!). Given his attitude, I am concerned about follow ups with him. Would I need to see him for several months after surgery to make sure things are healing properly? Or do I only need to go in if there is a problem?
Wish I lived closer to Fairfax. 🙁 Would make things much easier.
I’ll have Chrissy contact you with more information.
I’d prefer you follow up within 7-10 days after surgery.
Dear Dr. Wong,
I have a FOV scheduled in approximately 2 weeks. It will be the first of 2, if it is successful. I am 64 years old and had cataract surgery with crystalens implants more than a year ago. I was quite myopic prior to cataract surgery (-8.0). Shortly after the surgery I experienced vitreous detachments in both eyes and 2 retinal tears in my left eye. The retinal tears were repaired with an in-office laser procedure by a retinal specialist. Since experiencing the vitreous detachments, I have had significant floaters in both eyes. When they move across my visual field, they obscure my vision. The are large and cloud-like. I am very active and am a very visual person. One of my greatest joys in life is seeing the beauty of creation. I have tried to accommodate to the floaters with some success, but they do trouble me, particularly on sunny days and also when working on my computer, which I do frequently. I have now developed PCOs in both eyes and my visual acuity is deteriorating. I am facing the decision of either treating the PCOs with YAG procedures or having a vitrectomy and capsulectomy. My retinal surgeon informed me that there is the potential for creating more floaters with the YAG and that there is also the potential of pitting the crystalens. I don’t know the percentage of these risks with the YAG or there potential seriousness. I am a type A personality, which has its pluses and minuses. My natural inclination is to go for the greatest potential gain. In this case, it would be elimination of the floaters and no damage to the lens implant, thus I have opted for the vitrectomy and capsulectomy. If it were not for the risk of damaging the crystalens, perhaps a YAG would make sense and then a vitrectomy could be considered subsequently. As I said, I am scheduled for the vitrectomay and capsulectomy. Am I understanding the issues correctly and do you think I am making the right decision?
I would suggest either;
1. YAG then vitrectomy
2. Ask your retinal specialist if she’d be willing to open the posterior capsule with the vitrectomy instrument…I do it all the time.
In my opinion, there is almost no risk of the YAG causing damage to the IOL. On the other hand, there is no chance of damage when using the vitrector.
I think you may be over worrying?
(I’ll answer your other question next!)
Randall V. Wong, M.D.
Hello, first off I would like to thank you for what you do, you make a lot of peoples live’s better. I just saw one comment that I found interesting. My story is I am 24 years old. Just recently my distance started to go and I now wear contacts. I noticed a couple of months ago that I now have quit intense star bursts and sensitivity to light. After this I now see so many floaters I can hardly look at a computer screen. I have seen my optometrist several times and he says there is nothing wrong. Is it true that the starburts can come from the floaters? Do you perform this often on young patients. If you could respond that would be great. Thanks.
If you have floaters, you have floaters. I believe they can cause glare if dense enough (if they cast a shadow, they can also cause glare).
I’ve done this on 16 year olds…you aren’t that old.
Would love to hear more from you.
Hi Doc, Thank you for taking time to answer questions. I had retinal detatchment and was operated ( laser + gas bubble + sceral buckle) on to address the issue. The doc said it went well. I noticed floaters with in a month of surgery and it’s been almost a year now. I resumed wearing my contact lens after 2 months and started going to the gym after 6 months.
Here are my questions
1. I have been wearing contacts for the last 15 years. Did my retinal detatchment occur due to inappropriate use of contact lens ? Meaning if the lens got stuck to the eye and I ended up putting pressure on the eye to remove the lens ?
2. I went for a check up after a year ( i called him to complain about floaters) and the doc advised i should consider vitreoctomy to remove the floaters in the eye. when I asked how my eyes look, he said all fine. I want a second opinion to understand if the reason for the floaters and if there is any more retinal detatchment happening.
3. I can live with my floaters rather than tske a 5% chance to go half blind. I am 35-40 years range. I would rather have this when i am 70 and go blind then than do the risky procedure now. Is that reasoning correct ?
4. How easy is pars plana vitreoctomy and can’t the body destroy/remove floaters as foreign bodies ?
Thank you again.
1. Absolutely no way. No correlation.
2. Good idea. Are you interested in a trip to VA? If so, I can have Andrea or Chrissy help you make the arrangements.
3. Reasoning is incorrect. Where did you get the 5% of going blind? At most 1:10,000 of getting a blinding infection. Chance of retinal detachment is about 1%. While you might lose vision from a retinal detachment, blindness is not likely.
4. Pars plana vitrectomy is the simplest procedure a retinal surgeon performs.
Randall V. Wong, M.D.
Fairfax, Virginia 22031
I’ve read several comments people asking about the surgery on minors, my question is the other end of the spectrum…my mother is 81 years old and only has vision in her left eye (lost right eye in and accident) does age ever matter in this type of surgery. And should she decide to have it done is there a supplemental pre-treatment she could follow prior to the surgery to lesson the chances of infection?
There are very few reasons why surgery couldn’t be done;
1. Not medically fit, regardless of age.
2. Doesn’t want surgery.
That’s about it. My short answer is that she can have the surgery assuming she gets medically cleared and she wants surgery. I don’t do anything differently for patients with an only eye.
I suppose we could try antibiotic drops prior to surgery, but it has never been proven to be useful.
Hope this helped a little.
Best of luck,
Randall V. Wong, M.D.
Fairfax, VA 22030
Vitrectomy for floaters can decrease eye sight??? & forming cataract or infections inside the eye.
or any other complications is there is in surgery??
what is the recovery time from surgery???
Cataract formation may occur if there is a cataract at the time of surgery. It generally does not occur in patients without evidence of cataract. Recovery is within 24-48 hours. Drops will be needed.
Randall V. Wong, M.D.
Fairfax, VA 22030
ON JULY 19,2013 DR WONG PERFORMED FOV PROCEDURE ON MY LEFT EYE DUE TO LARGE FLOATER.
ALREADY HAD IMPAIRMENT IN RIGHT EYE DUE TO RETINAL DETACHMENT IN 2009. MY LIFE WAS A TOTAL MISERY UNTIL DR WONG CAME TO THE RESCUE! HIS FOV SURGERY WAS A BLESSING AND I WILL BE FOREVER GRATEFUL TO HIM. DR WONG IS AN EXCELLENT EYE SURGEON!
Congratulations and thanks for commenting!!
Randall V. Wong, M.D.
Fairfax, VA 22030
I had a PVD in my right eye in March/April, which caused a slight macular hole for a few months. The macular hole is gone, now that the membrane has released. My eye doctor has examined the eye numerous times and said everything looks fine now. Unfortunately, there is now so much debris in my eye, that it drives me crazy. I am seriously considering this surgery. My question is this. Besides the floaters, I swear I can see the membrane itself floating past my field of vision, every time I move my eye back and forth. It’s like a fixed veil that moves right to left. I can not see through it clearly. Is it the membrane? Will that be removed if I have a vitrectomy?
Obviously, I can’t be accurate in my answer due to the fact I haven’t examined you.
It is possible that the membrane, no longer stuck to the retina, is indeed “floating” in the vitreous. Also, it’s possible you’ve just got a gigantic floater.
Either way, it can come out.
Thanks and Happy Holidays!
Randall V. Wong, M.D.
Fairfax, VA 22030
Hello Dr, I am speaking from Chile, my English is not good,
I want to know, how long should I be in Virginia since the first medical visit to return to my country.
I would like to know the prices and if it is advisable to operate one eye and the other eye next year, or better to both eyes
You speak Spanish?
Thanks you very much
Plan on about a week. Normally I see you the day before the operation. If we need to cancel, we cancel.
If the operation proceeds, you can leave as soon as 1-2 days after surgery. I’d prefer you have follow up 7-10 days after surgery with your eye doctor.
Thanks and Happy Holidays!
Randall V. Wong, M.D.
Fairfax, VA 22030
Thank you for taking the time to read this. My name is David and I am 34 years old. I had a scleral buckle installed in my right eye to repair a spontaneously detached retina at age 17. I suffered an unfortunate blow to my right eye about a week ago. I had my eye checked and the retina is OK (the buckle held) but now I have a giant floater in my field of view. After considerable research I would like to pursue FOV to restore my vision.
A year ago I took my old bones back to school. I am a full-time student and hopefully a future doc. I truly want to heal the sick and help others ease suffering. I would like to address the problem with my vision soon and get back to serving my community.
What suggestions can you offer sir?
I’ll have Chrissy contact you via email to set up an appointment and visit. How does that sound?
Also, I’ve recently started a website for floater sufferers. Would you care to visit and subscribe?
All the best!
Randall V. Wong, M.D.
Fairfax, VA. 22030
Can a Vitrectomy be done a person who has had PRK corrective surgery?
Also, can this procedure be done on both eyes.
I have mass floaters in both eyes.
Does health insurances cover this, I’m in the military.
I just published this today on my other site;
This is my site for patients with floaters:
The short answer is that vitrectomy CAN be done on a patient who has had PRK. Yes, both eyes can have vitrectomy. Yes, insurance covers vitrectomy.
All the best and thank you for your service!
Randall V. Wong, M.D.
Fairfax, VA. 22030
Dear dr Wong do you make FOV to persons witch have amblyopia in one eye?
Question from Poland,
I don’t think that amblyopia is a factor in making the decision about FOV. It should not be a problem.
Randall V. Wong, M.D.
Fairfax, VA. 22030
Well, it has been well over a year since I had my FOV’s and I am still just amazed at being able to view the world without floaters! In my case the floaters were like kelp, brown globs attached to strings that were always in the center of vision.
I searched for ten or more years for a solution. I went to ophthalmologists who flat out told me either ignore them or in one case the ophthalmologist told me I did not have any floaters! I even went to see a Dr. here in VA that uses the YAG laser to blow up floaters – he told me I had too many and he could do nothing for me.
Fortunately I discovered Dr. Wong and capital Eye. I am floater free and loving it.
Now here is some more info. I was told by some OD’s that I had a small cataract many years ago – never bothered me. After the FOV’s my diopter started to change almost monthly. I started out as a -5.5 and I am now a -10.5. This is NOT because of the FOV’s it is due to the cataracts. My cataracts may have progress slightly after the FOV’s, but I think they were already heading t the point where I need surgery for them before I had the FOV’s
I was somewhat confused as to how cataracts can change the diopter, it boils down to the light being scattered and the lens changing because of the cataract formations.
I will be heading to Capital Eye in March to have my surgeries for the cataracts, I know this is not the Cataracts forum, but I know those of us who have or had floaters have the concern that the FOV will mean you get cataracts, I can’t say that is a direct link; most of us have a cataract hiding in our lens, chances are once the FOV is done the floater distraction is removed and then we become aware of what was already there – we just were too busy or irritated at having floaters to notice them.
So I will have the cataract and LRI’s (limbal relaxing incisions) to remove the astigmatism in my eyes.
Dr. Wong is a very skilled surgeon and will take very good care of you, he also works with a group of very talented Doctors who I trust and are recommended not only by Dr. Wong, but other peers in the Ophthalmology/Retina world.
Read these forums and blogs Dr Wong has provided, you will find a community of people just like you who have fears and concerns and can talk about them here and find comfort in knowing that they are able to overcome them and then move on to resolving their floaters problem and get their life back.
Your statement regarding cataracts and FOV are perfect. Thank you for your kind words.
I’ve started a new website for patients suffering from floaters;
I created this website to be a “safe” and objective place to share info and learn about floaters. Hope you like it.
All the best!
Randall V. Wong, M.D.
Fairfax, VA. 22030
Is it true that there is a great risk for delevoping cataracts after this FOV? I have been suffering from an onset of large black floaters that are very bothersome and right in my line of sight. What I can’t stop thinking about is how they developed after starting Prednisone for ear problems and then going under a CT scan of my temporal bones by an ENT and then a second scan of my jaw from a DDS. This was all within one month. Do you think there could be a connection to the sudden development of floaters? I was also under great stress over the ear problems(I am still undiagnosed). The ophthalmologist said the floaters are normal, but I never had them prior to my ear problems and recent scans. I also had an MRI during the same month. I am very interested in your work. Floaters are just making my ear problems even more depressing to deal with.
I agree with your eye doctor. I don’t think they are related albeit a really bad coincidence. Thanks for the nice comments.
Randall V. Wong, M.D.
Fairfax, VA. 22030
Hi. I am trying to decide which eye I should get a FOV for because my darker floaters are in my right eye but I am actually more nearsighted in my left eye and since my eye doctor said that floaters are usually worse in the more nearsighted eye, I was wondering if it is just a matter of time before my left eye gets even worse.
Answered the other post, too.
I think you’d want to consider doing the right eye – it’s the worst one now….who knows about later?
I developed black eye floaters in January and it caused me to zone in more on the clear worm-like ones I may or may not have had previous to the black ones. I don’t care about the clear ones, but there are three black ones that drive me nuts. They are just finally starting to hang out of sight unless I look for them or I am not focusing on something in particular. They are always visible in the sky and on walls, of course. My question is, is there a chance the black ones will fade into the clear ones? It has been 4 months and they are still very dark and large. I just want to know if that ever happens and if the time frame is different for everyone. Any averages on that? Thank you for what you do.
No way for me to tell. Floaters can be from several causes – each might lead to varying degrees of clarity or blackness. Make sure you get examined to make sure you don’t have a retinal tear.
Dear Dr. Randall Wong,
Hi, how are you Doctor? My name is Teddy and I’m from Hazleton, Pennsylvania. I’m seeking your services and will call one of your secretaries tomorrow, August 11, 2014.
I don’t have any questions as of now. I just wanted to tell you that I appreciate this forum and I have read many of the questions people wrote and the answers you gave them. I feel that there is hope for me.
Two years ago I had a sudden pain in my right eye. I went to my local Veterans Hospital emergency room and soon after they told me I had a floater. I could clearly see it then. For some reason, I went almost two years of ignoring it. But within the last 3 weeks, it became more visible. I can even see it with my eyes closed (during the day) and it did not fade away as some people say. It got worse.
Last week I went to a doctor (please let me keep his information private for his respect) and he used the YAG laser on my right eye for a vitreous floater. Since he said that it was too far back in the eye, he couldn’t get the laser to reach/focus on it. I’m grateful for his services, but now I need to move on to another alternative: the Vitrectomy for Floaters.
The floater in my right eye has caused me much emotional suffering. I usually wear an eye patch during the day so I’m not constantly bothered by it while it flys all around all day, up-down, left- right. It’s almost impossible to ignore…I’ve tried my best to do that and I’m failing.
My main concern is that I hope to obtain an initial consultation at your office and I hope to God that I can afford the operation if I’m a candidate.
Again, thank you Doctor Randall Wong for your trustworthy information on this site. May you, your family, your business and all that you do be blessed.
Thanks for all the kind words!
I wish you the best. I hope to meet you soon.
Can you tell me the percent of risk for each side effect of a FOV?
There are two feared complications;
1. Endophthalmitis – blinding intraocular infection. Rate in cataract surgery is about 1:2000. Rate in retina surgery (vitrectomy/FOV) is about 1:10,000 (far fewer than cataract surgery.)/
2. Retinal detachment – probably about 1-2%.
There are other things that can happen, but these are the two biggest concerns.
[…] Floater Only Vitrectomy Removes Floaters – Retina Specialist … – The risks of surgery are the same as cataract surgery. Eye Diseases of the Retina. Randall V. Wong, M.D., Retinal Specialist. Home; … Vitrectomy eye surgery can remove floaters. … of course. My question is, is … […]
Hey Dr. Wong,
I emailed you sometime last week, but I figured this is a good opportunity to bring up my concerns.
Unfortunately, I had a lasik procedure done May of 2016. I had good results for a year and a half before it all went south, and one of the issues being much more vitreous floaters than I had pre surgery. I was just wondering if the lasik procedure puts me at a higher risk of a tear, holes, pvd or quicker development of intrusive cataracts (I have congenital ones already, but don’t cause any disruption in daily living). It’s the main cause of my suffering… I’m thinking I have syneresis due to the large amount of pixilation and fuzzy contrast look. I’m just looking for a better quality of life… so please give me as much information as you can. Thank you..
Sorry for the delay.
LASIK surgery should not put you at higher risk for any of the things listed – your biggest risk factor for holes/tears/early PVD is that (I presume) you are nearsighted which is why you considered LASIK (most patients who have LASIK are myopic/nearsighted).
Dr Dr Wong, I had a detached retina in August with vitrectomy/oil/laser to repair. In January I had the oil removed and new lense. I am left with 4 issues – 1) I have a blind spot in my eye centrally. The macular was not detached and am told it is down to laser scarring. Is this possible in the central vision if the macular is fine? 2) I now have double vision as my new lense was meant to match near to my other eye (-4.5) but ended up being 0.5. My retinal Dr said it is hard to judge accurately a lense strength with oil in the eye. Is that true? 3) Even with glasses my vision with the new lense really isn’t great and colours are dull. Could YAG laser be of help? 4) I am left with a ton of oil floaters that were left behind after oil removal. Would you recommend a floater-only vitrectomy considering my history? I really would like to correct a couple of these issues if possible. Many thanks, Howard.
Can’t really advise much as I can’t examine you. The fact that your macula was not involved is promising. The double vision may be due to the new lens calculations, not much I can say. I don’t know if YAG can help you – again because I can’t examine you.
Dear Dr Wong,
I read much earlier (2012) in this Q&A that you do not induce a PVD in floater vitrectomy. Is this still your practice ? and does the remaining attached posterior vitreous not risk floaters later when it detaches ?
In most cases, I now prefer inducing a PVD when removing floaters. More efficient and decreases “frill.”
Thanks for the reply. So, your technique has evolved (as is the nature of all surgery, I guess). Do you believe now that induction of a PVD is not that risky? It seems that most VR surgeons who are prepared to carry out vitrectomy for floaters also induce PVD if not already present. Thanks for your expert opinion.