Vitrectomy for Floaters (FOV)

Fake Avastin Hits United States…Again
May 17, 2012
Ooops! Forgot to Add the Video
May 25, 2012
Show all

Vitrectomy for Floaters (FOV)

Floaters can be bothersome changes in your vision. Floater only vitrectomy, shown here, is the basic operation a retina specialist uses to treat patients with floaters.

A vitrectomy is the basic operation used by a retina specialist for treatment of blood, epiretinal membranes, macular holes, retinal detachments and…floaters.

There 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 removed to allow me to safely operate on the retina.

In the case of the FOV, once the vitreous is removed (and the floaters), the operation is complete.  In a way, it’s a partial operation.

3 Port 25 gauge Vitrectomy System

I use this type of system almost exclusively.  The “25 gauge” instrumentation requires small ports, or holes, to be made for passage of the instruments into the eye.  While this does dramatically reduce the operating time, it also significantly speeds the healing process as there is much less cutting on the ocular tissues.

The holes are self-sealing and do not require stitches.

Removal of the Vitreous Floaters

The instrument, a vitrector, rapidly “sucks and cuts” the vitreous hundreds of times/minute.  The vitreous is adherent to the retina.  Pulling on the vitreous could cause a retinal tear and then a retinal detachment.

This rapid succession of “sucking” and cutting makes it almost impossible to pull on the retina.

In many cases, the protein makeup of the vitreous has changed and the floaters, seen commonly as dark dots, move “to and fro” within the eye.  The vitreous is the only area in the eye where objects can move in this fashion.

Treatment of Floaters

FOV is the most viable treatment for floaters.  I recommend surgery if the opacities are bothersome, move to and fro and you understand the risks of surgery.  I prefer the floaters to have been present for several months.  After this time, they are unlikely to go away.

I do not perform laser for floaters and am not aware of any retina specialists who do.  I recommend against laser treatment as I believe the risks are too high for causing tears in the retina.

About the Video

I’ve been asked by several followers to publish such a video.  I thank “floateredeyes” for his patience in gently reminding me to get this done.

The movie was recorded directly from the operating microscope onto my laptop.  We used ONLY iMovie (the program and background sound).

What Does this Mean?

There are a significant number of patients suffering from floaters.  Too often, these patients are scolded and advised to “get used to them.”  Vitrectomy surgery is as safe, or safer, than cataract surgery and can be a viable option and life-changing.

Just as others want and need cataract surgery to improve vision, patients plagued with floaters can be helped.

 

173 Comments

  1. Jake Rashid says:

    I am going to have catarac surgery on my eye that has a psuedo hole of the retina
    Is ther any thing I should do before my surgery?
    Thank You
    Jake Rashid

    • Dear Jake,

      In my opinion, have the cataract surgery. In my experience, an ERM and pseudohole can sometimes progress and cause the vision to get worse shortly after surgery. You might consider a retinal consult before cataract surgery or shortly afterwards.

      r

  2. […] I’ve since embedded the video. Here’s a link to the vitrectomy video for floaters. […]

  3. Niels says:

    HI Dr. Thanks for such nice info. For clarification: I read in one post that you aknowledge that it is best to do FOV with induced PVD than without. If you won’t then there is future risk of natural PVD and so new floaters and maybe uncontrolled thus risk for RD. But then in another post I read you don;t induce PVD. So i want to come to you but I want pvd induced and stitches just to be sure… Is that ok and what are your thaughts?

    You are great!

    • Dear Niels,

      Thanks for the kind words!

      Ok, not sure what you read, but here’s my opinion;

      1. In FOV, best not to induce PVD as there is an increased risk for causing a tear…especially in young.
      2. No inducing a PVD does not mean floaters will “return” when a PVD naturally occurs. Remember most of the world doesn’t get floaters when a PVD occurs. Also, if you are young, you might not sustain a PVD for 30-40 years.
      3. We can certainly discuss your wants and needs if/when we meet. As long as we come to an agreement and understanding, we can do anything you want.

      r

  4. floateredeyes says:

    Dearest Dr. Randy,

    Thank you so much for listening to my requests. Means so much.

    I am already doing my job of trickling the video down various floater forums for education purposes.

    Thank you so much.

  5. Aggrey Omukuba says:

    Dear Dr. Randall, We thank you so much for being so open liberal and simplifying the information to such an extend that we none medicals are able to understand you 100%. If all Doctors could do this the world would have well informed patients and they the doctors would enjoy more fulfilling proffecianal work.Thank you and sustain this work. Please would you be so kind to talk about and the subsequent sprouting of the porous veins that leak blood to swell the macular area causing lose of vision. What is your normal procedure for treating this condition and whether you are successful in restoration of 100% Vision if approached early enough?

    • Dear Aggrey,

      Thank you for your support. Very kind.

      With regard to your question about porous veins, there are several conditions that can cause “macular edema” such as diabetes, vein occlusions, wet macular degeneration, etc.

      Do any of these sound familiar?

      Randy

  6. Aggrey Omukuba says:

    Dear Dr. Randy,
    In my earlier text I meant to talk about
    Thank you

    Aggrey Omukuba
    Nairobi Kenya

  7. Aggrey Omukuba says:

    Please talk about CRVO
    Regards
    Aggrey Omukuba

  8. Dear Sir,

    I have been diagnozed with wet AMD in the right eye and dry AMD in the left eye since july 2010 after a cataract opration in both eyes.

    I have since seen many doctors i Jordan,Turkey,Rotterdam eye Hospital in Holland and twice to Munchen in Germany. The AMD diagnosis was again confirmed byall the above hospitals and doctors afer OCT tests. The last eye specialist I have seen in Munchen has said that I have no AMD in either eye, but instead I have some kind of deposits which can be safely operated. The same eye specialist have treated me with lazer with very great improvement in my sight in both eyes.

    I have followed a very strict dietry methods since I was diagnozed with AMD,in addition to taking one daily tablet of PRESERVISION and omega 3.

    Please advise if my AMD cure was due to Strict dietry and the above medication?

    With all my appreciation and respect To you

    Sincerely yous,

    Abdulla Al-Mashta
    Consulting Electrical Engineer and researcher

    • Dear Abdulla,

      I am not aware of any evidence proving diet or vitamins IMPROVE AMD. If this is the case, you are very lucky!

      In the next few years, AREDS 2 will give us more information about the importance of diet and supplements.

      Randy

  9. Vlonder says:

    HI Doctor. What a website thanks. I want to have a FOV. Could you tell me whether you induce PVD or not? Is it with sutures? Can I opt for having sutures? Do you also operate on saturdays?

  10. Paul says:

    Dear Dr Randy,
    I have troublesome floaters in one eye. A recent visit to an ophthalmologist revealed the problem – after a thorough investigation he stated that I have a number of floaters within 2mm of my lens. Dr – I am considering vitrectomy – is an FOV likely to remove my floaters given their location? And would this pose any additional risks?
    Many thanks for your assistance and your very informative website.
    Paul

    • Dear Paul,

      Don’t believe proximity to the lens really matters. Only if they are really, really large can your doctor be certain they are indeed the exact floaters bothering you.

      I don’t think the location would pose any different or additional risks.

      Randy

  11. I’m only 21 and I have suffered from eye floaters since I was in preschool. I only had two and they were only in my left eye. One of them is a huge black spot with strings on it and it is VERY apparent even in dim environments. I can’t even watch TV without seeing the little dot in the left of my periphery. Around October 2011, a floater started to form in my right eye and over the course of two weeks, it grew to 6 times it’s original size and it looks almost exactly like a scorpion. It hangs out to the right most of the time but if I look to the left, it get right in the front of my face, VERY irritating. The floater is very defined too. In the following months, I started to see lots of new smaller floaters in my right eye that like to hang out in the bottom right corner of my vision. If I look up and to the left, all of them get right in my central point of vision. I cannot stress how incredibly annoying and depressing these things are. Just two weeks ago, another dark spot floater formed in my right eye, started off as just a small dot, and now it’s a full on floater with strings attached to it and everything. These things are ruining my life. I don’t like going outside during the daytime because all I see are floaters, EVERYWHERE. It’s hard to enjoy life when everything I do is clouded by floaters. I am highly considering a FOV. I know I’m only 21 but thats the worst time to have floaters… I can’t enjoy my life 🙁 I want these things gone, it’s like a curse. Please e-mail me so I can give you my contact information so we can discuss this further and schedule a FOV. I want these things gone so I can move on and have a good life..

  12. Diego says:

    Hello.

    I’m 24 years old and I got lots of vitreous floaters in my left eye as a secondary effect of taking desipramine (to control a gastrointestinal problem) for some months about a year ago. My work is related to filmmaking and graphic design and I can’t concentrate or enjoy my work anymore. I’m going nuts about this. My eye doctor told me last year that I’ll get used to it, that my brain was going to ignore it at some point, but I’ve lost the faith on that happening. I live in Santiago, Chile. Is the surgery an option for someone my age? and if so: how much costs this proceeding? I’d have to travel. Thanks!

    • Dear Diego,

      Not aware desipramine causes floaters, but the floaters can certainly be removed if they are bothering you.

      Often, patients do get used to them, but on the other hand, in patients where the floaters get worse or don’t decrease in severity, vitrectomy may be curative.

      I’ll have the office send you an email to see if travel is an option for you.

      Many thanks for commenting and good luck!

      Randy

  13. NIMI says:

    Hi…..

    Please write something about laser barrage surgery…..

  14. Jackie says:

    Dear Dr Randy:

    I am 34 yrs old live in Singapore. i found the floaters size like yellow bean with two long long thread at my left eye this Feb 2012 .
    I have been checked with local ophthalmologist, the eyes are ok except for the floaters and they don’t suggest me to do the FOV. but beacuse of the floaters, i will can not concertrate to see and thinking. another problem it cause my eye ball pain sometimes if i watch the floaters for a certain time.
    if i want to look for you to do the FOV for me, may ask few question:
    1, how long need i stay in hosipital if do the operation? how long the recovery time finish the operation? (that means how long i need stay in US then i can take plane back to singapore)
    2, what is risk rate of this operation? I heard of half of these patients have a significant complication. The most frequent complication is a cataract that must be removed within two years. Less frequent is a retinal tear or detachment (about 1-3% of cases).
    3, how much of the operation for one eye and both eyes.
    4, do i need going back to see you to check again at US after I back to Singapore, or i can get check after the operation at Singapore?
    5, do you or your team could speak Mandrian. for my English is not so well?

    thanks and hope can get your reply soon
    Rgs
    Jackie.

    • Dear Jackie,

      1. No hospital stay. The procedure is performed as an outpatient. I would ask you to stay 3-4 days if possible, but we can discuss your schedule.

      2. Yes, retinal tear is probably about 1-2%. The comment about cataract is too high and probably correlates with all patients who have had vitrectomy for ALL reasons, not just floaters.

      3. Cost: I will my coordinator email you about insurance and costs.

      4. You can get checked by someone in Singapore.

      5. I don’t speak Mandarin, but could easily find someone to translate if needed.

      Randy

  15. Filippi says:

    Hi doctor! How is the vitrectomy (FOV) recovery? can see in the same day like cataract surgery? Or how long it takes for vision return to normal?
    One more question, regarding retinal detachment when it occurs? during or after FOV?

    Best regards
    Filippi

    • Dear Filippi,

      Recovery is quick and as an outpatient (no hospital stay). Vision usually great within 24 hours of taking the patch off the next morning.

      If a retinal detachment were to occur, I would expect it to happen within a few weeks of surgery. Technically, retinal detachment could occur during surgery….but you would hope it wouldn’t be undetected and your surgeon would fix it before completing the operation.

      Randy

  16. Eleanor says:

    Dr. Wong
    So…..You replace the vitreous with air during the vitrectomy, and fill it with gas afterwards, or with air? The air or gas is “absorbed” within a few weeks, but what is it replaced by? Do our bodies create new vitreous?
    Thanks,
    -E

    • Dear Eleanor,

      For this particular operation, neither gas nor air is used. The vitreous is mostly water and replaced by saline solution. This artificial saline is replenished by our body within 24-48 hours.

      Gas is usually used for macular holes and retinal detachments…not for floaters.

      Randy

  17. Julio says:

    Dear Dr Randall,

    Is it recommended the use of Avastin in FOV surgery? if so, why..

    Congratulations for your good acts and work!

    Regards
    Julio

  18. Cheyrl says:

    Hello,
    Those who have had the FOV surgery can we hear from you and your results. There are many of us considering the operation and would like to hear from those who have had the FOV. WE are all in the same boat and need support from each other.

    I have a PVd in left eye, floaters, right eye partial vd and floaters. My eyes do not feel normal at all. Constantly trying to look past the floaters and long distance vision has gotten to where I need .75 glasses.

    Please comment. Anyone on your experiences.

    Thanks so much

  19. Ken E says:

    Cheryl,

    I had a FOV in my right eye. I had already gone through full PVD. I am very happy with the result and will eventually get my left eye (no PVD) done. I believe with the right surgeon, a vitrectomy is safe and the success rate is high. Reading Dr. Wong’s various blog submissions educated me and helped me make the decision. Dr. Wong is one of very few retina specilialists who will acknowledge our suffering and put info out about our disease on the web. I hope this helps.

  20. Steve says:

    Hi Dr,

    I’m a 26 year old male and a few weeks ago I received a poke to my eye while playing basketball. This resulted in 4 tears to my retina which were fixed by a well regarded Opthamologist where I live. I have literally thousands of them (mostly clear that I barely notice) but there are 3 that are particularly bothersome.

    – One slightly to the right of my central vision (at roughly 2 o’clock), it is not particularly big but it is very dark and dense. It seems to be shaped almost like a perfect circle with a clear centre (like a doughnut or stacked red blood cells). I suspect this is very close to my retina given its density and the fact that in certain conditions I can see what I perceive as a wake following it – this wake is constantly changing its shape and is very clear. I see it in most lighting.

    – One cloudy one just below my central vision that I only see in lighter conditions. When I am able to inspect closer it appears as multiple light circles that combined create a slightly denser object.

    – One at 12 o’clock that seems like a dot and I don’t see all that often.

    I am seeing my Opthamologist soon to check up on how my tears are healing and am planning on asking the below as well, he is apparently sympathetic to floater sufferers, but I also feel compelled to get feedback from somebody such as yourself.

    I am determined to “get used” to these floaters as I am sure my case is quite mild… but I also want the reassurance that I have a fallback that I have alternatives if I can’t get used to them. I work on a computer all day and even the slightest distraction severely limits my productivity.

    1.) Is it possible that my floaters are tiny droplets of blood that were not detected during my dilated eye examination?
    2.) Given the likelihood that my floaters are extremely close to my retina, would a vitrectomy ‘definitely’ be able to remove the really bothersome floaters? My biggest nightmare would be to pay for the op, take all the risks and the most bothersome floaters remain.
    3.) Even though my case is mild, is the anxiety it is causing sufficient reasons alone to consider a vitrectomy? The day to day anguish I am experiencing now is what I consider to be the worst part.

    My plan is definitely to wait it out for at least 6 months to see how I can adapt. But I do want to know the surgical option is likely to benefit me if I feel obliged to go down that route.

    • Dear Steve,

      1. It is indeed likely that many of the floaters are from blood. If so, they should decrease in number over the next few weeks.

      2. Yes, it is possible that some remain and never absorb. A vitrectomy should get rid of the floaters, even if close to the retina/macula.

      3. Anxiety is certainly reason enough to consider a vitrectomy.

      Waiting a few months is a good plan.

      Keep us up to date?

      Thanks,

      Randy

  21. Steve says:

    Hi Dr,

    I’m a 26 year old male from Australia.

    4 weeks ago I received a nasty poke in the eye playing basketball. It caused 4 tears to my retina (which were fixed by laser) and lots of floaters in my eye. The floaters are mostly clear and don’t really bother me except for 2 or 3 black ones. One thing, all of my floaters are almost perfect circles. The most bothersome is a small black ring, slightly to the temporal side of my central vision. It is very vivid and I imagine it is quite close to my retina (I can even make out what appears to be a ‘wake’ following the floater) . They have made me desperately unhappy.

    Even though my case is mild, I can’t imagine living my entire life with these floaters and if they’re still bugging me in 6 months time I plan on having the op to clear them. I plan on speaking with my Opthamologist about it when I go for my follow up, but I thought I would pick your brain with a few questions as well.

    1.) Is it possible my floaters are actually blood cells that were not seen when my eye was examined?
    2.) If they are in fact close to my retina, would they definitely be taken with the operation?
    3.) Do the retinal tears make a difference in terms of adding to the risk?
    4.) Are there any long term concerns other than the potential for early cataracts?

    Thanks

    • Dear Steve,

      1. Most blood in the vitreous is visible. So unlikely.
      2. Yes. Should not be an issue.
      3. Not really, I’d be more aware that you are at risk for tears.
      4. None.

      Hope this helps.

      Randy

  22. Thanks for the response, Randall! I’m still waiting on the e-mail from your surgical coordinator. I want to get this done as soon as possible. Some of my floaters are getting bigger and new ones are forming 🙁

  23. michael says:

    Dear Dr. have u read this article. They are talking about a new technique since 2 years. So it cannot be 25 or 23 gauge because these are here since 2002. what are they using. Is it same as you or have they something new??

    http://www.dailymail.co.uk/health/article-2177006/How-mini-guillotine-treatment-beats-misery-sight-blurred-floating-particles.html

    PS I love u. U give me hope

    • Dear Michael.

      The article describes the use of a 25 gauge vitrectomy system. It has been available here in the U.S. for about 10 years. I would agree it is safer than the older vitrectomy systems.

      Nothing really new described, but I agree with the basic comments in the article; 1) many people are discounted about the symptoms of floaters 2) these people can be helped and 3) the procedure is safe.

      Thanks!

      Randy

  24. Cheryl says:

    Dear Dr. Wong,
    Is it best to get every test done to make sure there are no underlying problems before going through a FOV? I have inflammation in the back of the eye and was on Bromday eye drops for one month.. It made my eyes very sensitive to light. I went to a second specialist and he said the inflammation was not that bad. I have had bloodwork done and don’t see any thing there.

    My floaters which used to be much darker are now more opaque and like looking through vasaline, cloudiness. My eyes used to be 20/20 up until May when everything became very blurry, and vasaline like. Is this normal when the floaters and vitreous becomes more dislodged and floats around more causing the cloudiness and shadows.

    It is causing me much ANXIETY.

    Thank you for any comments..that will help me and others like me.

    Sincerely,
    Cheryl

  25. Glen says:

    Dear Dr. Wong:

    I am 50 years old and have had floaters for many decades. At the end of February I noticed a sudden onset of many more floaters in my left eye. I went to my ophthalmologist who recommended a retina specialist. The specialist observed my condition and waited for the blood in my eye to clear. He eventually said I had a slight retinal tear. So he used an Argon laser to fix the tear.

    He continued to observe my progress and I eventually had a second procedure. Since my second procedure he has said I am doing fine. However, even though the floaters have cleared up and improved, I still have a huge amount. Greater than before the retinal tear.

    My first question is does it take 6 months to a year to clear up? My second question is would you recommend Vitrectomy and how long should one weight if it is recommended after having laser surgery?

    • Dear Glen,

      1. It can take months for the floaters (those related to bleeding) to clear..if at all. The blood from a retinal tear (another cause of floaters) tends to reabsorb.

      2. If you’ve been bothered for a few months, I’d consider surgery.

      Randy

  26. Evan says:

    Hi Dr Wong,

    I’m 31 and have suffered from floaters for about 8 years. I desperately want them gone as they are bad enough in my case to really lower my quality of life. I can’t believe more doctors don’t take this problem seriously. I’m glad that you do. It’s an excellent point that nobody thinks cataract surgery is unnecessary (since cataracts reduce vision and quality of life), so why should FOV for massive amounts of floaters be viewed differently?

    I’m very interested in surgery. Can you tell me what I need to do or what the next step is?

    • Dear Evan,

      I will forward your email to my office staff. You should hear from us within 1-2 days of my posting this answer!

      Basically,

      1. We will set up an appointment just prior to surgery. The surgery can easily be cancelled if you and I don’t agree the FOV is for you.
      2. Hotel arrangements can easily be made. We have found a couple of area hotels will give a discount if you are here for medical reasons.
      3. Surgery is usually performed on a Friday and we can discuss your returning home after your post-operative visit on a Monday.

      Thanks,

      Randy

  27. Steve says:

    Hi Doc,

    Follow up with my Opthamologist went very well. The holes in my retina have healed nicely.

    We discussed my floaters and he was able (with a bet of effort) to find what we think is the most annoying one. Given my case is mild, he expects I should get used to them.

    Obviously 5 weeks is too soon to opt for surgery, but if they are still bothering me at my follow up in 3 months we will probably push on with it.

  28. TK says:

    Dear Doctor have you read this article http://www.dailymail.co.uk/health/article-2177006/How-mini-guillotine-treatment-beats-misery-sight-blurred-floating-particles.html

    Here they are talking about new techniques available for 2 years now. Since 23 and 25 gauge are longer available. About what techniques they are talking? Do you use it too? Have they something interesting? Please let me know. I am thinking of coming to you.

    • Dear TK,

      They are indeed discussing vitrectomy surgery and highlighting thinner gauge instrumentation.

      I am in agreement with the article. I use 25 gauge instruments; 23 gauge is too large and 27 gauge is not as good as 25 gauge. The 25 gauge are safer than the older 20 gauge instruments.

      Look forward to seeing you!

      Randy

  29. Farsi says:

    Dear Dr.

    Could you tell me honestly how many patients of yours were floater free after the op without other anomalities? Could u tell me:

    -Have you ever head the complaint of patients telling you that they see the virtreous FRILL? (the edges of the vitreous were you stopped cutting?) Is this a possibility ?
    -Have people complaint about seeing ars in the periphery?
    -how do you shave the vitreous so that people won’t see the frill? Do you have techniques to specifically cut in suh a way that there wont be a frill?

    I ask this because I want to be floater free without these frill problems and other anomalities.

    So the question is have u heard typicall feedback of the FOV for floaters from your patients that they have some other problems after FOV?

    Could u give me a percentage of patiens of whom the floater symtoms completely disappeard and got back pre floater vision?

    Please dont skip a question and if you could be so kind to answer each of it ? thanks so much. I will come over soon.

    • Dear Farsi,

      Sorry for the delay, I have been away.

      I don’t keep stats, but I’d say almost 100% are floater free and almost 100% (lack of stats) get pre-floater visual acuity.

      I have never had anyone complain of vitreous frill. By removing the bulk of the central vitreous, and making it wide enough, the “frill” should not be an issue.

      Randy

  30. Farsi says:

    Dear Dr Wong,

    Is it possible to operate on a Friday and have the checkup the very next day. Because i am worried of Low IOP .. Just to make sure everything is ok and not waiting till monday. ???

  31. Nick Williams says:

    Hey Dr.Wong.

    My name is Nick Williams, I am a 20 year old Australian male living in Las Vegas, Nevada.
    I’ve had a pretty severe case of eye floaters for a little over a year now & am myopic. Since developing eye floaters, so much of life greatest/simplest pleasures are now a complete nightmare, I dread going outside into sunlight and will not do so without sunglasses. Being a sports fanatic & a definite outdoors person this has been a horrible experience so far and still wake up every morning with the hope that they’ll just disappear.

    I’ve done a bit of research on Dr’s experienced on performing vitrectomies, the yag laser etc & came across this video on youtube and clicked the link to this page. If you could get in touch with me just to give me a bit of guidance & for a chat i’d highly highly appreciate it.

    Thankyou so much Dr.Wong! Have a great day.

  32. Harm says:

    Dear mr Wong,

    How is made sure that the patient doesn’t move while having vitrectomy under local anesthesia? Am i right that FOV is mostly done with local anesthesia?

    best regards,

    Harm

  33. Arnold says:

    Your name has been praised a few times in a floater forum I frequent. You are described as a more sympathetic doctor offering FOV to patients that are debilitated by this condition, when others would simply say “learn to live with it.” I am 23 years old right now and I can assure you that it is a quality of life issue and the constant annoyance is akin to psychological torture. I suffer from the transparent type of floaters. While they are probably not as annoying as some other people have when they are dark, mine are still numerous and very annoying. MY plan is to wait a few more years before going in for a consult as technology continues to evolve and get better. I currently reside in NY, so I am not too far from fairfax.

    My question is this: Do you use the 27g instruments or ever plan too? A doctor in NY( Dr. Richar Spaide) does use the 27 guage and patients did have success with him. Seems like for floaters the smaller the wound is the less chance of complications. I know you use the 25g. What are your thoughts on the 27g?

    Also, can you give me a ballpark number for the average cost of an FOV in ONE eye? This would let me know how much to save up if I was to see you in the future and you deem me worthy of getting it.

    Last question is can you describe your incidence of complications? Specifically, what is the risk of cataracts for young patients with No PVD?

    Thank you so much, Dr. Keep up the good work.

    • Dear Arnold,

      25 gauge instrumentation, in my opinion, is ideal. While “smaller” seems intuitively better, the operation may become more difficult/longer as the instrumentation changes the fluid dynamics of the vitrectomy and the forceps (now thinner) operate differently, too.

      I like the advantages moving from 20 gauge to 25 gauge. Moving to 27 gauge doesn’t really offer any significant improvements. Wound leaks are uncommon in both situations and is probably the only “complication” with small gauge instrumentation.

      I will have Chrissy email you in the next 24-48 hours regarding costs and travel details. BTW – usually covered by insurance.

      Incidence of complications of all vitrectomy is less than 5%. Cataract formation in young (i.e. no pre-existing cataract) is unlikely.

      Thanks for your kind comments!

      Randy

  34. Chris Reed says:

    My Vitrectomy for Floaters Experience With Dr.Wong.

    My name is Chris and I am 27 years old living in Cleveland Ohio. I travelled to see Dr.Wong on July 26th and July 27th. I had followed Randy’s various blogs and postings for 8 months in order to make sure I was making an informed decision to receive surgery for my bothersome eye floaters. I had suffered with eye floaters for almost 2 years and wanted to gauge the success rate of this operation. After reading Randy’s blogs and determining his high level of expertise with these things I knew he was the one to go see and take care of these things once and for all.

    I met with Randy on Thursday in Fairfax, driving 6 hours from Cleveland, Ohio. We met in his office for a short time and he left the decision up to me, if I really wanted to go through with the operation the following morning. He assured me he had performed thousands of these operations over the years and I said let’s do it tomorrow.That night I went and saw The Dark Knight in Fairfax and got some rest for the following morning.

    I arrived at the surgery center at 8:30AM on Friday morning. Surgery was scheduled for 9:30AM. The nurses were great; very friendly and knowledgeable. I met with Randy very quickly before I was wheeled in and he made me feel very confident and calm. The anesthesia was administered and I really only remember being wheeled in to the operating room and waking up with a patch on my eye. I spent more time being prepped for surgery than I did being operated on. It was quicker than a haircut. The patch was left on for 24 hours and I spent Friday relaxing at the hotel and watching the Olympics. There is absolutely zero pain or discomfort. The following day, Saturday, each of the patients Randy had operated on Friday met at his office to make sure everything looked ok-eye pressure, vision etc. I was a bit nervous to remove my eye patch, however, as soon as I did, my eye was completely clear of floaters. Zero. None. Vision is a bit blurry for a few days but comes back very quickly. There will be blood in the whites of the eye from the operation and cosmetically this may look painful but again, it’s been 3 weeks and I have felt zero pain. The blood in the eye makes for great conversation with members of the opposite sex let me tell you! Overall, the operation was a complete success and I am going to have my other eye done in late October. While I was there, another patient of Randys, from New York was in town having the same procedure done on his other eye. His first operation was months earlier and was a complete success. He assured me everything will turn out fine, and it did.

    For those of you sitting at home on your computers desperately looking for a solution to these annoying things, you do not need to look any further. Randy is the man. I have emailed him numerous times late at night on weekends and he responds within the hour. The guy is the real deal. If any of you have any doubts or reservations about his expertise or skill, ask yourself this; how many doctors do you know will give out their email, have their own medical blog and respond to people who aren’t even their patients across the word? The answer is none. I work in the financial industry and have clients of mine that are eye doctors. I had consulted briefly with them prior to seeing Randy and every one of them said, Chris, why in the world would you want a vitrectomy? Thats a death sentence-just learn to live with your floaters. These are all highly skilled successful eye doctors in Ohio and they all had the same advice. One of my very good clients has his own practice here in Cleveland and is consistently voted as one of Cleveland’s Best Doctors. I saw him last week for my follow up per Randy’s instructions and he looked at my eye and said, wow this Dr.Wong guy is very good.

    I apologize for the long post but wanted to express my thanks to Randy for his accessibility and skill as well as illustrate my experience so others who are nervous or unsure can read a real life experience. I look forward to seeing you again soon Randy.

    Thanks, Chris Reed

    • Dear Chris,

      It has been my pleasure to meet and work with you. Thank you so much for your kind words and support. Your comments will serve as a great resource for future readers.

      See you soon.

      Randy

  35. Ken E says:

    @Chris,

    Please go back and post your story on floatertalk. Thanks for putting it here.

  36. Arnold says:

    Dr.Wong, I sent you another email but I figured I would post it here because as you stated it will benefit others. I don’t want to bother you too much. I know you must be extremely busy, yet it eases my anxiety when you answer my questions. Especially, if its good news. These will probably be the last questions I ask until I visit you.

    1.)You stated that cataract formation is unlikely in the young. Does that mean in the immediate future? Iv’e heard others say that vitrectomy accelerates it even in the young maybe 5-10 years. I take it in your experience in means that it won’t. Correct?

    2.) Is the operation done with sedation? I cant imagine being aware at all while having things being poked into your eye. What if the person has anxiety issues and this raises blood pressure/heart rate? I’ve had surgeries before but mostly under general.

    3.)I agree in not inducing PVD is the correct choice to minimize complications. Does not inducing PVD mean that floaters near the Retina can’t be touched? Where the small ones that are magnified by the retina are located.

    4.)Does no pvd induction mean that there is good chance for residual floaters or that floaters may come back? People on floatertalk keep debating about this.

    5.)What are black dots that are seen similar to floaters? They look like tiny cells or grains of sand. They are not typical crystal worm types. Are these also different kinds of floaters, that can be treated?

    6.)I will be on accutane for the next six months. I know it can alter night vision temporarily. If i see you 6months-1 year after I finish my course, will that be okay? This doesn’t affect surgical outcomes?

    • Dear Arnold,

      Sorry for the delay.

      1. Hard to say. So many factors contribute to cataract surgery. I’ll say it is possible to develop a cataract in 5-10 years in a young person. Vitrectomy can cause cataract, especially in patients with pre-existing cataracts at the time of surgery.

      2. I prefer sedation, but we can discuss this prior to surgery. 98% of my surgery is done with surgery. Quicker recovery time.

      3. I think the notion of floaters “too close” to the retina is a problem highlighted by those who feel YAG laser for floaters is safe and effective. With vitrectomy we/I can get within millimeters of the surface. Inducing PVD does not mean you can not removed the vitreous close to the retina.

      4. No. In theory you might get a PVD 30-40 years laters, but as most people with a PVD are unaware, there is no certainty to floaters recurring.

      5. Have no idea. As long as they move “to and fro” with eye movement, I’d categorize them all as the same.

      6. Sure. Correct, does not affect surgical outcome.

      All the best,

      Randy

  37. paul says:

    dear dr wong

    I am curious on the fov procedure,please get back to me when you get the chance I have a few questions

    • Dear Paul,

      I have sent your request to my assistant Chrissy. She should contact you within the next 24-48 hours.

      In general, I try and answer comments every 7-10 days, hence the slight delay. It is too inefficient for me to answer as they arrive…

      Randy

  38. Bill Morton says:

    Dear Dr Wong,
    I just turned a young 70. A year ago I was laser-treated for Vitreous Detachment in both eyes, and had cataract surgery in both eyes. Since then I have become dibilitated by thick floating clouds moving across both eyes, to the point where I have had to give up one of my favorite pastimes, reading, and have difficulty reading road signs when driving. In bright sunlight and flouriscent light, I am literally living in the fog and feel “detached” from life..
    I have discussed this with my doctors and of course get the live with it or risk blindness answer.
    Knowing I am aware of the risk, I have decided to check with you and perhaps start a dialog. Here are several preliminary questions I have:
    * Am I correct here: Basically you remove the remove the fluid and replace it with a saline solution which the eye replaces in several days with it’s natural fluid.
    * How is eye pressure maintained during the proceedure?
    * Is eye pressue an issue at all ?
    * Does Medicare cover any of the proceedure.
    Thank you for your kind assistance.
    Most Cordially,
    Bill in Wichita, Kansas

  39. Andrew says:

    Hi Dr. Wong,

    I have been looking over all of the comments and I have seen that you report that the incidence of cataracts in young patients is very low. What is the number of your younger patients (say less than 30 or 35 years old) who have developed cataracts? How long have you been following them post-op? Thank you for your time!

    Sincerely,
    Andrew

    • Andrew,

      You ask a very difficult question;

      1. Vitrectomy is performed for a variety of reasons other than FOV. Many have other diseases influencing cataract formation.
      2. Few healthy patients, younger than 30-35 get cataracts, but keep in mind, cataract formation in young patients, without disease or not, is not uncommon.
      3. I rarely follow patients without ongoing problems post surgery.

      Hope this is somewhat helpful!

      Randy

  40. Andrew says:

    Hi Dr. Wong!

    I was wondering how much of the vitreous you take out in a core vitrectomy. I am guessing on the order of 50%?

    Thanks!
    Andrew

  41. arnold says:

    dear dr. could u answer in detail the questions of the user arnold as stated above?

  42. Mike says:

    Hello,

    The floaters in my left eye have made my life miserable. They have got to come out.

    I live in California but woud be happy to fly to your office for a consultation and hopefully a surgery.

    I’m 32 years old and want it done! How many FOVs have you done?

    Mike

    • Dear Mike,

      As I said in an email, I don’t keep track (and I don’t know any colleague that does) of the number of surgeries I perform for specific causes.

      A vitrectomy is the basic operation performed by a retinal specialist and will be performed for many other reasons (epiretinal membranes, macular holes, retinal detachments, etc.) in addition to floaters. In this case, I’ve performed thousands of vitrectomies.

      I hope this was a little helpful.

      Randy

  43. Arnold says:

    Dr. Wong,

    Thanks for answering my questions. I don’t mind the delay, I know you are busy. I just started College and I am thinking of medical school. Who know’s maybe I will be inspired by my future surgery to become a retinal surgeon myself, and help others like you.

    1 final clarification needs:

    1.)You state in your first response to me that cataract formation is unlikely, but your new response indicates that it isn’t impossible. What is the rate of cataract formation in the young( healthy eyes), in your experience? I have no pre-cataracts to my knowledge, and my eye is healthy.

    2.) What is the rate of serious complications in young patients? Have you had any patients with serious complications?

    3.)This just came to mind. I will probably get surgery in a few years, so how do you see floater treatment evolving? I’d imagine by the time I’m in an operating room, technology would improve even more and lessen risks.

    Thanks.

    • Dear Arnold,

      1. Cataract formation is always possible. I didn’t mean to confuse. If a cataract is not present at the time of surgery, the data suggests that cataract formation is unlikely. You are young, ergo, unlikely, but we’d have to examine you.

      2. I’ve had one possible infection in 20 years of the thousands of vitrectomies I’ve done for whatever reasons, including floaters.

      3. Floater treatment is unlikely to evolve. It’s very safe and vision can improve when surgery is eventually performed. Ocriplasmin is not necessarily going to help floater sufferers.

      r

  44. Kara says:

    Hi Dr. Wong,

    The PVD in my left eye has caused one large floater and several smaller floaters that move around with eye movement throughout the day. It has caused me to have extreme anxiety for the past 10 weeks. I can’t imagine living with this very much longer. Is it too early to make a decision to have a vitrectomy? If so, how long should I wait?

    Thank you,
    Kara

  45. Kara says:

    Hi Dr. Wong,

    I live on the West Coast. If you were to perform an FOV, I would need to schedule my follow up appointments with a local doctor. Can you explain the standard follow up schedule after this particular surgery is performed? How many are needed, when, etc?

    Thank you very much.

    • Dear Kara,

      In general, I’d feel better if you saw your own doctor within 7-10 days of surgery. Obviously, I’d love to take care of you here….if you’d like to stay a couple weeks!

      Standard recommendations;

      Pre-Op Visit (day before anticipated surgery)
      Post-Op Visit (day after surgery)
      Follow-up 7-10 days.
      Follow-up 3-4 weeks.

      Randy

  46. Ted says:

    Chris Reed:

    Perfect description of the surgery process. I had the procedure completed on my right eye 1 week ago on Sept 28th to remove my absolutely intolerable floaters. I flew in from Miami and stayed a few days.

    After 5 days of highly dialated eye, the affected eye is almost back to normal size, with the exception of redness clustered in the whites of the eye around one side of my cornea. Vision is 95 percent back to normal and the floaters are gone.
    Yesterday I had a checkup with my local retina specialist and he said my eye has higher pressure than he would like to see, but he said the eye drops that were given to me after the procedure are probably the cause. I will be seeing him again in 1 week to monitor progress. Unfortunately after he had “poked” around my eye, after I left his office I noticed 3 very small air bubbles appear. After reading on the internet this is common and will go away after a short time. I’m hoping this is true, Dr. Wong?

    I would say only 1 week after the surgery things are going pretty good.

    Thanks again.

    Ted

    • Ted,

      Dilating drops vary in strength/duration of dilation. I typically use moderately strong drops (isopto hyoscine) just after surgery.

      These have recently been replaced due to a variety of factors, including isopto hyoscine no longer manufactured.

      Increased IOP/intraocular pressure can be due to steroid drops in about 10% of the population.

      Thanks for contributing and communicating with Chris.

      r

  47. LadyLady says:

    Hi Ted. Will you consider doing your other eye as well? Have you had any other anomalities like in the periphery odd images? Such as a frill? Could you report your progress here please? I will have the op too with this top Dr.

  48. Chris Reed says:

    Ted:

    Let the next couple of months play out of recovery and everything will be fine. I, too, had some fears during the healing process with vision or some very mild focusing issues but everything turned out great. I probably bothered Randy with my emails, however, just let it ride out and you’ll be fine! I plan on having the second eye done shortly.

    Chris

  49. Jochem says:

    Hi dr Wong,

    two questions about floaters:

    1. Do you think floaters can disappear by its own? On many websites Im reading that they drop below the line of sight eventually. My floaters appeared when I was 18 and I’m 32 now and they got worse slowly so absolutely no sign of disappearing. Weird thing is that my doctors cannot see my floaters while I see big clumps and strings everywhere.

    2. My floaters are less visible after pupil dilation for an eye exam. Would it be an option for floater sufferers to use low concentration dilation drops when they have to do something important like working or studying? For example. I am not able to work at the computer without sunglasses for some years already.

    • Dear Jochem,

      1. Floaters can disappear on their own, but usually do not. In most cases, patients become used to them. It is quite evident to me, however, floaters in younger patients usually don’t subside. I’m okay discussing removal if the floaters have been present for months (in my opinion, if they haven’t disappeared after several months…they may not).

      I have written many times, too, that a doctor doesn’t need to identify the floaters…it’s a fruitless task. Only those people attempting laser need to see the floaters, but then again, I don’t believe laser is a safe option.

      2. Seems extreme, but yes.

      Randy

  50. Jochem says:

    Hello dr Wong,

    Are you planning to use ocriplasmin for vitrectomy for floaters in the future if PVD can be induced more safely? I read that it is FDA approved some days ago.

    http://thrombogenics.com/news-events/latest-press-releases/

    • Dear Jochem,

      Although released and approved by the FDA, I am somewhat skeptical about its reception by retinal specialists. While the knee-jerk response is exciting, I’m really not sure if this will be a helpful tool.

      Good idea for an article!

      r

  51. Harm says:

    Hi dr Wong,

    How is made sure that the eye doesnt dry during vitrrctomy when it is held open for so long?

  52. Harm says:

    Hi Dr Wong,

    With my former question I meant the eye lids not the eye itself. How is prevented that the cornea will dry because the eye lids are held open?

  53. […] removal of an ERM (macular pucker), repair of a macular hole, a vitrectomy for vitreous hemorrhage, floater only vitrectomy (FOV) or retinal detachment surgery; the post-operative exam is […]

  54. floateredeyes says:

    Dear Dr. Wong,

    Has any of your non-pvd induced patients till now during the follow-up complained of residual floaters? Residual floaters are those floaters which appear 3-4 months after having clear vision post-FOV from the liquefaction of remaining vitreous or from loosening of strands off the hyaloid cortex into the saline.

    Any thoughts?

    • Dear Floateredeyes,

      No, or not that I am aware. Often there is a residual floater immediately after, but by 3-4 months certainly the answer is “no.”

      “Floaters” could remain from the original operation, or, recur if the cause were due to something else such as recurrent inflammation.

      r

  55. floateredeyes says:

    Dear Dr. Wong,

    I had non-pvd induced FOV. For 2.5 months, I enjoyed clear vision. But over last few months, new floaters have emerged/formed. These have different behavior than previous ones. Not as bothersome, but bothersome enough to make me suffer with adjustment disorder. My surgeon says he cannot see any floaters.

    Is there a possibility of doing a re-operation with you and getting these removed?

  56. Rambo says:

    Dear Dr Wong

    What is the maximum elevation change acceptable after surgery? Driving home to the mountains for example?

    Thank you.

  57. Tiago Comério says:

    Randall, the removal of the vitreous increases the chance of developing a degenerative disease over the years? If yes, what kind of problem can develop when you get older? I’m only 25, I am organizing financially to perform a vitrectomy in your clinic. Thank you for your attention.

  58. […] surgery and removal of floaters are great examples of “elective” surgery.  Elective means the timing of the surgery is […]

  59. Maher Boubess says:

    DEAR RANDALL

    I HAVE WROTE BEFORE CONCERNING THE REMOVAL OF RESIDUAL SILICON GEL FROM MY RIGHT EYE AND YOU HAVE RESPONDED WITH THE SIMPLICITY OF THE OPERATION AND ITS RISK FACTORS .HOWEVER AS I HAVE MENTIONED BEFORE I ALSO HAVE FLOATERS IN MY LEFT EYE (SIX MONTHS AFTER A CATARACT OPERATION) AND THEY ARE BOTHERSOME . I WONDER IF A FOV OPERATION IS DONE ON THE LEFT EYE ,WILL THE RISK FACTOR OF A RECURRENT RETINAL DETACHMENT BE LESS THAN THE REMOVAL OF SILICON FROM THE RIGHT EYE (IE WHICH OPERATION HAS MORE RISKS,AND WHICH HAS BETTER RESULTS)
    SORRY TO TROUBLE YOU WITH THIS LONG EMAIL
    MERRY XMAS TO YOU AND YOUR FAMILY
    MAHER BOUBESS

    • Dear Maher,

      I am going to say that operating on the left eye should be safer than removing the oil in the right presumably because the oil was used in a case where the original detachment surgery failed.

      Randy

  60. Carlos says:

    Dear Dr. Wong,

    You’ve probably answered this before but I can’t find it in the thread. I’m 34 yo and my floaters appeared after Lasik, so I guess it was the sucking device to make the flap that caused them. I have read that these floaters reside in the very back of the eye, which makes them harder to fix. My question to you is, have you treated these types of floaters and is your vitrectomy an effective treatment. Thanks.

  61. per says:

    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.

  62. rody says:

    Dear mr Wong,
    Can you operate me?
    i have chronic blehparit.and conyuctivit.can we use special antiseptic things for my situation?
    i need your help

  63. Eve Powers says:

    Dear Dr. Wong,
    I’m scheduled for a fov here in Hawaii next month. At the consultation, the nurse told me that once the vitreous has been removed, they replace it with saline solution, which is gradually absorbed by the body, leaving the area where the vitreous was, empty. Do you have an opinion on this type of fov? As a non-doctor, I was surprised and wondered how my eye could function with nothing replacing the vitreous.
    Mahalo! (thank you)

    • Dear Eve,

      The vitreous, mostly water, is replaced with artificial saline at the end of the operation. Within 24-48 hours, the artificial saline is replaced with your natural saline…nothing left empty.

      Sound better?

      r

  64. Cantona says:

    Dear doctor
    Is it possible to loss of sight entirely after fov vitrectomy.

  65. per says:

    Dear dr,thanks for answer/
    i was in our best doctors,they say that -i have Chronic blepharitis.and chronic conyuctivitus.its cause is staphillococus.during many years.
    can you operate me?
    can we do special antiseptic things before fov?was in your practice such things?
    i know that i must have fov.nut i afraid of infection during operation.Can we do special things for prepare the fov?
    Dear sir,how do you think about injection to conjuctivit during operation?

    stillation of Povidone-Iodine 5% onto the ocular surface at least 3-5 minutes prior to surgery?cefuroxim?Vancomycin?

    special insulators of eyelods for isolate meibomian gland and eyelods microflora during operation?

    to commence meticulous lid hygiene prior to surgery. This treatment is aimed at reducing blepharitis, with the added benefit of enhancing the health of the surface tear film through concomitant treatment of meibomian gland dysfunction?

  66. enrique ceballos says:

    Dear Dr.
    I would like information on the cost and how to contact you I am in Bogota Colombia and I am very interested in this treatment for floaters.

    thank you in advance for your attention and response

  67. Filippos says:

    Hello!

    I am 23 years old and my floaters began to be visible to me last October. On January the diagnosis from my eye doctor was vitreous syneresis in my left eye and slight-minor vitreous detachment in my right eye in which the floaters are a lot more.

    Does the fact that my right eye already suffers from a vitreous detachment makes the vitrectomy operation safer or not?

    Thank you in advance
    Filippos

  68. Larry Harding says:

    Hello Dr. Wong,

    I had Radial Keratotomy surgery circa 1984 on both eyes. Since that time I had cataract surgery on both eyes in 2010 and PVDs in both eyes, the left in April 2012 and the right in Jan 2013. Both left Weiss Rings and other bothersome floaters. I had the Weiss Rings lasered out successfully but the vitreous has continued to degenerate and I am interested in FOV.

    My question is about the after effects of the RK surgery and it’s possibly impact on a vitrectomy. The right eye in particular was described to me as very difficult to work on with the laser because of all the glares and reflections in that eye. Would this potentially increase the risk of failure or complications in a FOV or is that not a factor for this procedure?

    Larry Harding

    • Larry,

      Should be no problem at all. As long as the cornea is clear enough to see “in,” there shouldn’t be any effect.

      BTW – I try to answer comments and questions every week or so. Some weeks, I’m not as successful as others. Hope you understand the delay.

      Randy

  69. Larry Harding says:

    Hello Dr. Wong,

    I posted this question about a week ago and it said it would be moderated, but it has since disappeared so I’ll ask it again as I’m not sure whether it’s in process or lost.

    I had Radial Keratotomy surgery on both eyes in the mid-80s. It corrected my vision to 20/20 and I never noticed any problems with it, however I learned that it was a complication for cataract surgery when I had that done on both eyes in 2010. I’ve since had PVDs in both eyes that left me with bothersome floaters . I had the Weiss Rings lasered out of both eyes, and that improved my vision, but other floaters were left and the vitreous has continued to degenerate and create a even more.

    My question is, how much of a complication if any will prior RK be for FOV surgery? I was told that my right eye in particular was very difficult to work on with the laser because of a large amount of reflections and glare in that eye..

    Larry

    • Dear Larry,

      Sorry for the delay in responding. Some weeks I simply get overwhelmed with comments and it takes a while to catch up….as in your case. I apologize for the “silence.”

      All questions and comments are moderated (I personally must approve them). This avoids the LIKELY event of the blog overwhelmed with “comment spam.”

      Thanks for your understanding.

      Randy

  70. Larry Harding says:

    Thanks Dr. Wong! You were not late, you answered within a week. That was my mistake. When I first posted my comment it showed up at the bottom of the page I was on. I bookmarked that page but later the comment disappeared from that location and I thought it was lost, so I posted it again. It wasn’t I subsequently found it on a different page.

    By the way, I have learned more about FOV from your webinar videos and from these Q&A comments than I have from every other source that I’ve found combined, plus it was easy to understand and moved quickly. Well done!

    I have a few more questions:

    1) Have you ever needed to use a gas or air bubble during an FOV, perhaps in a case of a retinal tear? I’m wondering if anyone considering the operation needs to have time available to spend a couple of weeks in bed for positioning of the bubble if the worst happens.

    2) Do people ever complain of new floaters, perhaps months or years later, caused by continued aging of the peripheral vitreous that isn’t removed? If so, is the solution to perform a second FOV?

    Larry

    • Dear Larry,

      1. Not really. There have been a few times when operating on a diabetic retinal detachment where I had to use gas. That scenario is more likely. I’ve had a few cases of macular holes, where a PVD must be induced where a small detachment occurred, but gas is used anyway to fix a macular hole.

      Regardless, my gas of choice is 16% SF6….it’s gone within 10-14 days and I recommend only 5 days of face down positioning.

      2. In theory, a second FOV might be needed if the original surgery did not remove all the floaters. The floaters should not come back after an FOV unless the cause is bleeding or inflammation (neither are the usual cause floaters requiring vitrectomy).

      Randy

      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, Virginia
      http://www.RetinaEyeDoctor.com

  71. Shaun Moore says:

    Dear Dr. Wong,
    Im 26 years old and iv had floaters in both eyes for a little over 4 years now, my eye doctor explained to me wut was causeing it and that there is no serious need to worrie, and the rest of my eye is really healthy, there are a few good sized ones in both eyes with small ones, i kinda knw when new ones are comeing on cause ill have them little flashes or sparks of light in my eyes, im thinking about haveing the surgery but a nervious wreck! im about 4 hours from where your office is, could you still do the surgery for me if needed?

  72. Gian says:

    Dear Dr. Wong,
    I am a 59 year old male with 20/20 corrected vision and otherwise healthy eyes. I have had floaters bad enough to reduce my quality of life only for about a year; 6 months ago a retina specialist confirmed PVD and advised me that nothing should/could be done to fix my floaters. How long should I wait to see if they spontaneously fade, before considering surgical treatment, like an FOV?
    Thanks,
    Gian

  73. John says:

    Dear Dr. Wong,

    I wrote to you several days ago with a rather lengthy explanation of my situation and a question. I understand the delay in response due to review of the posts and your time constraints. Nevertheless, in the interim several more questions have come to mind. One of the reasons that I am considering FOV is that I am concerned that a YAG for my PCO’s may damage (pit) my implanted crytalenses. Is this a valid concern? My floaters are significantly troubling, but one retinal specialist insisted that I first do the YAG before she would even consider a FOV. Because I was seriously considering FOV this seemed potentially compromising of a optimum result. Secondly, how great a risk is there of significantly moving the crystalens implant as a result of the victrectomy and therefore altering my vision? Thirdly, do you normally use a retrobulbar block for your local anesthesia and how so the risks of this technique compare to the risks of general anesthesia? Thank you for your responses, I hope.

    • Dear John,

      As I said in the other comment, the YAG should not affect the IOL at all, especially if properly performed. I don’t think I’ve ever moved an IOL during vitrectomy…it is really unlikely to happen.

      In experienced hands, a retrobulbar is very, very safe. It is my preferred method and rarely want to use general anaesthesia.

      Randy

  74. John says:

    Dear Dr. Wong,

    Thank you very much for your answer to my second comment. In it you referred to your answer to my first comment, but as far as I can see your first answer has not been posted.

    John

  75. John says:

    Dear Dr. Wong,

    Having you available as a resource and someone to talk to when making a decision that will have a major impact on quality of life for the duration is extremely helpful and greatly appreciated. THANK YOU! I have another question for you based on your previous answer. If a properly performed YAG procedure will not damage an IOL, do you recommend doing the YAG for a PCO before having a FOV or is it better to do a capsulotomy for the PCO during the vitrectomy surgery. A retinal specialist told me that he could do a better (more controlled) procedure for the PCO with the vitrectomy tool than with the YAG. How do you advise your patients with both troublesome floaters and PCOs?

    John

  76. Larry Harding says:

    Thank you Dr. Wong. Could you please ask your staff to email me information about the cost of the procedure? I am an expat living in Thailand; my SE Asian insurance will not cover elective surgery in the US, so this would be an out-of-pocket trip and expense for me. I have considered having the surgery performed here but they are still using 23-gauge instruments in Chiang Mai. The cost is low ($3000 per eye), but from what I’ve read, I don’t think I want to go the 23-gauge route. It sounds like that creates more pain, slower healing due to sutures, and may also create more bleeding and/or other debris and complications. Am I correct in that assumption?

    By the way, a Thai retinal specialist told me that they tried using 25-gauge instruments, but the quality of the instruments in this part of the world was not good. The doctor said that one broke during his surgery once. They hope to resume 25-gauge procedures in the future when better instruments become available.

  77. John says:

    First, again a note of thanks to Dr. Wong for this website. It was a great help in making my decision to proceed with a FOV, which also included a capsulotomy for PCOs. I had suffered for two years with very large cloud-like floaters that moved horizontally through my field of vision every time I moved my eyes or head. The floaters were the result of PVDs that occurred in both of my eyes subsequent to cataract surgery and to two retinal tears that occurred at the same time. Also during this two year period I developed PCOs in both eyes, sometimes referred to as secondary cataracts. My quality of life was significantly negatively affected by the floaters. I lived with them every waking hour. One of my great joys is hiking and seeing the beauty of creation. The constant movement of the floaters almost robbed me entirely of this pleasure. I could expand on their negative impact, but those who similarly suffer already understand what I am describing.

    Nevertheless, the decision to proceed with FOVs was very difficult for me for several reasons. I studied the procedure extensively. I could still quote to you the percentage of every risk involved. Unfortunately, the information available on the internet tends to emphasize the risks and minimize the benefits. It appears that the medical profession has become so defensive in the current litigious environment that when communicating, it majors in potential complications and minors in hope. This is not true of Dr. Wong, which is one reasons that this website helped me significantly. Secondly, as a whole, the retinal specialist community still seems to minimize the seriousness of floaters. In other words, if they are not debilitating, live with them. However, in truth, there is a large portion of the spectrum of very negative impact on quality of life before you arrive at debilitation. Also, many people that you speak to say, “Oh yeah, I have floaters too.” This can make you feel that you must be severely visually OCD to even consider treating this condition. Sure some people can adapt or accommodate to floaters easier than others. However, there are floaters and there are floaters. In other words, not all floaters are equal. A little bubble here or there is not the same thing as opaque clouds obscuring a major portion of your vision as they pass back and forth.

    Thus my biggest struggle was with myself. Was I taking the very low percentage, but real risks associated with a FOV because I selfishly wanted too much in regard to good vision? Was I visually greedy? Well, I finally decided to proceed and thank God that I did. I had my first vitrectomy and capsulotomy three weeks ago and my second one week ago. I live in Lafayette, Colorado and the procedures were performed by Dr. Elisha Tilton (I hope Dr. Wong will allow his name to be included in this story). Both operations were immensely successful. I know that good vision is not to be anticipated immediately after surgery for many reasons, nevertheless I saw 20-20 in both eyes the day after surgery. At my one week after surgery examinations, I saw 20-15 in both eyes WITH NO FLOATERS. The surgical experience itself was not the least bit traumatic. It was performed with a retrobulbar block and me in a twilight zone of semi-consciousness. I had no post surgical pain. To say that I am grateful is an understatement. I am ecstatic! The joy of beholding beauty has been restored to my life. I thank God, those who prayed for me regarding this surgery, who were many, Dr. Wong for his encouragement and open communication, and Dr. Tilton for his excellent skill and care.

    I hope that this narrative will help someone in the valley of decision. If you have any more questions for me, you can ask them on this website, if Dr. Wong is amenable.

  78. John says:

    Dr. Elisha Tilton’s website address is http://www.eyecaresite.com. I hope more doctors follow your example of open communication and dialogue. Thanks again!

  79. Larry Harding says:

    Hi Dr. Wong,

    I saw in your email update yesterday that you will soon be offering 27 gauge vitrectomy. I know that in the past you’ve stated that you were very happy with 25 gauge. What is you thinking now about the merits 25 gauge versus 27 gauge?

  80. Nadine says:

    Hi Dr. Wong.

    I am a 37 years old with moderately high myopia (-5) combined with astigmatism (-2.75). Since my early 20s I had several photocoagulation seances to fix lattices and holes in the periphercity of my retinas. Last winter, I had the cataract surgery in both eyes. It left me with a significant increase of floaters, that are of course really annoying. i haave a refractive error that in both eyes that will be corrected in a couple of months with a piggyback sulcus fixated Sulcoflex lense, after I have Yag for PCOs.. Since I cannot be corrected with a PRK or Lasik procedure (keratoconus fruste), I was wondering what the odds were to experience a refractive change if I decide to opt for a vitrecromy after all these other procedures?

    Thanks a lot for your exceptionnal patience and involvement!

    Regards,

    Nadine

  81. Ty says:

    Hello Dr. Wong, I am interested in getting FOV’s but am unaware of the cost. Do I fill out the patient application form and enter my details? I’m paying out of my pocket. Thanks

  82. […] is no difference between FOV (Floater Only Vitrectomy) and a vitrectomy.  They are exactly the same operation.  FOV is a term used by patients and vitrectomy is the term […]

  83. Mikael Andreasen says:

    Hello Dr. Wong. I have watched your operation video for vitreous floaters (FOV). It seems like there a smaller risk of side effects with this kind of surgery compared to the traditional Vitrectomy surgery.
    I have been examined by two different doctors and they both diagnosed me with vitreous (Corpus vitreum) on both eyes. I think thats the right expression in english. I have a lot of floaters in both eyes which is affecting me mentally. I’m feeling very depressed and my body is experiencing a lot of stress which has caused tinnitus in my right ear. I also find it difficult to read and drive my car. I have to fina a way of treatment without any question.
    I live in Denmark and I’m not sure if there’s any treatment for floaters here. The Vitrectomy operation here has a lot of side effects. I’m not sure if the hospitals here use the same technology as you do (25 gauge Vitrectomy System). so it’s only as a last option they use this kind of surgery because of the high risk.
    Do you have any knowledge about hospitals in Europe which perform the same surgical procedure as you, with the same level and high skill?I can apply to be referred to a hospital abroad as part of the patient law in Denmark.

    Looking forward to your reply.
    Kindly regards Mikael Andreasen.

  84. Larry Harding says:

    Hi Dr. Wong,

    I have another question for you after some time away.

    Recently I corresponded with a former floater sufferer who had a successful vitrectomy several years ago. It was actually a combined vitrectomy-cataract surgery and he mentioned that his surgeon removed the anterior hyaloid membrane during the procedure, saying that there was no reason to leave that attached to the lens capsule and it might prevent the occurrence of a secondary cataract. Since I have already had cataract surgery and natural PVDs in both eyes, and have been told that I have a mild secondary cataract developing in at least one eye, I’m wondering what your thoughts are about removing that membrane during vitrectomy in my case.

  85. Mikael Andreasen says:

    Hello Dr. Wong. Thank you for your reply. I’m living in Denmark and wrote you february 15th. 2014 regarding my floater condition.
    How much is a Vitrectomy surgery (FOV) performed in your clinic by you and is it possible to do both eyes within a few weeks?
    I’m asking because of the travel logistics?
    Kindly regards Mikael Andreasen.

  86. Ted says:

    Hi Dr. Wong (and all):

    I guess it is time to give an update about my surgery journey…
    I had surgery in right eye in Sept 2012 and left eye in June 2013. I had tons and tons of criss-crossing floaters in both eyes. It was crazy and couldn’t concentrate on white screens and white paper.

    Here are the results:

    Left eye:
    After surgery was flawless and eye healed fast (within a month). Started using contacts in 4 weeks.
    Noticed a pin-sized leftover floater particle.. but very easy to disregard in my line of vision. Vision is just as good as before (which is great).

    Right eye:
    It went completely red and it looked and felt very sore for a week. It was like sandpaper in my eye and vision wasn’t great for about a week. Looked very red for about a month. I started using contacts again in about 8 weeks.
    Noticed larger floater in the very back of my peripheral vision. Can’t say I notice it much and vision is just as good as before.

    Good stuff! Hopefully I will be able to come into town sometime just to have a post surgery checkup and say hello.

    Hope this makes others on this site feel better. I was scared like crazy to do it… just ask Dr. Wong. I was so hyper they had to put me out of my misery fast. LOL. Glad I did the procedure(s).

    Thanks a lot! Have a great day.

    Ted

  87. inez canvasser says:

    Hi. Wondered if the 27 gauge is available as of now? Also having a FOV before cataracts appear, does that make cataract surgery more difficult in the future and how long can I expect to be cataract free after vitrectomy? I am healthy 66 year old. My only problem are these constantly moving opaque floaters in both eyes.

    • Inez,

      Thought I answered this…sorry.

      27 gauge is not on the market and no telling when it will be available.

      FOV can be done safely before cataracts appear, but at your stated age of 66, I’d be surprised if you didn’t have some slight degree of cataract. I look forward to meeting you soon.

      Randy

  88. inez canvasser says:

    I am scheduled to have surgery with you for my floaters and need to schedule a flight home. Surgery is on Fri. Can I return home on Sun? Thank you, Inez

  89. cheryl S says:

    Dr. Wong,
    I am writing to you after I saw a post from Nadine. She was having a SULCOFLEX lens implanted as a piggyback to correct a refractive surprise. I was wondering where she was having it done? Is it available in the U.S.? I have a refractive surprise and dysphotopsia since my FOV/cataract surgery over a year ago. Since that time my left eye has constantly hurt as it feel like something rubbing against the far left side and when light enters hits that area from glare off of cars it is extremely sensitive. Both eyes are sensitive to light since 2012 after a year of dealing with floaters (PVD). When glare comes off of cars it hurts my eyes and I see spots immediately. Even going outside without sunglasses I will see spots when I come inside. My eyes have become very dry this past year and I started seeing afterimages when my floaters started 2 1/2 yrs ago. Is there any information you can give to me or anyone else out there dealing with these same problems? I am interested in the sulcoflex foremost.

    Thank you.

    Cheryl

    Hi Dr. Wong.

    I am a 37 years old with moderately high myopia (-5) combined with astigmatism (-2.75). Since my early 20s I had several photocoagulation seances to fix lattices and holes in the periphercity of my retinas. Last winter, I had the cataract surgery in both eyes. It left me with a significant increase of floaters, that are of course really annoying. i haave a refractive error that in both eyes that will be corrected in a couple of months with a piggyback sulcus fixated Sulcoflex lense, after I have Yag for PCOs.. Since I cannot be corrected with a PRK or Lasik procedure (keratoconus fruste), I was wondering what the odds were to experience a refractive change if I decide to opt for a vitrecromy after all these other procedures?

    Thanks a lot for your exceptionnal patience and involvement!

    Regards,

    Nadine

Leave a Reply

Your email address will not be published.