What is Frill Following FOV?

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What is Frill Following FOV?

Vitreous Floaters, Randall Wong, M.D. Fairfax, Virginia 20031Frill is a term that is used by patients who have had an FOV (Vitrectomy for Floaters) to describe a visual disturbance that occasionally occurs post-operatively in their peripheral (side) vision.  This “frill” is noted by a very small subset of patients who have undergone a successful vitrectomy for floaters (FOV), that is, the floaters have been successfully removed, but a secondary problem has developed in the peripheral vision.

Unfortunately, I am unable to see “frill” through a visual examination of a patient.  Nonetheless, I do sympathize with those patients who experience “frill.”

Moreover, since “frill” has not been medically defined there is no specific course of treatment.

Goal of Vitrectomy for Floaters

The goal of performing a vitrectomy for floaters  is to remove and significantly reduce the number of floaters, and to do it safely.  Infection, retinal tears/detachment and cataract formation are the major complications which must be considered for every patient who requires a vitrectomy, regardless of cause.

The practice of medicine is inexact and no two patients are exactly the same.  Prior to obtaining a patients consent to perform a vitrectomy for the removal of floaters, I always advise that surgery may not remove all of the floaters.  I do not use the term “frill” in my consent because it is not a medical term, however, I do note that residual floaters may remain.

Safety is also a goal of every surgery.  I want to remove as much vitreous as possible without damaging the retina; therefore, all of the vitreous is not removed.  I do this by removing the central “core” of the vitreous.  The depth and the amount removed to the sides is not an exact science.   I remove what I believe is a safe amount without compromising the retina.  Remember, this can and will vary patient to patient.

Frill is Not a Complication of Vitrectomy

For reasons that I do not know, a small subset of patients who undergo vitrectomy report post-operatively a different type of visual disturbance than the floaters.  Fortunately, while still bothersome, the disturbances are noted in their peripheral vision.

And for those few who feel they cannot function due to the peripheral abnormalities, the only recourse may be to recommend a second surgery to remove additional vitreous.  With each surgery though there are risks, so the risk/benefit ratio must be fully appreciated by patients wishing to entertain a second surgery.

If I were a medical researcher with the facilities and budget to explore “frill” and its causes I certainly would; however, I am not a researcher.  Instead,  I use the tools and research of others to best help those in need.  At this point, for patients who have had their daily activities compromised by floaters, I recommend a vitrectomy to remove the floaters.

What Does This Mean?

My goal in performing an FOV or vitrectomy for floaters,  is to restore a patient’s ability to function in their daily activities without be hindered by debilitating floaters in their central vision. Over 22 years, I have performed thousands of vitrectomies and out of all of those vitrectomies only four patients have reported “frill.”

I do not say this to dismiss the very, real complaint of additional visual disturbances, rather, to show why I still believe that for the vast majority of patients I treat, vitrectomy is a highly effective procedure and that “frill” does not occur most of the time…making it even more difficult to figure out why it develops.

I understand that “frill” is discussed widely on forums and, for those patients, it is extremely frustrating to have undergone surgery, yet be left with a visual disturbance in their peripheral vision.  The following possibilities are what I believe could explain post-operative “frill”  and would be happy to discuss further (in later posts) with anyone who is in an ophthalmic research position that would like to explore these possible causes in greater detail.

  1. Unremoved Vitreous
  2. Shifting Vitreous
  3. Changing Vitreous
  4. Relative Loss
  5. Vitreous Hydration

Randall V. Wong, M.D. 
Ophthalmologist, Retina Specialist
Fairfax, Virginia

 

 

 

Comments
  • paul July 25, 2013 at 1:47 pm

    Is there any additional risks doing a second op besides the ones present at the first surgery?

  • Teri July 26, 2013 at 12:28 pm

    I am interested in learning more about frill. I have had two retinal detachments and have lost periferal vision with no explanation from my Dr. it has progressively gotten worse over time. it appears to be stable at this time. is thus related to frill?

  • Theresa Gachter July 26, 2013 at 12:36 pm

    Yesterday I read about the new surgery for Macular Degeneration performed on a man with problems and has now been able to see again with this new method inserting a telescope implanted in his eye at a cost of $15,000. Then the hospital at all other cost. Who can afford these prices?

  • Eric July 26, 2013 at 4:52 pm

    Can you explain in more detail what Frill is? You mentioned it’s a visual disturbance, but what type of disturbance?

    I recently had a vitrectomy for a retinal detachment and I’m seeing visual distortion on the amsler grid in the top half of my vision. As an example, when I drive up to, and past, stoplights hanging above the street, if I keep my eyes focused on the road, the stoplights start distorting like crazy non-stop (in various directions) until I’m fully past them. So something is going on in the upper half of my eye that is causing the light rays to be bent in all the wrong directions.

  • Gordon McLean July 26, 2013 at 5:37 pm

    Fantastic information!
    PLEASE doctor, where in Canada can one pay for a FOV vitrectomy?

    Thanking you in advance,

    Gordon McLean

  • Ray Norris July 26, 2013 at 6:43 pm

    I got your e-mail about “Frill”. It looks like this means that it blocks your peripheral vision. What would be another word for “Frill”. I can’t understand this. Thank you.

  • Paul July 27, 2013 at 10:07 pm

    Good to know,I want to see how things go in the next month to get a good evaluation,if my eye doesnt clear i may consider a clean up

  • Mike July 28, 2013 at 7:01 pm

    I’ve recently developed dry eye syndrome in the very eye that I’d like to have an FOV performed to remove a Weiss ring that is in the center of my vision. Will this complicate the recovery or healing process in anyway?

    Thank you.

    • Randall V. Wong, M.D. August 21, 2013 at 9:15 pm

      Dear Mike,

      Don’t think so. Dry eye should be completely unrelated to FOV.

      r

  • Paul August 16, 2013 at 11:59 am

    I am no expert and im not in the medical field so this is just my two cents,I was reading up on a 25 gauge curved vitrector I would immagine you could access more areas of the eye easier with a system like that,It sounded pretty interesting,Its amazing how far technology has come in the last 10 years in all fields.

  • Paul August 22, 2013 at 9:44 am

    I just want to say you’re an amazing person and your willingness to help people is extrodinary,I hope other doctors follow in your footsteps.

  • Paul August 27, 2013 at 9:23 am

    I see what you’re saying,so it could work but it has its disadvantages,Its kind of a double edged sword.Maybe a vitrector that can be mechanicly bent where the doctor would have complete control of the angle,you could still enter the eye straight.with technology comes progress.

    • Randall V. Wong, M.D. August 28, 2013 at 9:22 pm

      Paul,

      I understand the intrigue and do not discount the possibility of an advantage.

      Randy

  • maher boubess September 26, 2013 at 4:44 am

    HELLO DR RANDALL
    I HAVE BEEN ON THIS BLOG A YEAR AGO, BEFORE I HAD A VITRECTOMY ON MY RIGHT EYE PERFORMED TO REMOVE THE EXCESS SILICON OIL LEFT OVER FROM A PREVIOUS RETINAL DETACHMENT OPERATION ,BUT UNFORTUNATELY THERE WAS NO IMPROVEMENT IN THE VISION AS NOT MUCH WAS REMOVED IF ANY.
    I AM WRITING TODAY TO TAKE YOUR OPINION CONCERNING MY OTHER EYE ,WHICH I HAD A CATARACT OPERATION PERFORMED THREE YEARS AGO.SINCE THEN THE VISION HS IMPROVED A LOT ,BUT ABOUT EIGHTEEN MONTHS AGO I STARTED DEVELOPING FLOATERS ,AND THE QUANTITY HAS BEEN INCREASING WITH TIME. I AM THINKING OF HAVING A FOV PERFORMED ON THIS EYE NEXT MONTH AND HAVE A COUPLE OF QUESTIONS PLEASE
    1-COULD I HAVE A PVD WITHOUT FEELING IT ?
    2-COULD A FOV AFFECT MY CATARACT,ALTHOUGH I HAVE HAD ALREADY A CATARACT OPERATION THREE YEARS AGO IN THIS EYE?
    3-MY DR SAID THAT HE NEEDS TO PUT GAS IN MY EYE DURING THE OPERATION TO KEEP THE RETINA FROM DETACHING ,IS THAT THE NORMAL PROCEDURE DURING A FOV ,AND A NECESSARY ONE ?
    YOUR FEED BACK IS GREATLY APPRECIATED
    THANKING YOU IN ADVANCE
    MAHER BOUBESS

  • Starchild November 9, 2013 at 6:18 am

    Hi Dr. Wong,

    I also suffer from frill and am considering a follow up Vitrectomy to remove it.

    My question to you is have you ever performed a FOV to remove frill specifically and was the operation successful?

  • Marcel Peters December 2, 2013 at 7:12 am

    Hello dr Wong,

    I am 34 years old from Belgium . Two years ago I had a FOV in both eyes, PVD included with a perfect outcome. No other eye problems, glasses or what so ever.

    The last two weeks I developped some problems in my left eye. I see what looks like a crack in the window of my car, but only very shortly after blinking my eyes. Whitout blinking everything looks ok, vision completely normal.

    What can this be, maybe the beginning of cataract?

    Regards,

    Lydia

  • Lydia Peters December 2, 2013 at 7:17 am

    I tried to be anonymous haha

    Regards, Lydia

  • Lydia Peters December 2, 2013 at 7:19 am

    my original message is gone?

  • mike mariconda December 6, 2013 at 12:43 pm

    I’ve had floaters since childhood in one eye which happens to also be amblyopic. As the # of floaters grew in time I had them evaluated by both a retinal physician as well as a floater removal physician. The retinal physician observed no active disease and recommended to live with them. The laser physician could not see them and said they must be very close to the retina and since he could not see them would not be able to use a laser to destroy them. Both physicians recommended not to go the vitrectomy route due to risks. I agree that the risks are real but if they are equivalent or less than cataract surgery, that might be ok. My question is, if the floaters are very close to the retina so that they could not even been seen, then would a vitectomy get them out?

  • Michael Hernandez January 30, 2014 at 1:11 am

    do you think is better FOV Core or FOV PVD for a patient of 31 years? My doctor only gives me FOV Core. Do you think?

  • Michael Hernandez February 13, 2014 at 7:31 pm

    My floaters in my left eye are not as many compared to others (although my quality of life has been significantly reduced) are lines, dots and transparent worms, I would have a core vitrectomy, but I’m afraid because patients “frill” that are reported in the various forums, my doctor says that the edges of the vitreous are outside the field of view, I would like to know what percentage of patients complain of frill? and patients who complain of frill are young or old? Thanks Randy

  • Francois February 14, 2014 at 7:28 am

    Dear Randy,

    I am highly myopic (-15 range) French man.
    Back in June 2012, only a few weeks after a retinal hemorrhage on the right eye, leaving me with a damaged VA o this eye, I suffered suddenly on floaters on my left eye, following PVD according to my retina expert.
    Rather annoying to have big floaters on the ‘good’ eye!
    I posted at that time on your site and your very kindly answered on the possiblity to offer FOV, even to highly mypic patients.

    Thanks to yoru advice, and I must confess, to another very open and professional retina expert in France, I was offered the FOV on this left eye. Only after 6-8 months, to leave the time etc… as it is now quite well admitted.
    I was operated in May 2013, and was fantastically happy about the outcome. Clear vision. Not less.

    Tilll yesterday, when I noticed firstly flashes on left eye. It was not the first ones (had them few months ago, and retina check was okay and they faded over several months), but these ones, within a few hours disappeared and left me with 2 large floaters in what I thought would remain a floater free eye.

    These ones seem to come less often in central vision, but they sometime do. And I feel so sad to see again what I had seend disappearing with FOV!

    I know I ‘only’ got core FOV, quite standard practice. So I assume these floaters are coming from an evolution of the PVD on the remaining Vitreous?

    So my questions to you are:
    1) I think I saw in one of your post you would not expect new floaters to appear after FOV (I know some can REMAIN though, but that is not the case here). Can you elaborate on that? How would you explain my condition (with the limited information I give you, sorry).

    2. would you expect these two floaters to ‘behave’ differently from the ones I had already who a) were moving all over the field of vision and b) tended to consolidate over time in only one massive floater. Most importantly: do these have more chance to settle down somewhere in a place I can JUST FORGET THEM!? I swear if they stay there I wont attack them! The previous floaters never did.

    3. Would 2nd FOV be an option, if the floaters remain really annoying (I know this is not a comfort surgery and there are risks) and then what would it mean? Take out more vitreous? Risks of cataract then?

    I take this opportunity to say that, as usual, I did retina check this morning with eye doctor who confirmed no retinal tear/detachment, as this was obviously the most important to check.

    Many thanks in advance for your feedback.
    And a great thank for all your time and effort. You are very precious to our community.
    Kind regards from France
    Francois

  • Michael Hernandez February 19, 2014 at 2:45 am

    Randy thank you very much for your information.

    My last questions are:

    1. Some patients say this frill disappears in a time (6-18 months), is this true? or to remove the frill would necessarily need another vitrectomy?

    2. what is the risk of retinal tears iatrogenic with PVD?

    Thank you

  • Mario Cataldo February 20, 2014 at 2:50 am

    Hello Randy

    My name is Mario, I am from Peru, I am 30 years old

    I have carefully read your comments, they are a great information, I would like to ask some questions

    1. As expected the percentage of retinal detachment, vitrectomy for PVD, someone in his 30s?
    2 What is the most recurrent complication with PVD?, Regardless of future cataract
    3.. If anyone 30 years, a core vitrectomy is done. Percentage you think you might have a frill?
    4. What percentage of vitreous retina that a core vitrectomy or PVD?
    thanks

  • Cheryl Beatty March 8, 2014 at 11:59 am

    Positive dysphotopsia, a subsequent YAG and symptomatic PVD eventually (a year later) led to a successful IOL exchange and posterior vitrectomy on my left eye. Immediately after the surgery, I developed a small peripheral visual disturbance at the two o’clock position. It is flower shaped, scintillates in bright light and appears as a shadow in lower lighting conditions. My surgeon has concluded that it is caused by retinal scarring from a previous serous retinopathy. The scars existed before my surgery but did not affect my vision until I had the vitrectomy.

    Do you think this diagnosis may solve some of the mystery of “frill”? The symptoms have not changed in three months and I have gotten used to this minor inconvenience. It is a small price to pay for a clear vitreous.

    Thank you for this wonderful web site. I have found it to be very informative.

  • Luis Miguel Vallejo June 2, 2014 at 9:09 pm

    How much it costs for one eye?

  • Dillon June 4, 2014 at 4:43 pm

    Hello dr. Just a couple of questions if you don’t mind.

    1: I have read that some Dr’s performing fov if the surgery doesn’t get rid of all the floaters the first time that they will do another surgery free of charge to make sure that the customer is completely satisfied. Is this something you do or would do?

    • Randall V. Wong, M.D. June 9, 2014 at 11:26 pm

      Dillon,

      It would be foolish for me to guarantee anything with a medical procedure and, hence, I do not. Some obviously feel otherwise.

      Thanks,

      r

  • Dillon June 13, 2014 at 3:25 pm

    Thanks for the response Dr. Do most of your patients say the surgery gets rid of all there floaters 100%? Or do they still see some floaters but better then they were? Any percentages? Thanks again

    • Randall V. Wong, M.D. July 12, 2014 at 2:19 pm

      Dillon,

      “Most” say all are gone. I’d count on a huge reduction with the possibility of “all.”

      Randy

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