Vitreous Floaters: Evaluation and Treatment
January 17, 2013 By Randall V. Wong, M.D.

Vitreous floaters are any spots or shapes which move back and forth with eye movement. Floaters are very common and can arise from a variety of conditions. New onset floaters should always be checked to ensure there is no tear in the retina or signs of other disease.

Floaters may be from blood, cells from underneath the retina, inflammation, asteroid hyalosis, from a PVD or from condensation/changes in the proteins within the vitreous.

What Causes Floaters?

Blood: Floaters from blood most commonly occur as complications of a retinal tear, diabetic retinopathy or a retinal vascular problem.

Inflammation: Another term is uveitis. This is like having arthritis in the eye. Cells from the immune system (white cells) actually migrate into the vitreous and clump. Treatment of the inflammation doesn’t always resolve the floaters.

Asteroid Hyalosis is a special benign condition where white specs normally accumulate in the vitreous. Very similar to driving through a snowstorm, these asteroid bodies often make examining the retina very difficult. Miraculously, most people with asteroid hyalosis don’t complain of floaters, but on occasion, some do.

Posterior Vitreous Detachment: Change in vitreous proteins are probably the most common cause of floaters. A PVD causes floaters or a “cobweb” moving through your vision as the proteins condense or change in clarity.

The floaters can disappear, become tolerable or annoy you to no end. They can blur or decrease your vision and cause glare.

Vitrectomy (FOV) Removes Floaters

For the myriad of you in whom the floaters don’t disappear, you can get rid of them. Vitrectomy surgery is the safest and best way to rid yourself of the floaters. There are a few doctors who promote the YAG laser, but none are retina specialists.

With vitrectomy, the bulk of the vitreous is surgically removed. We don’t need the vitreous. It’s a vestigial tissue (i.e. a tissue we need during development, but serves no function once we are born. Another example? The appendix!).

The vitreous is similar to jelly fish…mostly water, but has some structure (that’s why you can catch a jelly fish with a net). With vitrectomy eye surgery, the vitreous gel, and floaters, are simply replaced with 100% water, or saline.

My Doctor Can’t See the Floaters

It is my practice to consider vitrectomy if; 1) the floaters you see definitely move back and forth with eye movement, and 2) you understand the risks and benefits of surgery. I don’t have to actually “see” your floaters.

The vitreous is usually optically clear to you, i.e. you shouldn’t see your own vitreous. As a doctor, everything in your vitreous, however, should be visible to me. Large floaters can easily be seen and identified to be the culprit, but this doesn’t occur that often.

More often, I can’t see the floaters because they are either too small for me to appreciate or I simply don’t know which one is causing the problem.

Anything moving back and forth with eye movement has to be located in the vitreous and no where else in the visual pathway. I believe the issue with “seeing” the floater stems from the fact that using a laser to treat floaters requires a “target.”

With vitrectomy, this is not necessary.

What Does This Mean?

I don’t understand why patients suffering with floaters have been discounted. There is a clear treatment available. The risks of the surgery have changed since vitrectomy was first invented in the 1970’s. The procedure has become much safer and is comparable to cataract surgery.

Because of the inability of physicians to knowledgeably council their patients, there are too many myths and rumors about vitreous floaters and the treatment. I’ll be adding articles about risks and benefits of surgery, risks of cataract formation, etc. in the near future to help set the record straight.

Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia