What are floaters?
Floaters are very common
Floaters are small bits of debris formed by connective tissue in the eye as the vitreous sack naturally degenerates over time. This bits of debris cast shadows on the back of the eye so are seen. Most people have some floaters but aren't aware of them.
But they can be treated
There are options for treating some types of floaters with laser or surgery.
What are floaters?
The vitreous humor is the clear, jelly-like substance in the main chamber of the eye, located between the lens and the retina.
At a young age, the vitreous is perfectly transparent. Over time as the eye ages, this vitreous humor can degenerate, losing its form and liquefying. Without the stable vitreous humor, the collagen fibers collapse and bind together to form clumps and knots. It is these fibers, which cast shadows on the retina and appear as spots, strings, or cobwebs that are commonly referred to as “eye floaters.”
In many cases as the eye ages further, the vitreous humor can peel away from the retina entirely. This is known as
Posterior Vitreous Detachment (PVD). PVD is often associated with a sudden increase in the number of floaters.
Types of floaters
fibrous strand floaters – common in young people, these appear as multiple dots and or string like cobwebs, which may be treatable depending on size and location
diffuse floater – these are cloud like floaters caused by aging which can sometimes be treated.
Weiss ring floater – this circular floater which is large and fibrous represents the connection between the vitreous and optic nerve head.
What is laser vitreolysis?
Known as floater laser treatment, this is a non-invasive and pain free procedure that can eliminate or reduce visual disturbance from some types of floaters.
How does laser vitreolysis work?
Vitreolysis involves the application of pulses of laser light to evaporate the vitreous opacities and to cut the vitreous strands. During this process, the floater’s collagen and hyaluronin molecules are converted into a gas. The end result is that the floater is removed and/or reduced to a size that no longer impedes vision.
What happens during the procedure?
Vitreolysis is performed as an outpatient procedure; you do not have to stay overnight in a hospital. Immediately prior to treatment, you will have anaesthetic eye drops administered.
A contact lens will then be placed on your eye, with the laser light delivered through a specially designed microscope.
During treatment, you will likely observe small, dark specks/shadows – signaling that the floaters are being evaporated into small gas bubbles. These gas bubbles quickly dissolve and resorb into the vitreous.
Once the treatment is complete, your ophthalmologist may treat your eyes with anti-inflammatory drops.
Each treatment session typically takes 20-60 minutes to perform and most patients will need to undergo two treatment sessions, sometimes three, in order to achieve a satisfactory result.
What can I expect after treatment?
You may observe small, dark specks in your lower field of vision immediately following treatment, which are gas bubbles and will quickly dissolve. It is also important to note that some patients may experience mild discomfort, redness or temporarily blurred vision directly following treatment.
Complications and side effects
Reported side effects and complications associated with vitreolysis are rare. Side effects may include cataract and intraocular pressure (IOP) spike.
Who will benefit from vitreolysis?
It is necessary to undergo an ophthalmic examination to determine your eligibility for vitreolysis treatment.
- Age. In most cases, younger patients (<45) suffer from microscopic floaters located close to the retina (1-2 mm) and are not considered to be good candidates for vitreolysis treatment.
- Onset of Symptoms: If your floater symptoms develop very quickly then they may be associated with PVD, which can be treated with vitreolysis.
- Floater Characteristics. Large floaters with a soft border, situated away from the retina, are ideally suited to treatment with vitreolysis
Case Studies
Mrs LAS is a 58 year old lady who has had floaters in both eyes after successful lens replacement surgery.
The Problem: She struggles with tasks such as reading as the floater centres in the middle of her vision so she needs to flick it away
- Driving is difficult as a blob remains in her central vision
- Difficulty reading due to blob in vision
- Driving difficult due to blob/spider floating in her vision
The Solution:
Mrs LAS underwent bilateral YAG laser vitreolysis. This eliminated more than 95% of the floater and the objects are no longer noticeable in either eye. Mrs LAS is delighted with the result, the procedure avoided invasive surgery and enabled her to carry out the tasks she loves.
Mr PW is a 47 year old executive who works at a PC most days
The Problem: He has a cloud of floaters in front of the right eye which is described like a big spiders web that floats in the way of his line of sight.
- Struggles to read the screen
- Driving is a struggle as there’s a curtain in front of his right eye which drifts in front of his eyes.
- Cannot see PC clearly due to cloud of floaters
- Cannot drive safely as floaters move in front of his eyes like a curtain
The Solution:
Mr PW underwent YAG laser vitreolysis to sever the fibres holding a large cloud of floaters in his central vision, in the line of sight. The cloud then fell into the lower part of the eye and well away from the line of sight. It was very rarely noticed thereafter and Mr PW was delighted.