Floaters and spots

**RetroRat** · 06-14-2010, 04:27 AM

Hi Optiboard!

We had a Px in today, just shopping around for some different styles and prices... but she disclosed to me that she'd been plagued with the floaties and spotty-dots since she was a little girl.

I know there are methods to remove floaters... but I would be interested to hear your opinions: How compromised does visual acuity have to be before recommending surgical intervention?

Should it even be a matter of visual acuity, what about just general standard of living?

I know I get little floaters in my right eye every now and again and it doesn't really bother me, but what do ya'll think on the subject?

**ilanh** · 06-14-2010, 09:08 AM

Two options: Both are rarely used due to small risk of serious complications.
-Yag laser to the floater or to the vitreous strands that are suspending the floater
-Posterior vitrectomy to eliminate vitreous and floaters entirely.

The Yag laser takes only a few minutes is painless. There is a small risk of causing a hole or tear in the retina. It usually works out well but sometimes the floater is not entirely gone because one can only chisel around it using the laser. The vitrectomy is a 100% cure and is also very quick and easy (less than half an hour). There is a small risk of RD or endophthalmitis but it is commonly considered to be well under 0.5%.

**Yeap** · 06-14-2010, 09:11 AM

hi, i do see Px with floaters quite regularly here. usually i will not refer for any further investigation unless i suspect for any retina or vitreous disorder. besides, i think is important to inform them about the risk of detachment of tear and when is the time they have to consult the ophthalmologist regarding the floaters issue. i have talk to some optometrist who work closely to ophthalmologist about floaters management. even the Dr will not take any action.

if any correction made, usually it only a matter of living standard. if any floaters that able to affect the VA i think it not just a few floaters but may due to retinal detachment or tear or any other thing that similar.

**Yeap** · 06-14-2010, 09:13 AM

hi Ilanh, how often did you proceed on Vitrectomy on floaters Px?

**DragonLensmanWV** · 06-14-2010, 11:02 AM

My OMD says that lasering the floaters basically only results in smaller floaters, or you can break up a chain floater to individual smaller floaters as the laser does not totally destruct the floater.
I have an increased incidence of floaters now since my cataract surgery (which was excellent for three months after) and I developed detached vitreous. Ugh!

**drk** · 06-14-2010, 12:57 PM

Vega, why don't you get Lasix?

**uncut** · 06-14-2010, 02:24 PM

Originally Posted by Vega

I always assumed everyone had floaters albeit small ones and not very obtrusive. I never realized there was a way to remove them although it seems that there are risks associated with removing them. For me, I have floaters but they don't bother me. If I focus on them, then they become distracting. I notice them more when I shift my eyes sideways but I think that may be due to my glasses and the fact that my glasses have a thin profile which means I have to turn my head up and down to see through my glasses.

WT....???What are you on, dude?

**RetroRat** · 06-15-2010, 03:38 AM

Two options: Both are rarely used due to small risk of serious complications.
-Yag laser to the floater or to the vitreous strands that are suspending the floater
-Posterior vitrectomy to eliminate vitreous and floaters entirely.

The Yag laser takes only a few minutes is painless. There is a small risk of causing a hole or tear in the retina. It usually works out well but sometimes the floater is not entirely gone because one can only chisel around it using the laser. The vitrectomy is a 100% cure and is also very quick and easy (less than half an hour). There is a small risk of RD or endophthalmitis but it is commonly considered to be well under 0.5%.

hi Ilanh, how often did you proceed on Vitrectomy on floaters Px?

I'd also like to know :)

Also, can you recommend any kind of management advice? Or is it more a case of just toughing it?

Thanks!

**ilanh** · 06-15-2010, 12:08 PM

Originally Posted by RetroRat

I'd also like to know :)

Also, can you recommend any kind of management advice? Or is it more a case of just toughing it?

Thanks!

I think that the risk of doing a Yag laser on a floater is very small. One of its firm proponents, Dr. Karickhoff, has published some studies in which he claims that it's close to zero. I read another study in which it was as high as 5%. I suspect that the risk of an RD following Yag laser is probably under 1%. I think that the numbers depend on the skill of the surgeon and the lens being used. Many ophthalmologists don't do this because of the perceived risk. I have done under 100 of these in my 18 year career. Dr. Karickhoff has probably done thousands. I've never had a complication

**RetroRat** · 06-15-2010, 07:55 PM

Originally Posted by ilanh

I think that the risk of doing a Yag laser on a floater is very small. One of its firm proponents, Dr. Karickhoff, has published some studies in which he claims that it's close to zero. I read another study in which it was as high as 5%. I suspect that the risk of an RD following Yag laser is probably under 1%. I think that the numbers depend on the skill of the surgeon and the lens being used. Many ophthalmologists don't do this because of the perceived risk. I have done under 100 of these in my 18 year career. Dr. Karickhoff has probably done thousands. I've never had a complication

A quick google of the name pointed me to http://www.eyefloaters.com/ , there are some pretty cool videos and some good info as well. I really appreciate you pointing me in the right direction, it's very helpful :)

**ilanh** · 06-16-2010, 10:36 AM

RetroRat,
I've only seen 2 cases in which a vitrectomy needed to be done for floaters. However, we do vitrectomies all the time for diabetic bleeds and other issues. The complication rate for vitrectomy is very low. Therefore, for someone who is plagued by a central floater (ie: posterior vitreous detachment) which has been in the visual axis for over 6 months, I think that a Yag laser would be a good first option. If the laser doesn't work and the patient is truly bothered by the floater, a vitrectomy would provide 100% relief at less than 1% risk. Don't forget that even if you are in the 1% that gets an RD, the vast majority of RD's don't lead to blindness. Therefore, the real risk of "worst case scenario" (blindness) is probably around 1/500.

**DragonLensmanWV** · 06-21-2010, 09:22 AM

This looks verrrry interesting. I think I will be contacting Dr. Karickhoff's office soon. My vision was so nice after IOL implantation, only to be compromised later with VD. Er, vitreous detachment, not venereal disease.:bbg::bbg:

**RetroRat** · 06-22-2010, 03:39 AM

Originally Posted by DragonLensmanWV

This looks verrrry interesting. I think I will be contacting Dr. Karickhoff's office soon. My vision was so nice after IOL implantation, only to be compromised later with VD. Er, vitreous detachment, not venereal disease.:bbg::bbg:

Our optom explained that she diagnosed a patient with VD once, before becoming very embarrassed and quickly explaining she meant vitreous detachment after a couple of, uh, confused glances to one another

I've now suggested looking into yag laser treatment for a patient who has been bothered by floaters, even gave her the link to the video, but mentioned that the vitrectomy would be a sure fire way of getting rid of those floaters once and for all. We'll see what happens then. Thanks for the advise :)

**DragonLensmanWV** · 08-17-2010, 10:04 AM

Well, I have my appointments set with Dr. Karickhoff. I'll be in Falls Church, VA, Aug 29-Sept 1, then head home. After talking to him it sounds like I'll be a perfect candidate. SV aspheric implants, PVD, and visible floaters.
Here's hoping I get my better vision back!

**npdr** · 08-17-2010, 10:22 AM

Aren't laser for vitreous floaters a cosmetic procedure?

**Judy Canty** · 08-17-2010, 10:46 AM

Dr. K is a GREAT doc. I'm sure you'll do well, Mark.

**DragonLensmanWV** · 08-17-2010, 10:57 AM

Originally Posted by npdr

Aren't laser for vitreous floaters a cosmetic procedure?

Code 67031.
It's covered, though for me it's out of network.

**finefocus** · 08-17-2010, 11:24 AM

I'm curious about the longterm effect of replacing the vitreous with something else, gas or liquid. What do you use? Is it as stable as the natural substance it replaces? What is the downside besides the original surgical risk?

**DragonLensmanWV** · 08-31-2010, 06:51 AM

Well, so far,so good. Dr. Karickhoff zapped my left eye yesterday. Turns out some of my floaters are too low and close to the retina to be treated,but I've got doozies of Weiss rings. So far he's gotten over 60% of the one in OS, will do a touch-up this morning and the major work on the OD. Touch up tomorrow, then head home.
I can already see a large improvement in my OD, looking at the computer screen reveals far less swirling anomalies OS.

**DragonLensmanWV** · 09-02-2010, 10:34 AM

After arriving home, I can say that overall, about 80% of my floater problem has been disrupted. Still have a few gas bubbles faintly visible when I move my eye rapidly, but they'll be gone by tomorrow.
ALL THOSE WITH BAD FLOATER PROBLEMS, SEE DR. KARICKHOFF!!
Nevermind that your local OMD will say that it won't work, that it will just break a big floater up into small ones, they're ignorant of the actual physics of the procedure. My Weiss rings are no longer visible, either to me or via scope, though there were some that were too far off-axis to treat. And he noticed my membrane is starting to wrinkle a bit and starting to opacify, so I'll need that done within a year or so.
But I can look at a white computer screen and actually see stuff now.

**ilanh** · 09-03-2010, 10:02 AM

I do this procedure also in my office, but have not always been impressed with the results. I utilize Dr. Karickhoff's lens and have a similar laser. I have to admit that Dr. K has turned this into quite a niche for himself but it's really not a difficult procedure and any ophthalmologist could do this with ease. I haven't had any complications yet and am intending to offer it to more patients over time. Thanks for reporting your experience.

**DragonLensmanWV** · 09-03-2010, 10:13 AM

Originally Posted by ilanh

I do this procedure also in my office, but have not always been impressed with the results. I utilize Dr. Karickhoff's lens and have a similar laser. I have to admit that Dr. K has turned this into quite a niche for himself but it's really not a difficult procedure and any ophthalmologist could do this with ease. I haven't had any complications yet and am intending to offer it to more patients over time. Thanks for reporting your experience.

I agree. All the Drs here COULD do the procedure, they just think it's ineffective, only breaking up floaters not eliminating them. I did mention to him that you also did this procedure, he was unaware of very many others who do it.
Do I think it's perfect? No. Do I think it's helpful? Yes, at least to me. It was getting hard to see to assemble glasses or do drill work and forget about driving at night, but now everything is easier.
Now a couple questions.
I still get some "squishiness" when I move my eyes rapidly due to the different viscosities of the sections in my eyes. Will they ever homogenize? If so, will it be more like jelly or more like saline, as far as viscosity?

**ilanh** · 09-04-2010, 10:08 AM

The eye is a closed system, therefore, it usually takes a very long time for changes to occur. I would expect that what you are seeing now is a myriad of tiny fragments that will eventually dissipate over time or move out of the visual axis. This would have been unlikely with the large floater that you had before but it much more likely in the current scenario. Furthermore, the "squishiness" that you are seeing is probably due to the fibers, cellular debris and suspended particles rather than to different viscosities. I think much of this will improve.