What are vitreous floaters?
People with vitreous floaters will see 1 or more spots or flecks floating before their eyes. The spot follows your eye movement. Typically it will keep moving a little bit after movement. The amount to which you will be bothered by it depends on the location of the floater. There are many kinds of floaters that you can get used to, but some will remain extremely bothersome.
Getting used to it is only part of the deal. Indeed, most people do get used to floaters, for example when the floater moves to a part of the eye where it is not bothersome. The brain may shut it off partly, but this will not work for a large spot right in the middle of your vision.
It is difficult to measure the gravity of the complaints. Floaters are hard to measure or photograph. A practical method is applying an objective complaint scale from 1-10. A score of 1 means no trouble at all; 10 an extreme amount of trouble. Complaints can be measured by this Floater Severity Score (FSS). Generally speaking, people will only start seeking help with a score from 5-6 upwards.
Floater simulation app
Floaters have all kinds of appearances. For many people it is hard to imagine what they look like. There is a smartphone app simulating the world vision of a person with floaters. The app Floaters Simulation van WAYS AS can be downloaded here.
Why are some floaters bothersome while others are not?
Compare your eye with a cinema. There is a projector (light entering the eye through the pupil) and a projection screen (retina). The projector’s light beam is relatively small compared to the room (vitreous humor). When somebody is walking across the room, he might walk in between you and the projection screen (only a small part of the audience will be bothered by this). This person might also walk right through the projection beam, which would be very bothersome for everybody there. If he stops right before you, it will be even more annoying. Sitting down, he will no longer be annoying. When he moves out of sight altogether, he will be registered but this will usually not be annoying.
The projection screen of the eye is built differently. You focus with the yellow spot (fovea), the central part of the retina which is about 1 square millimeter in size. The rest of the retina (the periphery) does not give a sharp image but reflects the environment. (Look at an object: when you zoom in on it, you can still see your surroundings but they will not be in focus.)
In fact, the image is being projected onto the fovea which is sized 1 square millimeter. Imagine that the floater is the person walking through the cinema hall. Depending on its location, the floater will be less or more bothersome. Right in front of your central fixation it will be extremely annoying.
In addition to location, factors such as size and density are important as well.
To conclude with, there is a personal factor; one person may be able to get used to floaters, whereas another may not. Those who are extremely bothered by it are qualified for treatment.
What can be done?
Wait for spontaneous improvement and learn to live with it. This is the classic advice from ophthalmologists. Most ophthalmologists will discourage surgery because of the high risks. Furthermore, most ophthalmologists think laser treatment is not an option (they do not know it exists). Waiting a few months will indeed suffice in the majority of cases. You seem to get used to it, the brain “switches it off” or the floater has changed location.
The group of people whose floaters remain extremely troublesome, even after a number of months, may consider treatment.
Some people respond well to regular advice, treatment with eye drops or special lenses. We can advise you on this during a consultation. Unfortunately, this is only a suitable solution for some people.
If floaters continue to be bothersome, treatment may be considered. The least aggressive form of treatment is laser treatment with a YAG laser, also known as: Floater Laser Treatment (FLT), YAG Floaterectomy, YAG vitreolysis or Laser Floater Removal (LFR). In most cases, floater laser treatment gives sufficient relief
The reported success rate varies from 0% to 95%. Our 2013 series showed a success rate of around 50% to 95% depending on the type of floater. Certain kinds of floaters are easier to treat than others with the floater laser. Considering the rare occurrence of complications (<0.1%), the success rate is extremely high. Complications that occur will almost always be without consequences. Any treatment, however, will never be completely risk-free.
The most effective floater treatment is surgery (vitrectomy) during which the entire vitreous body is removed. A vitrectomy, however, has a major disadvantage: it is invasive and risky. Numerous complications may occur: The most common are cataract (50-100%) and retinal detachment (around 1-2%).
In older studies, the complication rate was 2.5 to almost 10%. By using more modern surgical techniques, the complication rate has dropped to around 1%. More extensive studies show that most people are very satisfied with the result, but there are also people who have become nearly blind due to vitrectomy complications.
Advantages Floater Laser over Vitrectomy:
Disadvantages floater laser:
Damage to lens or retina; risk of this is extremely low and depends on floater location. High eye pressure.
When to perform treatment?
After a presence of at least 3 months with no improvement.
Misconceptions by most ophthalmologists:
“As many people are not bothered by it, everyone should be able to learn to live with it. Most people can get used to it, so can you.”
“Patients with floaters are soreheads, just deal with it, next patient please…”
When is a vitrectomy more efficient?
Large floaters close to the retina, thick and extremely widespread floaters can usually not be removed by laser. In this case, a vitrectomy is the best solution. Still, it may be possible to reduce the symptoms.
There are exceptions, however. Sometimes, people with clear floaters keep having complaints after an apparently successful laser treatment. Often they have a miniscule floater very close to the retina which was not noticed initially and is often only visible through a special lens. Or somehow a small fraction of the original floaters is still bothersome.