Tag Archives: fiber

Treatment of Floaters

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What are floaters?

Floaters are small specks, fibers, or bug-shaped objects that may appear to move in front of your eye.  At times they may appear like a veil or cloud moving in the vision.  Floaters differ from blind spots in the vision in that floaters have some degree of independent movement.  Blind spots are missing areas in the vision that move precisely with eye movement.  Although floaters do follow the movement of the eye, there is usually some degree of continued movement after the eye stops moving.  They are frequently seen when looking at a blank wall or blue sky. Floaters are actually tiny clumps of fiber or cellular debris within the jelly-like fluid (vitreous) that fills the inside of the eye.

What does this symptom mean?

Although many people have occasional floaters, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous.  Sometimes, the retina tears and may cause loss of vision from detachment of the retina. At other times, floaters may persist and chronically interfere with vision.

What causes floaters?

Floaters are usually due to degeneration of the vitreous gel in the eye from aging.  Over time, the vitreous shrinks, condenses, and pulls away from the retina.  The condensation causes fibers and cellular clumps to pull away from the retina and float freely inside the eye. The shadow of these opacities is what we see as floaters. Other causes of floaters include trauma, bleeding, retinal breaks and detachment, eye surgery, inflammation, and cancer (very rarely). 

vitreous floaters and haze
Vitreous floaters and haze interfering with vision after repair of retinal detachment. The vitreous opacities appear as fibers and haze in this photo. They interfere with a clear view of the retina when looking into the eye and they interfere with the vision when looking out through the haze.

What can be done about floaters?

It is important to have a thorough dilated eye examination to determine the cause of floaters.  Treatment is dictated by the cause of the floaters.  If there is no serious underlying cause (retinal break, retinal detachment, etc.), no treatment may be needed. New floaters often fade without treatment.  It can be helpful to avoid tracking or following floaters to allow your brain to ignore them. Floaters are less obvious in a darker environment, so wearing sunglasses outdoors may help minimize symptoms of floaters. Stress and depression appear to aggravate the symptoms of floaters and may be treated separately. 

YAG Laser Treatment:  A special laser may be useful in some cases of persistent floaters. It is an office treatment in which the laser in used to break the floating fibers and clumps into smaller fragments in the vitreous of the eye.  Although it may help, YAG laser does not eliminate floaters.  Repeat treatments are frequently necessary. Complications may include bleeding, increased floaters, retinal breaks and retinal detachment, which may require surgery to prevent blindness.  There is limited evidence on the safety and effectiveness of YAG laser for floaters and it may not be covered by insurance. YAG laser may result in loss of vision/loss of the eye.

Vitrectomy Surgery: Vitrectomy is a surgery performed in the operating room. It is commonly used to treat serious problems of the vitreous and retina.  It is very effective at reducing or eliminating floaters.  However, complications include bleeding, infection, retinal break and retinal detachment, which may require surgery to prevent blindness.  Serious complications occur in 1-2% of eyes reported in most studies, although some reports suggest the risk of complications may be as high as 10%.  The most common problem with vitrectomy is cataract formation.  After vitrectomy, cataract may develop over months to years and often requires cataract surgery.  Glaucoma has been reported years after vitrectomy, but the exact incidence is not known.  Vitrectomy surgery may result in loss of vision/loss of the eye.

For most patients the best course of action is observation of floaters without treatment at first.  If symptoms persist and significantly interfere with vision despite 6-12 months of observation, treatment may be helpful.  Most patients report good results with vitrectomy, but the possibility of complications must be carefully considered and accepted prior to embarking on surgery.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright 2019-2022 Designs Unlimited of Florida. All Rights Reserved.

Vitreous Hemorrhage

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Eye
Vitreous is the gel that fills the eye (click on image to enlarge)

What is vitreous hemorrhage?

Vitreous hemorrhage means blood has leaked into the vitreous gel of the eye. The vitreous is a clear gel that fills the center of the eye and helps to hold the retina in place against the eye-wall like wallpaper in a room. The retina is a thin layer of delicate nerve tissue, which acts like film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. The retina has many fine blood vessels, which sometimes leak blood into the vitreous and cause a loss of vision.

What symptoms does vitreous hemorrhage cause?

Vitreous hemorrhage usually causes many new floaters in the vision. Floaters may appear as round specks, hair-like or bug-like debris, or clouds moving in your vision as though they were in front of your eye. They are more noticeable when looking at a blank surface and may interfere with the good vision in the fellow eye.

Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes. Flashes are caused by vitreous gel pulling on the retina with eye movement.

Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous. In some people with these symptoms, the retina may tear and detach resulting in loss of vision.

What causes vitreous hemorrhage?

There are many causes of vitreous hemorrhage. Diabetes can cause vitreous hemorrhage by weakening the blood vessels in the retina and by causing the vitreous gel to shrink and pull on the retinal vessels. Hardening of the arteries in the eye can cause vitreous hemorrhage by blocking a retinal vein where the arteries cross over the veins in the retina. Ageing changes of the vitreous gel can cause it to pull on the retina and tear it. The tearing of the retina may result in bleeding into the vitreous. Less common causes of vitreous hemorrhage include birthmarks inside the eye, inflammation, trauma, tumor, surgery, blood disorders, and macular degeneration.

How is vitreous hemorrhage treated?

The most important step is to have a thorough eye examination with ultrasonography. The ultrasound machine uses sound waves to safely and effectively “look through” the blood in the vitreous to see if the retina is attached. If a retinal detachment is found, surgery (scleral buckle, pneumatic retinopexy, and/or vitrectomy) is required in an attempt to repair it. If no retinal detachment is found on ultrasound exam, your doctor may allow the vitreous hemorrhage to clear on its own with time. The ultrasound exam may be repeated periodically to assure the retina remains attached. In many cases the cause of the vitreous hemorrhage cannot be determined until the hemorrhage has cleared. If the hemorrhage does not clear on its own, vitrectomy surgery as a one-day surgery in the hospital operating room may be considered. The amount of visual return depends on several factors including the health of the underlying retina.

What should I be on the lookout for?

After examination or treatment for a vitreous hemorrhage, you should notify your doctor if you have a burst of new floaters, a loss of side vision, or pain. Sometimes, retinal tears or a retinal detachment occur at a later date after the examination.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright 2016-2022 Designs Unlimited of Florida. All Rights Reserved.

Posterior Vitreous Detachment (PVD)

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What is posterior vitreous detachment?

A posterior vitreous detachment (PVD) occurs when the vitreous gel inside the eye condenses and pulls away from the retina.  The vitreous is a thick, clear gel with invisible fibers that fills the inside of the eye.  From birth the vitreous gel is attached to the retina and helps to support it.  The retina is a thin layer of tissue that lines the inside of the eye like film in a camera.  Just like film, the retina serves to “take the picture” of objects you look at.  The primary cause of PVD is a degeneration of the vitreous, in which the tiny fibers clump together causing the vitreous to pull away from the retina.

vitreous gel
Clear vitreous gel fills the eye (click on image to enlarge)

 

PVD
A. Vitreous gel fills the eye at birth. B. Vitreous fibers begin to pull away from retina. C. Further separation of vitreous fibers that remain attached to the optic disc. D. Complete separation of vitreous fibers from the posterior retina.

 

What symptoms does posterior vitreous detachment cause?

The most common symptoms of PVD are floaters and flashes.   Floaters are specks, fibers, or veils that appear to move in front of your eye.  Floaters are actually tiny clumps of gel or cellular debris within the vitreous.  PVD sometimes causes bleeding inside the eye.  Blood in the vitreous appears as floaters described as hair-like strands or tiny round dots.  Over time floaters may appear like a cloud or veil that moves across the vision.  Flashes are brief streaks of light that are usually seen off to the side, especially at night, when you turn your head or eyes.  Flashes are caused by vitreous gel tugging on the retina with eye movement.  Although the sudden onset of new floaters is reported by almost everyone with PVD, flashes are only seen by half of all people with PVD.

Why is it important to be seen for these symptoms?

Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters, with or without flashes, is an important symptom to report to your eye doctor.  In about 10-20% of people with these symptoms, the vitreous pulls on and tears the retina.  A retinal tear by itself causes no pain or visual problems.  However, if a retinal tear is not detected and treated, it may go on to cause blindness from retinal detachment.  A retinal detachment is when the retina stops functioning because it is pulled away from the inner eye wall and floats freely inside the eye.  A retinal detachment causes a progressive loss of vision appearing like a curtain or shadow that slowly moves across the vision from the side.

What causes posterior vitreous detachment?

PVD is usually due to degeneration of the vitreous gel from aging.  Over time, the thick vitreous gel tends to become liquefied and the microscopic fibers in the gel tend to condense together becoming visible and causing traction on the retina.  The following conditions tend to accelerate the degeneration and cause PVD to occur earlier in life:  trauma, inflammation, diabetes, and myopia (near-sightedness).

How is posterior vitreous detachment managed?

The most important step is to have a thorough, dilated eye examination.  The eye doctor will check for the presence of a tear in the retina.  If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment.  If a retinal detachment is found, more extensive surgery is required in an attempt to repair it.  If there is no retinal tear or retinal detachment found at the initial exam, another exam several weeks later may be performed to be certain that a delayed tear has not occurred.  Generally, there are no restrictions to your activities.

What happens to the floaters and flashes?

There is no treatment to make the floaters and flashes go away even though they may be quite annoying.  The flashes gradually subside and disappear over days to weeks without treatment.  However, the floaters rarely completely disappear.  They will gradually fade and become less obvious over weeks to many months.  For the first few days or weeks, many people find that the floaters are less annoying if they wear sunglasses when out of doors and turn the lights down when indoors.

What to be on the lookout for?

After examination or treatment, any new floaters or loss of side vision should be reported to the doctor without delay.  Sometimes, new tears or a retinal detachment can occur after the eye examination.  In fact, 7% of eyes with PVD will develop a retinal break sometime after the initial eye exam; about half occur more than one year after PVD.  This is more likely to occur in near-sighted eyes and eyes with lattice degeneration.

PVD may stimulate the formation of macular pucker, which may cause symptoms of distortion of vision. Treatment of a retinal tear does not prevent macular pucker.

When one eye develops a PVD, the fellow eye will usually do so at a future date.  Whether the floaters and flashes are more or less severe in the second eye, they should be promptly reported to the eye doctor.  If the first eye develops a torn retina, the second eye runs about a 20% chance of developing a tear as well.  But even if the first eye does not have a torn retina, the second eye may still develop a tear when a PVD occurs.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright 2014-2023 Designs Unlimited of Florida. All Rights Reserved.