New Terminology and Methodology for the Assessment of the Vitreous, Its Floaters and Opacities, and Their Effect on Vision: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities (SK VFO Test)

Abstract

Objective: To introduce VFO and SK VFO Test: new, more representative terminology for symptoms of vitreous floaters/opacities (VFO) and new standardized kinetic (SK) anatomical-functional assessment. Materials and Methods: Eight eyes underwent before-after limited vitrectomy (LV): best-corrected visual acuity, low-luminance visual acuity, Minnesota Low Vision Reading Chart near visual acuity in logMAR, contrast sensitivity function (CV1000E), and straylight measurements (SM) (HDA/LDA/C-Quant). SK infrared confocal scanning laser ophthalmoscopy (SK IRcSLO) and swept-source widefield optical coherence tomography (SS-WF-OCT) identified VFO and posterior vitreous detachment (PVD). SK IRcSLO was performed with gaze directed towards the extreme superior, inferior, and lateral directions. Results: Anatomical-functional results after LV improved in 7 eyes (87.5%): objective scatter index (27.34%), disturbance index (47.97%) and C-Quant Log units (2.26%). Pre-LV SK IRcSLO and SS-WFOCT imaging identified dynamic well-defined VFO and PVD status (100%). A residual asymptomatic anterior cortical vitreous-induced shadowing ripple effect was detected post-LV. Conclusions: This is the first objective-standardized test accounting for VFO kinesis and intermittent effect. There is potential for personalizing treatment and establishing best candidates for laser or surgery. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:306–315.]

Visualization and Identification of Silicone Oil Emulsification Using Dynamic Infrared Confocal Scanning Laser Ophthalmoscopy

“…The use of real-time imaging techniques such as IRcSLO has become commonplace not only in retina but also in vitreous examination [ 3 – 7 ]. Recently, the near-infrared images produced by IRcSLO have been used to visualize vitreous floaters and opacities, evident as shadows projected onto the retinal surface [ 3 – 7 ]. However, as far as we know, the presence of SO emulsification in real-time IRcSLO has not been described yet.…”

“…Despite this necessity, traditional imaging techniques often fall short when trying to visualize SO, similar to the hurdles encountered while imaging the vitreous. This problem can be solved using scanning laser ophthalmoscopy (SLO) imaging, which has been recently used to image the vitreous floaters and opacities [ 3 – 7 ].…”

The role of ultra-widefield imaging with navigated central and peripheral cross-sectional and three-dimensional swept source optical coherence tomography in ophthalmology: Clinical applications

“…The assessment of the vitreous and VRI with respect to the absence or presence of VFO bears an increasing importance among eye care specialists. [ 36 37 ] There is no doubt about the significance of the vitreous status and its relationship with both central and peripheral VRI abnormalities such as retinal holes, retinal tears or RD. [ 36 ]…”

Floater Stories: Assessing the Potential Benefits of Vitrectomy

“…Because one patient's daily visual activities are more challenging, their symptoms may be substantial from vitreous opacities measuring similarly to those that another patient would tolerate relatively easily, making the objective measurement of floaters and their symptoms superfluous. Yet parallel to our use of floater stories to assess and document DVS, various vision researchers still obsessively pursue measurement of vitreous opacities, 10 while others attempt to measure floater-related symptoms using "quality of life" questionnaires. 6 Both efforts reflect the discomfort of complete reliance on the history and physical examination that remain, however, the keys to individual treatment decisions, better than any measurements derived from them.…”