To Treat or Not to Treat: Management Options for Symptomatic Vitreous Floaters

Abstract

Vitreous floaters are a common cause for presentation to ophthalmologists, and may significantly affect visual function. In the absence of some more serious underlying pathology such as uveitis, many patients may not experience significant persistent visual impairment from floaters. For some patients, the symptomatic effects of floaters may persist. For these patients, treatment options are available, of which the most commonly reported is vitrectomy. Other treatment modalities have also become more common, notably YAG vitreolysis. Selection of appropriate patients for surgery is often difficult, in part due to the relative lack of objective outcomes with which to measure both visual impairment and improvement post-procedure. Although well-tolerated, vitrectomy does carry with it risks, including iatrogenic retinal breaks, retinal detachment, and in phakic patients, subsequent cataract formation. Techniques such as small gauge vitrectomy, intraoperative examination and treatment of breaks or other worrying lesions, and careful consideration of the need for posterior vitreous detachment induction may help limit the incidence of these adverse events. For other treatment options such as YAG vitreolysis, research and clinical experience remain more limited, and as such the long-term efficacy and risks of these therapies are still unclear. Here, we review the evidence surrounding the role of vitrectomy and YAG vitreolysis in the treatment of vitreous floaters and potential means to minimize therapeutic complications.

Pars Plana Vitrectomy for Symptomatic Vitreous Floaters: Another Look

“…Currently, there is no clear consensus among ophthalmologists when it is appropriate to treat symptomatic vitreous floaters with PPV [17,18]. Currently available data suggests that PPV provides better visual outcomes for patients with floaters compared with YAG vitreolysis, although there has been limited re-0.24).…”

“…Due to the prevalence of floaters, and their frequent occurrence as a result of natural aging, many view floaters as not clinically significant and therefore not necessary to treat [3,5,7,13]. ports comparing these two modalities [17,19]. As more reports of outcomes following vitrectomy for vitreous floaters become available, the field can more quickly arrive at a consensus that is supported by the most up to date evidence.…”

The Efficacy and Safety of YAG Laser Vitreolysis for Symptomatic Vitreous Floaters of Complete PVD or Non-PVD

“…Whether YAG laser vitreolysis is ready for primary symptomatic floaters is still under debate [ 4 , 13 , 24 , 32 , 40 ]. Nguyen et al [ 32 ] reported that YAG-treated eyes had 23% less vitreous echodensity and found no changes in BCVA, CSF and NEI-VFQ-39 questionnaire scores compared with untreated control eyes with vitreous floaters.…”

“…Primary vitreous floaters are due to localized build-ups caused by the molecular derangement of vitreous collagen fibrils during the degenerative process [ 2 ]. These artifacts within the eye can lead to visual symptoms such as cobwebs, spots, shadows and other assorted shapes that appear to drift across the visual field with the movement of the eyes [ 3 , 4 ].…”

Vision degrading myodesopsia assessed with Optos ultra-widefield scanning laser ophthalmoscope

“…VDM affects an increasing number of adults due to the global prevalence of myopia and the aging of the population [1]. As the eyes move, VDM may manifest as spots, cobwebs, shadows, and other diverse forms [2,3]. While oaters are typically only a minor annoyance, some eyes develop numerous symptomatic vitreous opacities that signi cantly impede reading, driving, and other daily visual activities.…”