EYE SURGERY CENTER AT THE BILTMORE

 

Vitreolysis for the Treatment of Floaters

About Floaters:

If you suffer from vitreous strands and opacities (commonly referred to as “eye floaters”), then you are already familiar with the frustrating visual disturbance caused by these cobweb and cloud-like shadows.

The vitreous humor is the clear, jelly-like substance in the main chamber of the eye, located between the lens and the retina.

At a young age, the vitreous is perfectly transparent. Over time as the eye ages, this vitreous humor can degenerate, loosing its form and liquefying. Without the stable vitreous humor, the collagen fibers collapse and bind together to form clumps and knots. It is these fibers, which cast shadows on the retina and appear as spots, strings, or cobwebs that are commonly referred to as “floaters”.

In many cases as the eye ages further, the vitreous humor can peel away from the retina entirely. This is known as Posterior Vitreous Detachment (PVD). PVD is often associated with a sudden increase in the number of floaters

Treatment of Floaters:

Also known as floater laser treatment, vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. It is performed in your ophthalmologist’s office and typically takes 20-60 minutes per treatment session. On average, patients will require two treatment sessions to achieve a satisfactory result.

The goal of vitreolysis is to achieve a “functional improvement”. That is, to allow you to return to “normal” day-to-day activities without the hindrance of floaters.

How does vitreolysis work?

Vitreolysis involves the application of nanosecond pulses of low-energy laser light to evaporate the vitreous opacities and to sever the vitreous strands. During this process, the laser energy evaporates the collagen and hyaluronin molecules to form a gas. The end result is that the floater is removed and/or reduced to a size that no longer impedes vision.

What happens during the procedure?

Vitreolysis is performed as an outpatient procedure; you do not have to stay overnight in a hospital. Immediately prior to treatment, you will have eye drops administered to prepare the eye and to provide mild anesthesia. A contact lens will then be placed on your eye, with the laser light delivered through a specially designed microscope.

During treatment, you will likely observe small, dark specks/shadows – signaling that the floaters are being evaporated into small gas bubbles. These gas bubbles quickly dissolve and reabsorb into the vitreous humor.

Once the treatment is complete, we may treat your eye with anti-inflammatory drops. It is important to note that most patients will need to undergo two treatment sessions, sometimes three, in order to achieve a satisfactory result. As there is no inflammation post-treatment, these sessions can be performed on consecutive days.

What to expect after treatment?

You may observe small, dark specks in your lower field of vision immediately following treatment, but these small gas bubbles will quickly dissolve and will not impede vision.

It is also important to note that some patients may experience mild discomfort, redness or temporarily blurred vision directly following treatment.

Complications and side effects:

Reported side effects and complications associated with vitreolysis are rare. Side effects may include cataract and intraocular pressure (IOP) spike.

Who will benefit from vitreolysis?

While some floaters can be effectively treated, several floater types are difficult to treat and/or less likely to regress than others. To that end, it is necessary to first undergo an ophthalmic examination in order to determine your eligibility for vitreolysis treatment.

Generally-speaking, if you suffer from persistent moving shadows in your vision due to vitreal condensations, fibers, strands, and/or clouds, you are a good candidate for vitreolysis. A number of factors, such as age, onset of symptoms and floater characteristics, will also determine whether vitreolysis is your best treatment option.

Age. In most cases, younger patients (<45) suffer from microscopic floaters located close to the retina (1-2 mm) and are not considered to be good candidates for vitreolysis treatment.

Onset of Symptoms: If your floater symptoms came on very quickly then they may be associated with a posterior vitreous detachment (PVD), the characteristics of which can be effectively treated with vitreolysis.

Floater Characteristics. Large floaters with a soft border, situated away from the retina, are ideally suited to treatment with vitreolysis.

In cases where floaters negatively affect a patient’s quality of vision, laser therapy (vitreolysis) and surgical treatment options are available.

Vitreolysis:

Vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. During treatment, nanosecond pulses of laser light are used to evaporate the collagen and hyaluronin molecules within the floater, converting them to a gas. The end result is that the floater is removed and/or reduced in size, significantly improving quality of vision.

Surgical Treatment:

The surgical treatment of floaters involves removal of the vitreous humor and carries a significant risk of bleeding and infection. It can also result in cataract formation. Depending on your diagnosis, there are several forms of surgery available:

  • Pars Plana Vitrectomy
    Pars Plana vitrectomy (PPV) is typically performed to treat diseases of the retina such as detachment or proliferative diabetic retinopathy. It involves the removal of the entire vitreous humor, which is then replaced with a balanced, electrolyte saltwater solution. On average, PPV takes 1-2 hours to perform.
  • Floater-Only Vitrectomy
    In the case of Floater-Only Vitrectomy (FOV), only the floater-affected portion of the vitreous humor is removed. While FOV results in fewer complications than total vitrectomy (PPV), remnants of floaters may remain post-surgery, resulting in significant patient discomfort and frustration.

One of our ophthalmologist will be able to discuss these options with you in more detail.