Eye Floaters (cont.)
IN THIS ARTICLE
Surgery is almost always not recommended for benign eye floaters. Some patients are annoyed by the floaters and are best advised to avoid those circumstances in which the floaters are most bothersome. The classic advice is that the treatment is worse than the disease. Pars plana vitrectomy (PPV) is a remarkable modern technique that can remove most of the vitreous contents, including virtually all the noticeable central floaters. Due to the significant effort and cost entailed by PPV, its use for minor conditions is not warranted or recommended. There is approximately a one in 1,000 risk of serious complications following PPV, including infection. This is admirably low rate nevertheless does not justify major surgery for a benign nuisance condition.
Some patients by nature of their profession are significantly hindered by larger or very central floaters. After careful consultation with the retino-vitreal surgeon, a PPV may be recommended in very specific and unusual cases. These professions might include pilots, truck drivers, athletes, or jobs where continuous outdoor work in bright sunlight renders the floaters severely symptomatic.
Because the most common side effect of a PPV is cataract formation, the patient must be fully aware of a decision to move forward with elective PPV surgery for floaters. PPV for serious pathologic conditions such as PDR or vitreous hemorrhage are clearly warranted despite the risks.
Some eye-care providers recommend laser therapy to dissolve or remove vitreous floaters. Unfortunately, this is not a standard therapy and efficacy is not generally accepted by most eye-care practitioners. There are no prospective randomized clinical trials to demonstrate the safety of the efficacy of laser therapy for benign vitreous floaters. Until such trials are accomplished, or a laser specifically designed to efficiently and safely dissolve floaters is developed, laser treatment for floaters is not considered by any means a standard or acceptable practice.
Hyaluronic acid is a very common protein in many tissues throughout the body. It is also present in the vitreous cavity. An enzyme capable of dissolving hyaluronic acid called hyaluronidase is available for vitreous injection. It has been investigated for the treatment of vitreous disorders and may be appropriate for some pathologic conditions. It is not recommended for routine benign vitreous floaters. Consult your eye-care professional if you have questions about treatments for your floaters.
John D. Sheppard, MD, MMSc
David M. Salib, MD
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