Eye Floaters (cont.)
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Eye Floaters Treatment
Benign eye floaters caused by vitreous syneresis and posterior vitreous separation or detachment (PVD) do not require specific treatment. Additional observation may be required. Patients are generally cautioned to watch for more serious symptoms suggestive of retinal disease, including
Pathologic floaters may necessitate a wide variety of therapeutic interventions. The treatment of a retinal hole is accomplished most readily by a laser surrounding the hole and thus sealing the retina from ingress of fluid that could cause a detachment. The repair of a retinal hole will not in itself decrease the symptom of floaters. Sometimes a retinal hole may require more aggressive intervention, including the injection of gas into the vitreous cavity (pneumatic retinopexy), freezing therapy (cryotherapy), or even a vitrectomy.
A retinal detachment is far more serious than a retinal hole, especially when a large portion of the retina is detached or when the detachment involves the macula or center of vision. The earlier the intervention, the better the results generally speaking. This timing judgment can only be made by a qualified ophthalmologist with expertise in retinal and vitreous disorders. Retinal detachments can occasionally be accomplished in an office setting utilizing the pneumatic retinopexy technique. More serious detachments require a trip to the operating room, the injection of anesthetic agents around the eye, and extensive repairs using sclera buckles, pars plana vitrectomy, cryotherapy, or intraocular endolaser. Operative detachment techniques may also require the infusion of specialized gases or oil into the vitreous to accomplish a reattachment.
Diabetic retinopathy presents a growing challenge to eye-care specialists due to the burgeoning population of patients with both type I childhood onset and type II adult-onset diabetes mellitus. If diabetic retinopathy is allowed to progress to the proliferative stage (PDR) wherein abnormal friable new vessels appear, the risk of blindness is markedly increased. The treatment of PDR involves a wide variety of treatment modalities customized by the retinal specialist to the individual patient's needs. Treatments may include laser therapy with a pan-retinal photocoagulation (PRP) to deter the impetus to new blood vessel formation. Newer injection techniques with highly advanced biotechnology medications have also been used successfully for PDR. Recalcitrant or progressive PDR often requires surgical intervention utilizing modern vitrectomy techniques. When PDR advances to a scarring stage, also called fibrotic or cicatricial, the surgery becomes far more difficult and the prognosis deteriorates.
Thus, every stage of diabetic retinopathy requires close observation and intervention. Every diabetic patient should have at least an annual dilated eye examination by their eye-care professional. If this simple recommendation was actually fully executed, the morbidity, costs, and blindness due to diabetic retinopathy would be markedly reduced. Central to the avoidance and control of diabetic retinopathy is the aggressive control of blood sugar, weight, blood pressure, and other parameters essential to good health. Additional measures also should include immediate cessation of all tobacco use, regular exercise, and dietary consultation with reduction of glycemic load.
John D. Sheppard, MD, MMSc
David M. Salib, MD
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