Floaters are commonplace, especially if you’re a little older. Floaters are those things you see floating around seemingly in front of your eyes, as if you could reach out and brush them away. They look like strings, cobwebs, black or grey specks, or blobs. They drift about when you move your eyes and when you try to focus on them, they seem to drift away.
If floaters become so prevalent that they begin to impact your life, it may be time to treat them. At Cape Fear Cataract & Cornea, we can perform a procedure known as vitreolysis, where a laser is used to evaporate and break up the floaters, making them less visible to the retina.
What causes floaters?
Most eye floaters are due to changes in the vitreous of our eyes as we age. The vitreous is the jelly-like substance that fills our eyes. As we age, the vitreous becomes more liquid. This allows microscopic collagen fibers in the vitreous to clump together. It seems as if they are in front of your eye, but actually these clumps and strings of collagen are casting shadows on the retina at the back of the eye. These shadows are the floaters you see.
Who has floaters?
Everyone has at least a few floaters in their vision. But they tend to increase as we age. Studies have shown that about 25 percent of people have changes in their vitreous by age 60, creating more floaters. This percentage rises to over two thirds by age 80. For about one third of people with floaters, they interfere with their daily activities.
When are floaters an issue to address?
Floaters are just a part of being human, particularly an older human. However, a sudden increase in floaters is a reason to see us at Cape Fear immediately, especially if the increased floaters are accompanied by light flashes or if you lose your peripheral vision. This can be a sign of a torn retina and it needs immediate attention to avoid vision loss.
In most cases, however, treating floaters is optional. If they are so prevalent in your field of vision that they are impeding on your life, then it’s time to do something about them.
What our patients have to say
What is vitreolysis?
Formerly, there was only one way to address floaters. This involved the removal of the vitreous, a procedure known as a vitrectomy. Recent technological advances have added an option — vitreolysis, laser removal of floaters.
This laser treatment is a non-invasive option that is highly successful on some types of floaters.
It uses laser energy to break up and evaporate the clumps of collagen. This reduces their visual impact. The laser used by Dr. Brian J. Groat is the Ellex Ultra Q Reflex YAG laser, and it has been designed specifically for vaporizing floaters.
How is vitreolysis performed?
These are outpatient procedures performed in our Wilmington offices. The first step is to administer eye drops to prepare the eye and to provide mild anesthesia. A special lens is then placed on your eye.
Dr. Groat delivers the laser light through a specially designed microscope. During the treatment, he aims the laser at the floaters in the vitreous delivering microsecond bursts. The energy breaks up the clump and bands of collagen, evaporating much of the collagen. When this happens you will notice small, dark specks/shadows. These are gas bubbles, and they are a sign that the floaters are being evaporated. These gas bubbles quickly dissolve and resorb into the vitreous.
The procedure takes only 20-60 minutes.
What floaters can be treated with vitreolysis? Would I be a candidate?
Not all floaters can be effectively treated with lasers. But if you suffer from persistent moving fibers, strands, and/or clouds, you are likely to benefit from vitreolysis at Cape Fear Cataract & Cornea.
Generally, people younger than age 45 are not good candidates for laser treatments. This is because their floaters are located too close to the retina.
If your floaters have changed quickly, you may be able to benefit if you have posterior vitreous detachment. Laser treatment is effective on these floaters.
The best floaters for laser treatment have soft borders and are situated away from the retina.
Will the Laser Just Create Smaller Clumps and More Floaters?
It's not uncommon to question how laser treatment for floaters really works, and if it really works. So we'll discuss some of the technical details of vitreolysis with you. The YAG laser emits a cone-shaped beam of light that passes through a special microscope. The laser energy concentrates at the tip of the cone, which is directed to the surface of the floater. Energy comes in ultra-short "shots" that last only a fraction of a second. Upon contact, the laser beam creates a plasma state. This fourth state of matter pulls electrons out of their normal location and creates a sort of "bubble." The gas bubble then gets absorbed into the bloodstream. Because physical matter is converted to gas, there should be few if any smaller clumps left behind.
How Effective is Vitreolysis for Floaters?
There are too many variables that affect eye health to list in one discussion, but we can say that some of those variables may influence the overall success of the vitreolysis procedure. Studies indicate that the treatment may achieve 60 to 90 percent improvement with one session. Some people may require one or more additional treatments to achieve optimal results. Very few patients fail to see improvement after vitreolysis. Those who do are usually under the age of 40 and have very thin floater material.
Will I Need a New Eyeglass Prescription after Vitreolysis?
You should not need to change your prescription for eyeglasses or contact lenses after having laser floater treatment. This procedure does not affect visual acuity because the laser is not targeting anything other than the material that is causing floaters. It does not reshape any part of the eye, as is common with procedures like LASIK, which are intended for vision correction.
Can Floaters Go Away on Their Own?
This can be a difficult question to answer. Most of the time, floaters occur due to age-related changes in the eyes. The vitreous gel that fills the center of the eyes decreases and may become dry, resulting in small pieces breaking loose and floating through the middle of the eye. Sometimes, the clumps of protein settle toward the bottom of the eye where they are not noticed. Sometimes, the brain gets used to the floaters so doesn't register them as often as it once did. Sometimes, if you move your head, floaters move out of the field of vision. These small effects can make it seem as though floaters have gone away. It isn't necessary to get rid of floaters if they aren't creating a visual obstruction. Only when they are do you need to talk to an ophthalmologist.
What are the risks involved with vitreolysis?
These laser treatments are very effective with very low risk. Studies of this procedure have shown a complication rate of 0.8%. The main complication is increased intraocular pressure. This can be addressed with eye drops used in treatment of high blood pressure. There can also be a spike in cataract development, although the relationship is hard to directly quantify, as the development of cataracts is an almost universal condition in all people over the age of 60.
These are safe, effective treatments for removing eye floaters.
What happens after my vitreolysis?
You may see small, dark specks in your lower field of vision immediately following your treatment. These are more of those small gas bubbles described above and they will dissolve quickly. You may have some mild discomfort, redness, or temporarily blurred vision immediately following treatment, but this resolves quickly.
Your results from these procedures with Dr. Groat are immediate.