Question for Dr. Stacy Regarding Floaters

Discussion in 'Optometry Archives' started by Charles Braverman, Dec 28, 2006.

  1. Dr. Stacy,

    In a recent discussion regarding floaters (which I unfortunately deleted), I
    believe you stated that floaters would have to be VERY bad before a
    vitrectomy might be justified.

    I have what I consider to be very bad floaters for the past 7 years, and
    have been wrestling with that question over that time.

    What criteria does one use to determine whether to seek a vitrectomy? In my
    case, I have large globs of "mud" that obscure a large portion of my vision.
    Reading is very difficult, for example, not only because so much of a line
    of print is obscured, but because the contrast between the print and
    background is poor. It is also not an exaggeration to say that the globs
    torment me almost all of the time and seem to cause persistent eye strain
    and tearing. Yet I have something close to 20/20 on an eye chart and no eye
    disease according to recent dilated eye exams. What are your thoughts as to
    what criteria justify vitrectomy?

    Thank you for your comments.

    I would also be interested in any additional opinions from other readers.

    Charles Braverman, Dec 28, 2006
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  2. Charles Braverman

    Dan Abel Guest

    Google is your friend.

    20/20 on the eye chart is a first cut. It isn't the final answer.

    What does your doctor advise?

    ObOT: I had a vitrectomy about a year ago. My doctor said that as a
    side effect, I would lose the floaters.
    Dan Abel, Dec 28, 2006
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  3. Charles Braverman

    Jane Guest

    Charles, if I were in your situation, I'd be setting up a pre-surgery
    consultation with my retinal surgeon rather than seeking opinions on
    the internet. I had a vitrectomy about a year ago to remove a macular
    pucker. The worst consequence of the surgery was the development of a
    cataract in the surgical eye. (I've read that it's the result of the
    lens' exposure to oxygen.) Unless you are at high risk for retinal
    detachment, I believe that the a vitrectomy is quite safe if done by a
    competent retinal surgeon. And with the new 25-gauge "sutureless"
    equipment, recovery is very rapid. One surgeon wrote that the day
    after the vitrectomy, it's frequently difficult to tell which of the
    patient's eyes had the surgery.

    Best of luck!
    Jane, Dec 29, 2006
  4. Good advice, but since he's asking, I'll venture that he might be a
    candidate for it, especially if he is over age 50, since the subsequent
    cataract surgery that is certain to follow if he hasn't yet had it is
    sort of a blessing in disguise. I'll bet he's 20/20 only part of the
    time, and when the goop is in the way he may drop to worse than 20/100
    or so in the affected eye.

    w.stacy, o.d.
    William Stacy, Dec 29, 2006
  5. Charles Braverman

    Dan Abel Guest

    Mine went quite well. However, I was on restriction for two weeks (no
    lifting or bending over). Since I had already given notice at work, and
    had planned to spend the next week cleaning out my office, this was a
    problem. I talked to my boss and extended my leaving another two weeks.
    This was a good thing, since I had over a hundred days of sick leave, so
    I spent two weeks at home at full pay.
    Dan Abel, Dec 29, 2006
  6. Charles Braverman

    Jane Guest

    My vitrectomy was done with the older 20-gauge equipment, which
    required sutures. One day post-op my eye was practically swollen shut
    and bright red. I looked terrible, although it wasn't painful. I
    later developed a severe suture reaction, which was reportedly related
    to the (mis)placement of the sutures (put in by a resident who--in my
    opinion--didn't know what he was doing.) This left an unsightly red
    mound on the white of my eye that lasted for weeks.

    But happily, surgery with the newer 25-gauge "sutureless" equipment
    inflicts no such torture on the patient. I believe the surgery time is
    quicker, and recovery is reported to be faster and painless. I believe
    that Charles has a lot to gain from the procedure and should certainly
    schedule a consultation with the best retinal surgeon in his area.
    (This does not require a referral from an optometrist.)

    I haven't kept up with my reading in the area of retinal surgery.
    However, I do know that just a few years ago a vitrectomy was not done
    to remove a macular pucker until vision was worse than 20/60. Today,
    with better equipment and technique, some surgeons will operate on a
    patient with 20/20 vision if the distortion from the pucker is
    bothersome. I also believe that vitrectomies for floaters are
    performed more frequently today than in the recent past.
    Jane, Dec 29, 2006
  7. I think the chance of endophthalmitis is pretty small, given modern day
    procedures and antibiotics. And I think that "cracked" is a poor choice
    of words to use with someone who is not familiar with the procedure,
    where 3 very small holes are cut in the eye
    for the instrumentation. It is minor in that the patient is usually not
    under deep anesthesia, and intubation of the trachea is usually not
    needed. I think vitrectomies for major vitreous opacities is becoming
    more common, as it is quite successful. This person should indeed
    consult a vitreous surgeon before consulting a psychiatrist.

    w.stacy, o.d.
    William Stacy, Dec 29, 2006
  8. Charles Braverman

    Jane Guest

    According to a June '06 article on, postoperative
    endophthalmitis is a rare complication of intraocular surgery. Data
    from Bascom Palmer from '84 to '94 show that only 0.05% of patients
    developed endophthalmitis after pars plana vitrectomy. (The rate was
    0.08% for patients undergoing cataract extraction.)

    Even with the older 20-gauge equipment, having a vitrectomy is not a
    painful ordeal. My surgery was done at a teaching hospital with local
    anesthesia alone. (I opted to skip the sedation.) I experienced no
    pain during the surgery and was actually able to see the instruments in
    my eye and follow the action. (A fascinating and hopefully
    once-in-a-lifetime experience.) After the surgery (with one eye
    patched), I had lunch and then walked over to the local multiplex,
    where I stayed for a double feature. My vision improved from 20/50 to
    20/20 during the weeks that followed.

    You guys really perform a valuable service for us nonprofessionals by
    posting info on this web site. But I really disagree with you in this
    case, Anon E. Muss, and your comment about antidepressant medication is
    a little offensive. Have some empathy--how would you feel living your
    life with the types of problems that Charles has been experiencing?
    Jane, Dec 30, 2006
  9. 20/20 is a subjective finding, not an objective one. And floaters
    notoriously cause 20/20 vision to drop to 20/100 or worse as the floater
    passes over the macula.

    w.stacy, o.d.
    William Stacy, Dec 30, 2006
  10. I should rephrase that: "large floaters notoriously CAN cause 20/20
    vision to drop to 20/100 or worse as the..."
    William Stacy, Dec 30, 2006
  11. Once again I disagree with the "standard" then. Acuities and
    *subjective* refraction data belong together in the SUBJECTIVE area.
    Retinoscopy and auto-refractions belong in the OBJECTIVE area.
    But you cannot determine the degree of "honest and proper effort".
    That's why it's so variable and subjective.
    Nor can you ALWAYS tell if they are hysterical or malingering.

    I also put these in the subjective realm.
    Fake a strabismus? Or more important, fake orthophoria when the patient
    is a strab? I think not. But obviously these are objective, as we are
    making direct OBSERVATIONS by definition. OTOH, things like phorias and
    fixation disparity measurements are just as obviously subjective items.
    Some of those are signs, some are symptoms. You're lumping them
    together, I think unnecessarily and confusingly.
    Agreed with those, if reported by the patient and not observable (eyes
    bug out should easily be observable as exophthalmos or proptosis).
    A very good objective test, don't you think? I'll bet you're using it
    more than you used to "order it" from your glaucoma guy? I had a nice
    exchange with a lecturer at the Monterey Symposium in which he asked for
    a show of hands as to who was "modifying goldmann readings" by the
    pachymeter. I was about the only one to raise my hand. He challenged
    me and I said I do it in my head, not on paper. Helps me get a feel of
    what's going on. He then explained patiently that my correction tables
    are not all that accurate. I patiently explained to him that in most
    aspects of medicine even variable or imperfect corrections are better
    than no corrections at all. Love to make those guys squirm. He allowed
    that it was a good point.

    w.stacy, o.d.
    William Stacy, Dec 30, 2006
  12. Charles Braverman

    LarryDoc Guest

    Indeed. But thanks for taking the time to so concisely present the
    issue. This is precisely what the glaucoma specialists in my
    neighborhood live by and that which most of us have come to accept as
    valid rationale for the diagnosis and management. At least for now.

    But on another, possibly related issue:
    What of the thousands of LASIK's/PRK'd people with now thin corneas?
    Might they have to classified as higher risk glaucoma suspects? Do thin
    corneas alone predict risk or is there an underlying genetic cause that
    relates simultaneously to thin cornea and glaucoma? Inquiring

    LB, O.D.
    (rarely seen around these parts these days)
    LarryDoc, Dec 31, 2006
  13. Given the context of your post, I think you meant never measured >22.

    w.stacy, o.d.
    William Stacy, O.D., Jan 1, 2007
  14. Agreed, it's just that your quote translates: "many people with iops
    never measured "LESS THAN 22mm Hg develop glaucoma." That statement is
    certainly true, although it would be more meaningful to have said "most
    people who never measured less than 22mm Hg have glaucoma".

    But what I think you were trying to say was what I originally answered

    It's kind of a pet peeve of mine, like when people specify + when they
    meant - in an Rx. Or when the order says "DNR" when the patient is not
    terminal. Little things like that sometimes are important.

    w.stacy, o.d.
    William Stacy, O.D., Jan 1, 2007
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