Of all the possible ways that sufferers might want to try and deal with their eye floaters symptoms and signs, vitrectomy is probably one of the floaters to treatment options that almost universally scares and divides people the most. In this blog, I will be looking at why a vitrectomy operation should not be feared, but instead should leave all floaters sufferers feeling less anxious about their eyes and more hopeful for the future.
Even though I suffer from eye floaters myself, it’s never got so bad that I feel depressed, particularly about my floaters. Although in the early days when I first got my floaters round about 20 years ago, I did feel worried and concerned about whether my eyes would last me into old age. However, since starting this channel about a year ago, it’s been really sad to hear from viewers who have got it so bad, really with their floaters that they feel suicidal or just constantly worry about the impact that floaters are having and effectively it’s taken over their whole life.
Many people would no doubt have looked into the possibility of getting a vitrectomy operation done as a way of instantly removing and dealing with their floaters but understandably, the risk might well have scared them off, or perhaps they’ve spoken to another eye care professional that they felt perhaps didn’t fully appreciate what they were going through and have kind of put them off completely from having the procedure done.
Now, all of this is very commonplace, and I think a lot of the fears stem from a time when the use of vitrectomy for floaters was newer and had a lot more associated risk with it. People haven’t refreshed their understanding of the procedure, it’s easy for optometrists like myself and family doctors and people reading old articles on the Internet to discount vitrectomy, which, if done right, can be a life-transforming operation for the right individuals.
Now, this doesn’t mean that it’s right for everybody I think it’s not right for most people, particularly if you only have a few floaters in your eyes. But we’ll come back to that later on, uncover who I think this procedure is really for.
For those not familiar with what vitrectomy for eye floater is, then please check out the short video that I made previously to explain what that is in a bit more detail, so you can catch that just over here. In short, though, it’s a procedure where the eye surgeon will remove part or all of the vitreous fluid in the eye to remove the floating debris in the eye. The vitreous is replaced with sterile water known as saline to refill the space taken up by the vitreous.
Three probes are then placed into the eyeball at specific locations to achieve this,
- The first probe is a fibre optic light.
- The second is an infusion probe that squirts the saline into the eye.
- And finally, the third probe is called vitrector, and it both grubs and suctions out the vitreous and floaters with it.
So traditionally the main cause of fear and risk, vitrectomy has been the following;
- The risk of serious eye infection,
- The risk of retinal detachment,
- The risk of a cataract formation and after the procedure has been done,
- and forth, the risk of not removing all of the floaters completely.
So these are real concerns that have prevented many people who could have benefited from getting the opportunity to sit down and have a consultation with a surgeon about the individual suitability for a vitrectomy from doing so. Now, the downside of this is that many of these people who would have benefited the most have been left feeling that there is no hope for the future as they’ve got nowhere to turn to. I find this extremely sad and I believe that the tables have turned as far as the safety and effectiveness of floaters only vitrectomy is concerned.
Now, with that in mind, here are the reasons that I think that the four risk factors that we mentioned earlier, one are not so much of the risk that they used to be.
First of all, the risk of serious eye infection.
As with many of our operations, the risk of internal infection is very important to avoid and the keyway that this is the cause is by allowing bacterial infections through the wound. Now, over the years, the three incisions that are made in the eyeball to allow the three probes into the eye have got smaller and smaller with improving surgical technology. So about 15, 20 years ago, vitrectomy would have been done with what we call a 20 or 23 gauge probes in the eye. The 20 gauge probe is about 0.9 millimeters in width, while the 23 gauge is about 0.7 millimeters in width. Now, the smaller the gauge, the larger the size of the incision wound, and the more healing time and risk of infection are caused as a result. Modern vitrectomy is now more likely used at 27 or 25 gauge probe size. For the three probes, and this is a probe width of just 0.4 millimeters in the case of the 27 gauge even with a 25 gauge probe, the incision holes are so small that once the probe is removed, no stitches are needed and the wound will heal without leakage in about 48 hours, on top of that, of course, you’ll be given eye drops to take home to help prevent infections and inflammation over the period while your eye is healing.
The risk of retinal tears and detachment.
This is the risk that may arise more from poor surgical experience or caution. In the case of floaters to only vitrectomy, it’s not usually the case that the whole vitreous is removed unless this is necessary, as this increases the risk of retinal attachments significantly. It’s more likely that a pocket of a central vitreous will be suctioned out with floaters in that region, and the fusion probe refills it straight away with saline solution.
So the risk of retinal detachment due to this change of fluid is more unlikely, now a surgeon may decide to use a gas bubble in the vitreous as an extra precaution to support the retina against detachment temporarily and the gas bubble will disappear of its own accord in about one week. Currently, some of the biggest risks for retina attachment may arise from surgeons getting a bit too close to the retina with a probe by accident or out of necessity due to complications and causing unplanned damage. This is probably not common these days, but it’s where an experienced surgeon is very important, just as in any other delicate surgery.
The other key important thing that helps to minimize the risk of retinal detachment is the fact that the gold standard procedure is now a pause plana vitrectomy, this means that the three probes into the entry point enter into the eye in the region of the eye that we call the pars plana. What’s important about that is the fact that the pars plana region is a pigmented area in the eye that doesn’t contain any retina, so if the entry was an area that involved coming through the retina, that would effectively be like creating three-tier points in the retina with the probe. So as a result, once the probes in the pars plana area are removed, they seal straight away without extra risk to the retina and this is critical for floaters only vitrectomy.
The risk of cataract formation.
It appears that the main mechanism apart from surgical trauma that causes it, maybe really due to oxidation of the crystalline lens, which means when the vitreous is removed, particularly directly behind the lens, there may be an opportunity for oxygen to come in contact with the crystalline lens, causing a reaction that leads to the formation of cataracts. Cataracts by the way, if you don’t know, is when the ordinarily transparent crystalline lens in the eye becomes partially or fully cloudy and are blocking your view through the lens. As I understand it, it’s thought that some oxygen may come up from the retina if a lot of vitreous is removed directly next to the retina and then the oxygen may come in contact with the lens if the vitreous behind the lens has been mostly removed as well.
So it appears that the vitreous humor has a negative oxidative property, so the way they understand that surgeons have looked to minimize the risk of cataract is to leave a good portion of the vitreous that is around the edges of the vitreous cavity so that the retina and the lens are still lined by the original vitreous and only suction out to the floaters, which hopefully are confined to the central area, so that way no oxygen can be released from the retina to get in contact with the crystalline lens. Of course, it’s not always going to be possible and sometimes it may be necessary to remove a lot of the vitreous.
So cataracts are a possibility but a lot of surgeons will probably tell you now that it’s not that common in their experience, so in the worst case, you get a cataract, but that can be treated quite easily. I think the biggest downside of a cataract to be aware of, I think, is more for people under the age of 45 who may need to start using reading glasses for the first time after a cataract operation because they will lose the ability to autofocus for reading. In any case, the removal of your floaters should make a big enough lifestyle enhancement that any negative impact of early cataract may cause the next.
The risk of not removing the floaters entirely.
So vitrectomy is the only certain way that we have of being able to remove all floaters in a person’s eye today. So naturally, when you go through such a procedure, you expect nothing less than perfection. However, everyone’s different, and sometimes it may not be possible to remove every single speck floating in the eye unless you remove the complete vitreous, this may carry more risks than your surgeon may not think it worth taking for floaters the only vitrectomy, so it’s important to realize that sometimes you may still notice one or two very specks of floaters post-surgery. But compared to what life was like before, this really shouldn’t negatively impact your life compared to the pre-surgical situation. So while perfection will always be your surgeon’s aim, I think it’s wise to manage your expectations a little bit down from complete perfection, that’s certainly what I would recommend.
So with that being said, who should be considering looking into Floater Only Vitrectomy? I think the criteria for suitability are very similar to the criteria that I would use for cataract operations. So if it can be demonstrated that floaters are impacting you in the following ways, I think you may well be suitable. So the obvious thing is that you should be somebody who has vision being reduced significantly by these floaters.
Secondly, not so obvious is that these floaters may well be impacting your contrast sensitivity significantly, so this means in the test chart, you could be achieving 20/20 vision but in the real world, because your contrast sensitivity is so low and it could be reduced by as much as 80 percent. It makes it very hard for you to do a lot of practical things because you can’t quite see the differences between subtle shades of black and white and, you know, that contrast, it gets really kind of blurred there so that’s an important one to look out for.
If you’re struggling with floaters and you feel that nobody believe in you, it may be worth getting your contrast sensitivity checked just to make sure that is not being affected too much because if it is being impacted a lot, then that’s certainly one criterion that your optometrist could use to get you referred or might be an indication that you need to have this procedure done.
The other criteria are that the floaters may well be causing you a significant glare and this may be both the type of glare that we call discomfort and also a type of glare that we call disability glare, so either one of those can be significant and can be significantly impacted by having lots of floaters in your eyes.
Another criterion that we consider is whether it’s making life unsafe for you, for example, if you have a large floater that comes into your vision at the wrong time, such as when you’re driving or if you’re working with fast-moving machinery, then you don’t want a situation where your floater moves out of sight and then comes back into vision at the wrong time, making it hard for you to do your tasks safely.
Finally is a consideration is how much of an impact this floater is having on your general lifestyle. So if it’s impacting you in such a dramatic way that it’s making it hard for you to read, cook, clean, remain independent, or navigate your house, then you may well be suitable for consideration.
Vitrectomy may be something that can transform the impact on your lifestyle and also in the case of eye floaters, I would add to that list that if they are causing mental health issues, such as feeling suicidal, depression, along with anything else on that list of points, then that may well make you suitable.
It’s important to know that even if you meet all of the criteria here, the next step is to have a consultation with a reputable specialist clinic about whether they are satisfied themselves that you meet eligibility criteria. It’s never a case of you really just walking in, or at least you should never be a case of you just walking in, wanting to have a procedure done and they just doing it without really giving you a thorough assessment.
So let me know in the comments section below if you think you would go ahead and consider vitrectomy for floaters or if you have had one done yourself and want to share your experiences for other people to read in the comments section.
So I started the blog alluding to the fact that I think the option of vitrectomy should now make floaters to sufferers like you and I feel less anxious and here is the reason why. So when I first got floaters, I remember feeling anxious about them because I didn’t know how bad my eyes would eventually get and how fast that would happen, as well as feeling worried about whether my eyes would last into old age. Well, for many floaters sufferers, the feeling of depression and anxiety may well be for the same reasons as I had as well so that uncertainty is very worrying but probably the biggest worry is that if things get really bad, you won’t have an effective treatment and your only option will be just to live with it.
Well, I think that if things do get really bad or if they are already really bad for you and that you feel that you can’t live with it, then vitrectomy is a genuine solution that is worth considering.
Now, for many of us, we’ve heard so many bad things about vitrectomy and everything we read about seems to be just so negative. It’s no wonder that it gets so many people down there. Remember that vitrectomy is not a rare procedure, but is done every day all around the world, it’s just that it’s usually done as part of other treatments at the back of the eye and not just as a floater only vitrectomy.
Now, with that said, if you’re like most people, you may well be holding out for a non-invasive remedy one day in the future and hope to never need to have a vitrectomy in the first place. However, in my experience, it is reassuring to know that if it comes to it, there is an option out there that has matured enough and can eliminate your floaters even if you have to have surgery for that. So I hope that if you are somebody out there reading this and that you feel really down or even suicidal about your floaters, then just knowing that there is a real option out there gives you enough hope to stay positive for the future.
In the next blog, I’ll give you some important tips and questions to ask your surgeon if you do decide to look into having a vitrectomy, so please check that blog post out.
Thanks a lot for your supports and until the next time, take care.
