Floaters in your vision are an odd phenomenon. They look like squiggly lines, cobwebs, gray or black specks, or strings and they float around seemingly in front of your eye. Try and focus on them, however, and they move quickly away to the outside of your range of vision.
Floaters are another part of aging, as fibers clump within the vitreous gel on the inside of our eyes. They are harmless in most people, but a sudden increase in floaters can be a sign of retinal detachment, and you should see Dr. Sondheimer immediately. Otherwise, if your floaters are becoming a perpetual distraction in your vision, Dr. Sondheimer performs laser vitreolysis to remove your floaters.
Am I a Candidate for Laser Vitreolysis?
It is important to realize that treatable floaters need to be far enough away from the lens and retina for us to safely treat them. They need to be distinct. Dr. Sondheimer needs to correlate your visual disturbance with your treatable Floater.
In a comprehensive eye examination, Dr. Sondheimer can determine if Laser Treatments are likely to help your Floaters. Dense discrete Floaters such as seen in a Posterior Vitreal Detachment usually respond well to Laser Treatment. Diffuse dense opacities as seen in Asteroides Hyalosis or diffuse amorphous areas of syneresis respond poorly to Laser Treatment.
Your Floater or Floaters should be present for over 2 months and not have any association with active eye diseases. They should be no longer changing. You should no longer be seeing flashes of light which can be associated with the Vitreous Gel pulling away from your retina. Dr. Sondheimer can advise you what your chances of success with Laser Treatment are.
What Is Laser Vitreolysis Like for the Patient?
Laser vitreolysis with Dr. Sondheimer is non-invasive and pain-free. Dr. Sondheimer first places anesthetic eye drops into your eyes. There is no pain. You will notice small, dark specks and shadows during treatment. These are the floaters that are being evaporated and turned into small gas bubbles. The eye will absorb these bubbles quickly. After your session, we will place some anti-inflammatory eye drops in your eyes.
What Is the Ultra Q Reflex Laser?
Dr. Sondheimer uses the Ultra Q Reflex Laser to perform laser vitreolysis. This platform provides the highest standards of safety, accuracy, and efficacy. The key to this system is called True Coaxial Illumination (TCI). This technology provides Dr. Sondheimer a full view from the cornea to the retina, along with excellent special context. The ability of this TCI technology permits a multitude of potential illumination settings, which allows the treatment of floaters in any part of the eye safely without risk to the retina or the lens.
What Are the Chances That Vitreolysis Will Improve My Vision?
As a result, If you are a good candidate for Vitreolysis, there is an 85 to 90% chance that you will get substantial improvement in your symptoms. Sometimes, Dr. Sondheimer requires 2 or 3 treatment sessions to get a satisfactory result.
What Is the YAG Laser?
Dr. Sondheimer also uses the Nd: YAG Laser for vitreolysis. This is a second laser platform that has a longer history of treating floaters. Recently, advances have made this laser more and more effective for vaporizing floaters with virtually no complications. Former iterations of the YAG laser could elevate the chances of the patient developing cataracts and glaucoma, but the YAG laser no longer has that problem.
Dr. Sondheimer is very knowledgeable and approachable. I appreciated that he took the time to answer my questions and concerns. He was never rushed or distracted. My surgery went well and I would recommend Dr. Sondheimer to anyone.
– Faina R.
What Are the Risks of Laser Vitreolysis?
As technology has improved and the focusing standards have improved, laser vitreolysis has become very safe. Side effects and complications with laser vitreolysis are rare. The procedure can slightly increase the patient’s potential to develop cataracts (although cataract development is almost universal in aging eyes on its own) and it can also increase intraocular pressure inside the eye. The risks of treating floaters with laser vitreolysis compared to the former methods of surgical treatment are incredibly low. Surgery carries significant risk of bleeding and infection, and a much higher risk of cataract development.
Modern Vitreolysis Laser Vs Older Lasers
New Optical Systems have been developed to better align the Aiming Beam of the Laser with the Energy Beam of the Laser. The energy of the Laser Beam is more concentrated than with older Lasers. New contact lenses have been developed which enable better visualization and treatment of Floaters with the Yag Laser.
What Results Can I Expect From Laser Vitreolysis?
Patients can expect a noticeable decrease in the appearance of floaters after laser vitreolysis with Dr. Sondheimer. Most patients require 2-3 treatments to achieve the results they desire. This is a safe and effective procedure, but some floaters may be too close to the retina to remove with laser vitreolysis.
What Are Vitreal Floaters?
Vitreal Floaters are composed of protein and other substances that rest in the Vitreous of the eye. The Vitreous is a gel that lays between the lens and the retina. It consists mostly of water but also collagen and hyaluronic acid. As people get older. They tend to get more of these floaters that move with the eye. One common cause of Vitreal Floaters is the Vitreous pulling away from the retina at the back of the eye. This is called a Posterior Vitreal Detachment and where the Vitreous used to be attached to the Optic Nerve a large often oval floater commonly is seen.
Most people with Vitreal Floaters get used to them with time and forget about them. This is called Neuroadaptation but some floaters can become very disruptive to important visual function. Neuroadaptation doesn’t always work. In severe cases, people may seek help.
What Causes Floaters?
Most floaters are simply the result of normal aging, but they can also have other causes:
- Aging eyes — The vitreous in our eyes keeps the eyeballs filled and maintains their round shape. When young, the vitreous is a thick gel, but it partially liquefies after we pass our 50th birthday. This makes the vitreous shrink and sag to a degree, and this causes it to pull away from the eyeball’s interior surface. As this happens, it clumps and becomes stringy. These formations cast shadows on the retina and we see them.
- Inflammation in the back of the eye — Posterior uveitis, caused by infection or inflammatory diseases, can also create floaters. With uveitis, there is inflammation in the uvea in the back of the eye, and inflammatory debris is released into the vitreous and creates floaters.
- Torn retina — As the vitreous sags, it tugs on the retina in the back and this can cause a tear. Without treatment, this can lead to retinal detachment, when fluid accumulates behind the retina and it separates from the back of the eye. This can lead to permanent vision loss.
- Bleeding in the eye — Diabetes, hypertension, blocked blood vessels, and injury can cause bleeding in the eye. Blood cells are seen as floaters.
- Eye medications and surgeries — If medications are injected into the vitreous, this can cause air bubbles to form. They are seen as floaters until your eye absorbs them.
What Are the Symptoms of Floaters?
Floaters can have different shapes. Some appear to be like worms. Others are like a cobweb. They can be black or grey specks. Most floaters look somewhat transparent because you can see through them, but really this is simply because they are shadows, not the actual clumps that you are seeing.
These are typical symptoms:
- Small shapes in your vision that appear as strings, specks, or are ring-shaped
- The spots move when you move your eyes
- If you try to focus on a floater, it quickly moves to the side of your visual field
- Spots are most noticeable when looking at a plain bright background, such as a clear blue sky or a white wall
Are There Different Types of Floaters?
There are different types of floaters and they have different causes. Most can be treated with laser vitreolysis, although diffuse floaters usually need other treatment.
- Fibrous strand floaters — These are most common in young people. They appear as multiple dots and/or string-like cobwebs. They form when there is clumping in the collagen fibers of the vitreous.
- Diffuse floaters — These floaters look like small clouds. They are caused by aging and changes in the vitreous.
- Weiss Ring floaters — These are large, fibrous floaters that are ring-shaped. They can be quite annoying due to their size. They are far enough away from the crystalline lens and the retina and can usually be effectively removed through laser vitreolysis.
Vitreal Floaters Treatment
For many years the only effective treatment of Floaters was to remove the Vitreal Gel in a Vitrectomy Surgery. Unfortunately, this extensive surgery can lead to other problems such as Cataract Formation or Infection. All things considered, we reserve vitrectomy for a very small minority of people with bothersome Floaters.
Recently, there have been improvements with Yag Lasers which can now safely improve Floaters in many patients. As a matter of fact, engineers have developed YAG Lasers with improved focusing and better concentration of energy that can now help many people suffering from interference of vision.
Is the Yag Laser that performs Vitreolysis FDA-Approved?
Yes. The FDA has approved devices and technologies developed for the treatment of eye floaters. Laser vitreolysis has been around since the 1980s. Since that time, the process has been refined through the use of YAG laser technology and Ultra-Q laser devices, both of which treat floaters efficiently using lower amounts of energy.
How Safe is Laser Vitreolysis?
Laser vitreolysis has been performed for several years with few instances of complications. The complications that may occur include:
- Increased number of floaters
- Increased intraocular pressure and risk of glaucoma
- Post-treatment cataracts - requiring cataract surgery
- Retinal tear
- Retinal detachment
- Retinal hemorrhage
- Macular Injury
- Poor vision
Dr. Sondheimer is very selective in his recommendation for this procedure. The procedure is only indicated if the floaters are interfering substatially with the quality of your vision. The floaters must be located an adequate distance in front of the retina and behind the lens to be safely treated with the Laser. During your consultation, you can expect to have a detailed discussion of your symptoms, lifestyle, and other factors that may influence the outcome of your ophthalmic treatment. If laser vitreolysis is not ideal for you, Dr. Sondheimer will discuss other viable options to alleviate your symptoms.
Can I Drive Myself Home After the YAG Laser Vitreolysis?
Usually, it is not possible to drive immediately after receiving YAG laser eye treatment. We encourage you to arrange to have a loved one accompany you to your appointment. Some patients, but not all patients have been able to safely drive the day that they have had Yag Laser Vitreolysis.