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Is it possible to improve vision in patients suffering from floaters? This study investigates this question by measuring contrast sensitivity function in individuals with floaters. In the short-term, vitrectomy improved contrast sensitivity function. This documents the effectiveness and safety of the procedure, but larger and longer studies are need.
Is it possible to quantify vitreous opacities and measure the impact of floaters on vision? This study investigates this question by using ultrasound to measure the density of vitreous and evaluate vision by measuring the contrast sensitivity function. This study found that increasing vitreous density is associated with reduced contrast sensitivity function, offering a means to quantify the impact of floaters on vision. This approach is not only useful in quantifying the impact of the disease on an individual patient’s vision and quality of life, but can also be used to assess potential improvements following treatments of various types.
Does posterior vitreous detachment (PVD) reduce vision, specifically the ability to discern shades of gray (contrast sensitivity function; CSF)? Can this be normalized by limited vitrectomy? This study documents that individuals without floaters can develop them after experiencing PVD, which can result in substantial reduction of CSF. Limited vitrectomy cured the floaters in each case and restored CSF to normal levels. This supports prior studies which suggest that the CSF not only offers a measure of floater severity in the clinical setting, but also the very favorable response to surgery. The limitation in this study is the small number of subjects.
Explores outcomes from 27-gauge pars plana vitrectomy for symptomatic floaters in 47 patients with a mean age of 34.7 years. Patient satisfaction was high (91.5%), although not evaluated with a standardized/validated questionnaire. 91.3% of patients felt their floaters were removed completely or only had an acceptable residual. No operative complications occurred. However, there was one case of endophthalmitis and one retinal detachment. Although the procedure was generally effective and safe, there are risks of severe complications, which suggest the procedure should be undertaken with caution.
This study suggests that Nd:YAG laser can offer effective and safe treatment for individuals deemed to be suitable candidates based on the size and location of the opacities. However, there are methodological problems with the study [https://doi.org/10.1001/jamaophthalmol.2018.0212] and the results showed improvement in only half of treated subjects. Thus, better studies using objective outcome measure are needed.
Is contrast sensitivity function (CSF) impacted by aging changes in the vitreous body? This study suggests that posterior vitreous detachment (PVD), which is the leading cause of the visual phenomenon of floaters, causes substantial degradation of CSF. Furthermore, after PVD there are changes in the vitreous body that further increase vitreous density, as measured by ultrasound. Concurrently, CSF continues to worsen.
What are the long-term effects of surgery for floaters? Limited vitrectomy to remove the vitreous opacities that cause the visual phenomenon of floaters was found to be successful in improving vision (contrast sensitivity normalized within 1 week of surgery in each of 139 consecutive cases) and patient well-being (standardized/validated NEI Visual Function Questionnaire). There were no cases of infection, retinal tears and retinal detachments occurred in only 1.5% of cases, and cataracts developed in 16.9% of cases. Thus, this long-term study found that limited vitrectomy is an effective and safe treatment for floaters with minimal complications.
What is the cost effectiveness of limited vitrectomy in improving quality of life for floater patients? Based on results using the National Eye Institute Visual Function Questionnaire and measures of contrast sensitivity function before and after surgery, limited vitrectomy is more cost effective in improving quality of life than cataract surgery, amblyopia (i.e., lazy eye) therapy, or retinal detachment surgery.
This laboratory study explores the use of gold nanoparticles and low-energy lasers for destruction of vitreous opacities. This method requires ~1,000 times less energy than current methods employing YAG laser, theoretically enabling safer, faster, and more reliable cures than current laser-based methods. Although far more research and development are needed, this study suggests that this new method has the potential to be further developed as a treatment option, if experiments in animals (which have been completed) followed by human trials are successful.
Does YAG laser treatment benefit patients with floaters? This study explores how patients who have had YAG laser treatment of vitreous opacities compared to untreated patients complaining of floaters. Analyses found no differences in the YAG-treated patients compared to untreated patients. However, in a small subgroup of patients there was decreased vitreous density and better contrast sensitivity function, suggesting that there may be some patients who benefit from YAG laser treatment. Prospective, randomized trials are needed to determine this and to identify what type of patients might benefit.
This study suggests that Nd:YAG laser can offer effective and safe treatment for individuals deemed to be suitable candidates based on the size and location of the opacities. However, the methods employed in this study are not standardized and validated, and the journal that published this paper has a relatively low status in the eye world.
Can optical coherence tomography (OCT) imaging accurately diagnose posterior vitreous detachment (PVD)? This study suggests that when compared to discovery during surgery (considered the ‘gold standard’) spectral-domain OCT cannot accurately diagnose PVD (predictive value = 53%). The investigators suggested that diagnostic accuracy may be improved by employing ultrasound.
Retrospective survey study that suggests that pars plana vitrectomy for symptomatic floaters generally resulted in high patient satisfaction with relatively low rates of severe complications in a large group of patients (581 eyes operated on by 48 surgeons in 16 countries). The authors concluded that surgery may be safer with core vitrectomy, no surgical PVD induction, and moderately high cut rates (>1500 cuts/min). Proper patient selection and informed consent are important considerations as to whether or not to perform the procedure.
Is myopia (near-sightedness) in patients complaining of floaters associated with changes in vitreous and vision? This study links structural abnormalities that are common in myopic eyes with the presence of increased vitreous density and reduced contrast sensitivity function (CSF). It offers an explanation as to why myopia is associated with the development of Vision Degrading Myodesopsia (VDM ≡ clinically significant floaters) in young people. The worse the axial myopia, the more dense was the vitreous body and the more degraded was CSF.
This study explores the use of 3-D swept source optical coherence tomography (SS-OCT) for imaging the vitreous body in relation to assessing age-related changes. While imaging the entire vitreous body was the goal, only the anterior portion (the part of the vitreous in the front of the eye, nearer to the lens than the retina) could be evaluated. Nonetheless, this method offers a detailed means to image vitreous opacities that cause the visual phenomenon of floaters, and work is ongoing to images the entire vitreous body.
Using carbon quantum dots (CQDs), a kind of nanoparticle, in combination with a low energy laser that distributes ~1,000 times less energy than the currently used YAG lasers, vitreous opacities resulting from collagen aggregation can be efficiently destroyed. In combination with other nanoparticle research, this study highlights the need to further explore these technologies in order to develop a safe, effective treatment of Vision Degrading Myodesopsia (VDM). Positive in vitro results were obtained for destroying opacities in vitreous material removed from floater patients undergoing vitrectomy.
Investigates the use of gold nanoparticles and low energy, pulse-based lasers for photoablation of opacities. The nanoparticles effectively bound to Type I collagen fibers stimulated outside of the eye. They also bound effectively to collagen fibers injected into the vitreous of rabbits. In both cases, opacities were effectively and rapidly destroyed following the use of low energy, pulsed-lasers. This study shows promise and supports further investigation of the method via human trials.
Assessment of the quality, content, and readability of online information relating to vitreous floaters. Generally, the quality of information varies.
This explores the use of software to track floaters, technology that could be useful in implementing real-time correction of the visual phenomenon that relies on reducing or canceling the resulting retinal shadowing using a phase retrieval method. The computational load is currently limiting.
Review of techniques for imaging human vitreous.
Review and discussion of the complexities of imaging the human vitreous body.
This review of 728 published cases highlights the negative impact on quality of life resulting from floaters and discusses treatment options. The development of sutureless vitrectomy with small gauge instruments, along with performing only a limited central vitrectomy without induction of a posterior vitreous detachment, may reduce the risks of surgery. The effectiveness of Nd:YAG laser treatment remains unconfirmed.
This review article explores the impact of floaters on patients’ quality of life, psychological factors that correlate with patients seeking treatment, and safety and efficacy of existing treatment options. Only vitrectomy was found to be viable at the present time. The potential for reduced surgical risks associated with the development of smaller gauge instruments is highlighted.
This article reviews antioxidant molecules within the vitreous and the role they may play in vitreous health and age-related vitreous degeneration.
Vitreous biology and the causes of Vision Degrading Myodesopsia (VDM) are reviewed. Vitrectomy is highlighted as a surgical means to improve vision and quality of life for those impacted by VDM. Current laser-based treatments (YAG), may be effective for some individuals (based on the location of the opacity within the vitreous and its size). Future, non-invasive procedures merit exploration including improved laser treatments, pharmacotherapies, and optical corrections. Better understanding of VDM and its underlying pathologies should result in defining preventative measures.
This text is a definitive, in-depth book devoted to the human vitreous written for medical professionals. It covers topics relating to vitreous embryonic development, biochemistry, anatomy, function, aging, and pathology, including the development of opacities and Vision Degrading Myodesopsia (VDM).
Alder’s Physiology of the Eye has an entire chapter devoted to the vitreous and associated diseases, including Vision Degrading Myodesopsia (VDM). It was written for an audience of medical professionals. Dr. Sebag is currently publishing an update of this chapter for the 2022 edition.
This text derives from the Annual report of the French Ophthalmology Society which each year is dedicated to a chosen theme. The 2003 symposium resulted in this book that explores various aspects of vitreous pathology.
This chapter discusses molecular biochemistry, anatomy, development, age-related changes and degeneration, and pathologies of the human vitreous.
The structure, functions, and key features of the vitreous are discussed. This is a detailed yet concise chapter on the topic.
This is an encyclopedia entry on the human vitreous and posterior vitreous detachment.
Dr. Sebag’s Vitreous – in Health and Disease has 56 chapters (90 authors) dedicated to topics concerning the biochemistry, anatomy, development, physiology, aging, pathology, vitreo-retinal surgery, and pharmacologic vitreolysis of the vitreous body.
Causes and visual impacts of floaters are discussed along with treatment options and their associated effectiveness and safety. While Nd:YAG laser based treatments remain unproven as an effective treatment option, 25-gauge vitrectomy has been shown to be safe and effective. Conclusion: it is reasonable to offer limited vitrectomy to individuals who have not been able to cope, and whose vision degradation (contrast sensitivity) resulting from the vitreous opacities causing the visual phenomenon of floaters can be quantified.
Overview on the anatomy and pathology of the human vitreous.
Overview on the anatomy of the vitreous and vitreo-retinal interface.
Comment on the posterior vitreous detachment classification method proposed by Kakehashi et al.
Argues that ophthalmologists who examine patients presenting with floaters must consider that this as a disease which impacts the patients quality of life, regardless of the doctor’s perception of the problem.
Peer-reviewed letter highlighting that YAG lasers do not ablate vitreous opacities but operate via photodisruption. This was in response to the article “YAG laser vitreolysis vs sham YAG vitreolysis for symptomatic vitreous floaters: a randomized clinical trial”.
Editorial supporting the surgical treatment of floaters when they are clinically significant (i.e., represents a case of Vision Degrading Myodesopsia). It is recommended that surgeons make determinations based on ultrasonography showing significant vitreous echodensity, documentation of decreased contrast sensitivity, and significant decreases in quality of life.
Note on the title of the article “Much ado about nothing (or something) – What is the role of vitrectomy and yttrium-aluminum garnet laser for vitreous floaters”. Editorial notes that this title “aggravates the disconnect that currently exists between the experience of patients and the perception of doctors with respect to vitreous floaters.”