View of traffic through simulated floater
With time, many floaters absorb, some gradually move to the sides of the eye where they are not noticed, and in some cases the patient just learns to ignore them. Such floaters do not need any treatment at all.
However, if the floaters are present for months with no real improvement, and the floaters are bothering the patient in reading, driving, at the computer, tasks on the job or bothering their concentration, treatment can be very helpful.
Patients with floaters must have a very careful evaluation to see if they are a candidate for laser treatment. The entire vitreous is examined and the location of the floater is drawn. This examination is widely done with the Karickhoff Laser Lens. At the end of the examination we have the patient look inside their own eye and see with perfect clarity the floater that is bothering them. This is done with an optical system that Dr. Karickhoff developed and published.
Many patients are offered laser treatment. These ideal candidates typically (1) developed their floater due to a vitreous detachment, (2) have a small number of floaters, and (3) the floaters are located away from the lens and the retina.
Perhaps 25 percent of patients under the age of 55 can not be offered treatment because usually there is not a posterior vitreous detachment (PVD). A PVD is a collapse of the vitreous that brings the floaters that are usually found on the back side of the vitreous into the center of the eye away from the retina so they can be easily treated. In other cases in young patients, if their floaters are in the middle of the vitreous body, even though it is not detached, usually they can be treated. PVD's are very common after 60 years old, making it possible to offer treatment to almost every patient in that age group.
Laser treatment of floaters can be done if the patient has had cataract surgery and received a regular(monofocal) or accommodative (Crystalens) intraocular lens implant. However, the Restor multifocal implant makes treatment of the floaters more difficult because it separates the laser treatment beam into two beams, but we have successfully treated floaters through it. The Rezoom (another multifocal) implant separates the laser beam to a lesser extent than the Restor implant.
Contact lens wearers may have the procedure, but we ask them to stop wearing the contacts five days before coming here.
We do not offer the treatment to patients with asteroid hyalosis (hundreds of tiny floaters) or when active inflammation in the eye is causing the floaters.
The treatment is usually not offered to those with floaters and membranes from vitreous hemorrhage. These patients are typically referred for vitrectomy. This is surgical (non-laser) removal of the vitreous gel. This procedure carries a significant risk.
The procedure is sometimes not offered to those patients that have or have had elevated eye pressure or glaucoma.
Some particularly anxious patients find themselves unduly bothered by the usual number of small, visually unimportant floaters. This situation is also detected at examination, and they are not offered laser treatment. Patients who are unusually anxious or depressed because of their floaters, may not be offered the procedure.
If the patient has a history of significant psychiatric problems that might worsen if there were no improvement or a complication from the procedure, it is possible that the treatment will not be offered, or it may be necessary to have a letter of clearance from the patient's psychiatrist in order to offer the procedure.
(more details pages 73-76 Our Book)