Background summary

This report outlines the need to separately classify more severe cases of vitreous floaters, and to recognise patient reports that are often in conflict with general opinion such as:

• Vitreous floaters are associated only with the ageing eye. (incorrect);
• The brain will adapt and patients will 'get used' to vitreous floaters. (incorrect);
• Patients with significantly visually disturbing vitreous floaters have "healthy eyes" and are therefore not candidates for treatment or professional support. (incorrect).

According to Dr Johnson, MD, Orange County California,

the presence of vitreous floaters is not an eye health problem.  It is, though, a condition of the eye creating a comprehensive disturbance of vision perception with significant adverse quality of life implications. Anyone who tells you to simply ignore them is not listening to you. For many people, the brain will not get used to them.¹

He goes on to admit that,

We think that in general eye doctors have not really been listening to their patients when they have visually-significant or dense floaters... Eye care professionals can be collectively blamed for not listening to patients and taking the floaters seriously. If we did, there would be a simpler cure by now. We have always considered it adequate to pronounce the eye as healthy, and send the patients on their way.²

For an ophthalmic professional to speak with this degree of candour on behalf of his patients represents real progress.

There exists a shared resentment toward the medical profession for trivialising the implications of what is commonly regarded as an 'innocuous' and 'benign' change to the internal structure of the eye, known as vitreous floaters. The following citation is from a signatory to an online petition created in 2003, addressed to the Jules Stein Eye Institute.³

I have had floaters for almost 7 years now. They consist of a matrix of debris in both eyes that severely obscure my vision. There is not one or two floaters, but literally hundreds if not thousands that make up vast clouds of debris that distort and block what I am trying to see. They appeared within a week when I was 21. Prior to getting floaters, I had 20/20 vision. The amount of floating debris has never reduced. In fact, it has slowly become worse over the years...I believe that this is a disabling disorder with many sufferers that live silently because they don't know who to turn toward for help.⁴

and elsewhere:

Floaters have seriously diminished my quality of life [for] more than thirty years now...I have the impression ophthalmologists collectively don't take this problem seriously. I have encountered nothing but total indifference.⁵

It does take some effort of empathy and imagination to appreciate this as a 'non-trivial' disorder – the descriptive term 'floaters' is perhaps itself not helpful in this respect – but those affected would implore you to make this effort. There is no physical pain, threat to life or loss of vision as such. However, patient reports clearly aim to communicate a quality-of-life issue that is better understood as a virtual 'life sentence': professionally & personally debilitating and a major impediment to psychological well-being. Some time spent reading the petition will give a clear impression of the truly devastating impact that the more severe cases of 'floaters' can have – a sorry fact made worse by the obscurity of this document.

The patient reports are in stark contrast to the teachings that are found, for example, in medical textbooks:

Once reassured that they [vitreous floaters] are not of serious import, patients are usually unaware of them most of the time.⁶

It is crucial to note that this might correctly apply to small and visually insignificant opacities that nearly everyone is aware of in their vision occasionally, and are a perfectly normal feature of healthy eyes. However, it is entirely inappropriate to classify these under the same heading as symptoms such as the following:

My eyes are filled with vitreous debris. It is nearly impossible to watch tv. I no longer can drive or enjoy the outdoors, or indoors for that matter. My floaters are so bad that i cant imagine blindness being much worse. Every day is so difficult to get through with this condition. I have spent about $2000 in Doctor fees in hope for some answers or help. No one should have to live with a condition this bad. Not all floaters are benign.⁷

Vitreous floaters are accepted as common in elderly people, and otherwise are taken seriously as a potential indicator of retinal detachment, but of themselves apparently not regarded as a problem by eye doctors. Where they appear in large numbers independently of other factors, their causes are apparently not well classified or documented – and neither are their implications. In younger people the prospect of having to endure, for the remainder of their lives, this permanent change⁸ to the vitreous is a major threat to the possibility of effectively engaging in their life and work.

[T]hese things drive me to distraction every single day of my life. I have many many floaters, and see an eye doctor yearly. I have been told over and over that they're "nothing to worry about", but the "doctors" don't seem to understand how difficult they are to live with.⁹

Standard eye examination techniques may not indicate the extent to which a patient is suffering this continually aggravating visual disturbance – perhaps resulting in a misdiagnosis of 'neurosis', or 'hallucination'.

...[R]eading has become painful work and the source of frustration and severe headaches...I need the ability to read several hours a day more than ever, due to re-education. But the most frustrating aspect is the ignorance of school medicine, which arrogantly depreciates the suffering to a 'psychological problem'.¹⁰

Vitreous floaters are in dynamic state and can take the form of clumps, spots, clouds and strings all of which can appear more visible to the patient looking out than their eye doctor looking in. (Of course to ordinary people, there is no outward sign of a disability of any kind whatsoever.) A patient may therefore have the unwelcome position of dealing not only with the symptoms themselves, but a significant communication barrier and dismissive attitudes. There is no 'escape' from vitreous floaters, morning to night – clinical depression is frequently cited (I had prk surgery and then started getting floaters. Dr. say it is not related to surgery. I find it hard to believe. I new(sic) nothing about floaters before the surgery. I have been to numerous psycologists and I'm on my 3rd type of anti-depressant. I'm suffering from severe depression and anxiety.)¹¹

Coping with clinical depression, persistent vitreous floaters, and no professional guidance or support is a tall order by anyone’s standards.

Currently the only options for those seeking relief from the intolerable forms of 'vitreous floaters' are treatment by Nd:YAG laser or surgical removal of the vitreous (vitrectomy) – the former being offered by only a handful of doctors worldwide, the latter in general highly un-recommended due to the associated risk factors. Strangely, laser treatment has been known for over 20 years, but appears to have remained a completely marginalised practice. Dr Johnson, who offers this at his practice in the US, claims to achieve up to 95% improvement of symptoms in certain cases. However, he himself acknowledges it as an 'off-label' use of the laser that very few doctors know about, and that is not suitable in all cases.¹² Despite the expense and risk factors, patients do seek the surgical solution in preference to living with the problem – a process which is generally an up-hill struggle, and with no guarantee of achieving an improved situation:

I've been to three different doctors in the last year, one of which is one of the top experts on diseases of the vitreous in the United States. None of the doctors could tell me why I have floaters or if they will go away or at least stop getting worse. It has gotten so bad that I asked the last doctor if it was possible for me to have a risky vitrectomy operation to remove the floaters from my vision, but he told me that no doctor in the world would preform(sic) that operation on ‘healthy eyes’.¹³

References

Note: The website www.gotfloaters.com which was the original source of some of these references has now been replaced by www.vitreousfloatersolutions.com, and hence the links may now be out of date.  The accuracy and legitimacy of the information contained in the above report is unaffected by this change.

1. www.gotfloaters.com (This citation has been modified by Dr Johnson for clarity)
2. www.gotfloaters.com
3. http://www.petitiononline.com/qd2584/petition.html. Online petition addressed to the Jules Stein Eye Institute.
4. Ibid
5. Ibid
6. Crick Khaw, A Textbook of Clinical Ophthalmology, pp. 444.
7. http://www.petitiononline.com/qd2584/petition.html
8. ...the body and the eye doesn’t try to get rid of floaters because there has been no invasion of foreign material to the eye, just a change in the molecular composition of the vitreous. http://www.gotfloaters.com/1whatisafloater.html
9. http://www.petitiononline.com/qd2584/petition.html
10. http://www.petitiononline.com/qd2584/petition.html, Entry number 5590
11. http://www.petitiononline.com/qd2584/petition.html
12. The Lasers used to treat floaters are FDA approved for use in the eye. In 2002 Dr. John Karickhoff submitted a document to the FDA outlining the current understanding of the laser physics, the past published studies as well as a summary of his years of experience with the procedure of treating floaters with the laser . The FDA had ruled that his proposed study of laser treatment of vitreous opacities was a non-significant risk device study. They further ruled that a special device exemption from the FDA to use a YAG laser in the study was not required. As such, the use of the YAG laser to treat vitreous floaters is still considered an off label use of the laser, and it is up to the individual surgeon to determine the appropriateness of its application.
13. http://www.gotfloaters.com/1frequentlyaskedquestions.html
14. "I'm 24 and developed terrible floaters post-lasik surgery. Now I’m in visual hell, and can hardly concentrate to read my textbooks. "http://floatertalk.yuku.com/topic/1652 see also: http://www.gotfloaters.com/1whogetsfloaters.html

Sources

1. http://en.wikipedia.org/wiki/Floaters
2. www.gotfloaters.com The website of Dr James Johnson MD. Accessed on January 12, 2009
3. Ronald Crick & Peng Khaw, A Textbook of Clinical Ophthalmology, 3rd Ed. World Scientific, London 2003.
4. www.floatertalk.yuku.com
5. http://www.petitiononline.com/qd2584/petition.html