Guidelines for primary carers

Eye floaters represent one of the most common presentations to hospital eye services. A 2002 survey of a proportion of the 9,349 practising UK optometrists suggested that an average of 14 patients per month per optometrist presented with symptoms of floaters 1.

There are various causes for the appearance of floaters, simply stated, any damage to the eye that causes material to enter the vitreous humour can result in floaters. Serious pathology is rare as a cause, but patients with new onset flashes and/or floaters, especially when associated with visual loss or restriction in the visual field, should seek more urgent ophthalmologic evaluation.

For a small minority of patients opacities are so dense, numerous or severe that they negatively impact quality of life2, 3.  Using an objective qualitative measure called Utility Value, Wagle and associates found patients expressed that floaters have a similar or higher impact than the ocular diseases of AMD, retinopathy and glaucoma as well as the systematic diseases of mild angina, mild stroke, colon cancer, and asymptomatic HIV2.  Unfortunately, many of these patients report a lack of empathy and good advice from primary carers at the time of diagnosis.  Our poll into sufferer experiences of the eye profession suggested that three quarters of people had a negative one.

Top complaints that sufferers of severe vitreous opacities have told us about are:

1. Professionals invalidating their experiences:  It seems that some ophthalmologists are reluctant to accept that a patient’s experience of the severity of their condition can be rational, accurate and proportionate. Patients frequently report that they have been accused of having obsessive personalities, despite there being nothing to support this evaluation.
2. Lack of empathy: Some doctors understandably focus on the the pathology of visual health and can be dismissive of the emotional and practical impact of vision conditions. 
3. Information about treatment options and further support being withheld or presented in a slanted way.
4. Being told that the condition will "get better over time". Patients feel more frustrated and distressed when this proves not to be the case and it undermines their trust in their doctor.

This experience is unfortunately reflected in the general profile of and research into the condition. Treatments carry significant risks and have variable outcomes while research is almost non-existant. We support the view of Drs Wa and Sebag:

"In view of the fact that floaters are perceived by patients as a significant health problem, it is incumbent on the medical profession to develop effective and safe methods to cure this disease."

What can you do to help?

Do’s

1. Acknowledge the sufferer’s experience of the severity of his/her situation as valid. A few sympathetic words can make a vast difference. Fears over physical health are only part of the reason a patient is visiting you.
2. Explain that eye floaters are quite common, especially in adults. However, it is extremely important to recognise that there is a spectrum of the condition and for the patient to understand where they sit on that spectrum.
3. Where appropriate, encourage the patient with practical suggestions for how to improve their quality of life:
   1. For some suggestions, see our Living with floaters page.
   2. Offer referrals to support agencies or Visual Impairment Groups. For some suggestions, see our Support Agencies page.
4. Explain that surgery is an option if their situation becomes intolerable. Contrary to doctors' fears, being aware of this option can make sufferers less likely to seek serious intervention prematurely as they feel more confident about waiting.
5. Refer them to our charity and give them a copy of our leaflet.
6. Help to promote recognition of the condition amongst your peers.

Don’ts

1. Do not offer negative counseling. Avoid using words and phrases such as "incurable", "permanent" or "you’ve got to live with it" or "you have the eyes of a 60 year old" when that person is much younger than this. These will only worsen the patient’s perception of his or her vision problem and general health.
2. Do not label the sufferer’s experience as psychological without good reason for thinking it is.
3. Do not tell patients that floaters will get better over time if there is unlikely to be a physical change, rather that the patient's perception of them may do.

• 1. Alwitry, A., H. Chen, and S. Wigfall. "Optometrists' examination and referral practices for patients presenting with flashes and floaters." Ophthalmic Physiol Opt. 22.3 (2002): 183-8.
• 2. a. b. Wagle, Ajeet M., et al. "Utility values associated with vitreous floaters." Am. J. Ophthalmol.. 152.1 (2011): 60-65.e1.
• 3. Sebag, Jerry. "Floaters and the quality of life." Am. J. Ophthalmol.. 152.1 (2011): 3-4.e1.