This fact highlights that many patients become accustomed and adapt to floaters, but others report distressing symptoms interfering with many activities of daily living. There must be an explanation, but no studies have been undertaken to identify why.
Because no pathologic effects on the eye result from vitreous synchysis and syneresis assuming no anomalous PVD 2 with an associated retinal tear or other pathology 3 , observational management of the patient with floater symptomatology is undertaken with the expectation that accommodation and adaptation will occur.
To date, this approach has certainly been a useful, conservative manner to manage these individuals.
- J Sebag - Google Scholar Citations.
- The vitreous : structure, function, and pathobiology - Ghent University Library.
- Green’s Functions in the Theory of Ordinary Differential Equations;
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However, some patients continue to report adverse effects of floaters on their quality of life, and they seek help, sometimes desperately. However, the majority of patients who undergo Nd:YAG vitreolysis for treatment of their floaters will not be aided by that intervention.
Abnormalities of human vitreous structure in diabetes
Pars plana vitrectomy can rid the eye of floaters, but it can have side effects. The greatest risks of PPV are retinal tears at the time of surgery and cataract formation in the near term after the surgery. These consequences are perhaps alleviated by a surgical approach wherein subtotal vitrectomy is accomplished: no vitreous detachment is induced, and at the conclusion of the case, the superior trocars are extracted with nonhollow probes within them to mitigate against vitreous incarceration in the sclerotomies. Leaving an intact posterior vitreous cortex, however, can lead to an anomalous vitreous separation later, associated with a macular pucker or other manifestations of anomalous PVD.
In addition, a later complete posterior vitreous separation can be associated with recurrent floater symptoms. Further, in phakic patients, the anterior vitreous is kept intact behind the lens to guard against cataract-inducing oxygenation of the lens after vitrectomy.
Structure, Function, and Pathobiology
In consideration of these issues, how shall we counsel patients with floaters who feel they are negatively impacting the quality of their lives? This month, we are fortunate to have the expert commentary of Drs. Jerry Sebag and Frank Koch. Sebag J. The Vitreous — Structure, Function, and Pathobiology. New York, NY: Springer; Anomalous posterior vitreous detachment — a unifying concept in vitreo-retinal diseases. Graefes Arch Clin Exp Ophthalmol.
Vitreous Anatomy and Pathology
Vitreous anatomy, aging, and posterior vitreous detachment. Encyclopedia of the Eye. Oxford, United Kingdom; Elsevier; Utility values associated with vitreous floaters.
Am J Ophthalmol. Floaters and the quality of life [editorial]. Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters.
Retinal Physician - Controversies in Care
Eye Lond. Safety of vitrectomy for floaters. Wilkinson CP. Safety of vitrectomy for floaters — how safe is safe?
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Vitrectomy for floaters: prospective efficacy analyses and retrospective safety profile. W e began performing vitrectomy for floaters approximately 15 years ago when the use of YAG lasers to treat floaters was promoted on the East Coast. Patients from California traveled there to be treated, but some returned miserable, worse than they were before. The results with vitrectomy in these patients were excellent, and the patients were happy. Yet the degree of surgery required with gauge instruments and the methods employed at that time seemed too invasive to offer to more patients complaining of floaters.
With the advent of sutureless gauge vitrectomy, attitudes began to change. When a study appeared demonstrating how we in the medical profession have underestimated the negative impact of floaters on quality of life, the approach to these patients became more respectful and open minded. What was lacking, however, was an objective means to quantify floaters, either structurally or functionally.
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It was the brilliant Alfredo Sadun, MD, PhD, at the Doheny Eye Institute who reasoned that light scattering by vitreous opacities would not only cast shadows perceived by patients as floaters, but it could also degrade contrast sensitivity. Finally, a way to distinguish between patients who were truly disturbed by floaters and not just obsessing and over-reacting was available. It seems that you're in Germany. We have a dedicated site for Germany. The vitreous body long has been the most mysterious of all ocular structures, owing perhaps to its seeming simplicity.
There have been few concerted, sustained efforts to unravel the mysteries of how the vitreous is composed and what role it plays in normal physiology. Over the years, however, many studies have produced independent findings concerning vitreous biochemistry, structure, and physiology. The first few chapters present an exhaustive, yet readable, review of the body of scientific data that have come from laboratories and researchers throughout the world. Extensive bibliographies direct interested readers further into specific aspects of the basic science of the vitreous.
Chapter II: "Embryology" and Chapter IV: "Structure" present a novel organizational approach to assembling and presenting data in an integrated manner.
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