Dr. Lisa Wiedeman does an in depth review of eye floaters and current treatment protocols. This video will review surgical options such as a vitrectomy for floaters and laser vitreolysis.

generated summary

What floaters are

  • In an optometric practice spanning over 30 years, floaters are among the most common concerns. They can look like transparent threads, dots, cobwebs, or floating blobs.
  • Floaters are suspended inside the eye, not on its front surface. They move with eye movements, and trying to follow one with the eyes makes it seem to move away.
  • The vitreous is the cushioning gel that helps maintain the eye’s shape. It is about 98% water; collagen and hyaluronic acid make the rest resemble raw egg white.
  • With age, sections of the vitreous liquefy and the gel shrinks. Collagen fibers clump into strands and spots, casting shadows on the retina that are perceived as floaters.
  • How sharp or blurry a floater looks depends partly on its distance from the retina. The collagen clumps are visible when a slit-lamp beam passes through the vitreous.

When floaters signal danger

  • A sudden shower of new floaters, peripheral flashes like a camera going off, or loss of vision needs an eye examination as quickly as possible to exclude retinal detachment.
  • With age, the vitreous can pull safely away from the retina in a posterior vitreous detachment (PVD). This can produce a circular floater called a Weiss ring without harming vision.
  • If the vitreous tugs a hole or tear in the retina, fluid can get underneath it and detach the retina. Laser or surgery can repair the damage, but action is needed before the detachment spreads.

Frequency and visual impact

  • Most floaters are benign and very common. One survey found that 76% of people had seen them; they become especially common after age 50. [1]
  • After a PVD in one eye, a PVD may eventually occur in the other eye.
  • Some floaters are an occasional dot mistaken for a flying bug. A large collagen clump suspended centrally in the visual axis can make reading or driving difficult, although long-lasting, very large central floaters are uncommon.
  • There is no eye drop or vitamin that makes floaters disappear. Management depends on how disruptive they are.

Observation and neuroadaptation

  • For an uncomplicated floater or PVD, the usual approach is observation: wait, reassess in about six months or at the annual eye examination, and allow natural improvement.
  • About 95% of all floaters improve on their own within roughly six months, without any intervention.
  • Neuroadaptation helps because the brain learns to ignore a relatively small obstruction and fills in the image, so the floater becomes less noticeable even if it remains.

Laser vitreolysis

  • For a persistent floater that seriously changes quality of life, office-based laser vitreolysis is an option. Improvement is put at 40–50%, while 7.7% became worse. [2]
  • The laser targets and breaks apart the suspended floater. After numbing the eye and placing a special contact lens, the procedure takes around 15 minutes, is painless, and may require more than one visit.
  • The possible complications include a retinal tear, retinal detachment, a spike in intraocular pressure, or a cataract if the laser reaches too close to the lens.
  • Long-term safety data are lacking, not every surgeon recommends it, and the procedure is reserved for major, persistent visual disruption, not an occasionally annoying speck.

Vitrectomy

  • Vitrectomy is the older, much more invasive operation. Instruments enter the eye, remove the vitreous gel along with the floaters, and put fluid in its place to maintain eye shape.
  • About 90% of patients are satisfied after vitrectomy, but it is not a guarantee that floaters will never return. [3]
  • For someone who has not undergone cataract surgery, the extra cataract risk is put at about 30%. Other risks include retinal tears or detachment, vitreous hemorrhage, glaucoma, and severe infection, with an approximately 2% risk cited for other complications. [3]
  • Despite its high success rate, this operation is for people with substantially impaired daily life, not a tiny passing floater.

Floater supplements

  • Products with names like ‘Vitreous Health Eye Floaters Formula’ are sold. The small placebo-controlled FLIES study, with 31 subjects, found a benefit from its supplement. [4]
  • Marketing promises warrant skepticism, but someone with substantially bothersome floaters who is not ready for laser or surgery might try the supplement after reading the study and deciding for themselves.

The pineapple idea

  • Pineapple contains bromelain, an enzyme thought to break down the collagen fibers in the vitreous and thereby reduce floaters. A pineapple-consumption study examined this possibility. [5]
  • The pineapple work has not been independently replicated, and its regimens involve eating different amounts of pineapple each day. [5]
  • If bromelain breaks down collagen in the eye, the same effect on collagen in skin, cartilage, and muscle is a concern.
  • The pineapple cure is rejected because of concerns about loading the body with fruit sugars—glucose, fructose, and sucrose—and their effects on insulin and blood glucose.

Carnivore, food, and healing

  • Messages received through Carnivore Doctor work include positive changes in eyesight and eye diseases after moving to keto or keto-carnivore eating.
  • One person wrote that a large island of floaters interfering with vision disappeared after six months of carnivore eating.
  • The dietary approach removes processed foods, seed oils, grains, and sugars. Its root-cause focus is to eliminate food viewed as toxic and give the body the opportunity to heal and move toward health.

Questions from viewers

  • For someone seeing floaters after a steroid shot, if there is no sudden shower, flash, or change in vision, a simple floater is likely; an eye examination is still advised to rule out a small retinal hole or tear.
  • A weight-loss stall on ketovore is unlikely to be caused directly by a prior detached retina, eye operations, or a cataract; many other factors affect weight loss.
  • Floaters can be vivid against a plain blue sky. One floater visible since the early twenties resembled an armless stick figure; no personal PVD had occurred.
  • Nearsightedness raises the chance of floaters and PVD: the eye has a longer axial length, leaving the vitreous to occupy more space and making separation more likely.
  • Oral collagen supplements need not be avoided because of floaters. Collagen eaten for joints, muscles, or hair does not simply enter the vitreous and cause clumping.
  • Type 2 diabetes need not be lifelong or require lifelong medication; it can be reversed, and even early diabetic retinopathy can reverse.

References

  1. [07:00] Prevalence of vitreous floaters in a community sample of smartphone users — https://doi.org/10.3980/j.issn.2222-3959.2013.03.27
  2. [10:38] Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters — https://doi.org/10.1038/sj.eye.6700026
  3. [13:37] Efficacy and Safety of Pars Plana Vitrectomy for Primary Symptomatic Floaters: A Systematic Review with Meta-Analyses — https://doi.org/10.1007/s40123-022-00578-9
  4. [15:08] Dietary Intervention With a Targeted Micronutrient Formulation Reduces the Visual Discomfort Associated With Vitreous Degeneration — https://doi.org/10.1167/tvst.10.12.19
  5. [16:04] Pharmacologic vitreolysis of vitreous floaters by 3-month pineapple supplement in Taiwan: A pilot study — https://doi.org/10.7537/marsjas150419.03