Doctors Without Compassion

Why is it that the average Ophthalmologist is so dismissive and inhumane when someone complains of floaters? People who complain or seek treatment are reflexively labeled "neurotic," or "obsessive." They are told to "ignore" it or not to "fixate" on them or "forget" about them. Please!

How do you "ignore" a big black clump of crap that is constantly in the center of your field of vision and constantly whizzing by from one side of your eye to the other as your eyes scroll left to right to read or drive or....do anything?

In my right eye, I have what looks like two Q-tips with big, fuzzy black heads, long stems, and many pieces of debris attached to them -- and they are ALWAYS in the center of my field of vision and are plainly visible WITHOUT fixating on them or looking for them....they're just there, as someone's fingers would be if someone were to jam them in my eye. They ricochet left to right and top to bottom as I move my eye. It is clearly visible even in dimly lit rooms. My Ophthalmologist said it bothers me so much because it is barely 1 mm away from my retina.

In my left eye, I have countless strands, cobwebs, dots, etc, that are in constant motion and in my field of vision most of the time.

Now, not all floaters are the same. They differ in size, darkness, mobility and proximity to the retina. Some are more tolerable than others. It kills me when doctors are too narrow-minded and stubborn to accept the notion that NOT all floaters are easily "ignored" and that not everyone is a kook because they seek treatment.

Doctors, please wake up and be a little more understanding and less arrogant and judgmental.

[Michael J Kutryb, MD]

Very interesting thread.  I think it is totally legitimate to talk about why treatment for floaters is not more mainstream.  It seems to me that east coast male may have personal motives behind his posts, maybe?  Are you a provider of floater treatments?  

Some floaters are definitely more bothersome than others and I completely agree that it is strange that there have been no large peer reviewed studies on laser treatment of floaters.  Now regarding vitrectomy for floaters, this is a controversial treatment with definite side effects that can be much worse than the original floaters. I do at least one surgery a week on a cataract that worsened after a vitrectomy (for other retinal problems.)  I empathize completely with my patients with bothersome floaters and explain the possible treatments.  It is my job to lay it out in honest terms to them and to try to be an advocate for them.  Only the patient can finally make the decision to have certain treatments based on the advise they have gathered.  In my opinion, in the future, treatments for floaters (probably laser treatemnt) will be much more mainstream but I'm not really involved in that movement myself since I don't do retinal or vitreous surgery.  I'm a little disappointed that you have a poor image of our profession.  I always thought it was the most amazing field ever and I love my job.  I know that there always a few crabby apples in any profession. I hope you won't judge all by your experiences.

MJK MD

MJK MD

[JodieJ]

We all have lapses in showing empathy for others, and doctors are people just like the rest of us.  (Some ophthalmologists are also very much bothered by floaters.)  Unfortunately, there are no safe, effective treatments for floaters currently available.  Some ophthalmologists do perform vitrectomies for floaters.  You might want to investigate the costs/benefits of this option if your floaters are truly impairing your functioning.  (Try googling for more info.)

[east_coast_male]

Jodie:

I think the "we're all human" excuse is a copout. It doesnt account for the prevailing and ubiquitous arrogant mindset among the vast majority of ophthalmologists with regard to people who suffer from floaters. Just read some of the comments on this board. We're not talking about a doctor having a bad hair day and losing his cool one day.

Some doctors will demoralize a patient by glibly [and falsely] stating that "there's nothing that can be done for floaters," or as you out it "there are no safe, effective treatments for floaters currently available", when the truth is quite the opposite.

I have indeed already researched FOVs (Floaters Only Vitrectomy) and while it certainly has its risks that one must consider before making the decision to go forward with one, it also has had extremely high success rates and the complications are usually expected and manageable. Pars plana vitrectomies have been performed for over 30 years, and with the advent of 25G catheters and other techniques, they are safer than ever. They have come a long way.Still with serious risks, no doubt.

There is also Vireolysis, which leverages the power of a YAG Laser and does have some measure of success, depending on the type of floater and its location.

Both procedures offer hope for those who are willing to take calculated risks and try them.

It is irresponsible and disingenuous for a physician to say "there's nothing that can be done" and leave a floater sufferer feeling hopeless when its simply not true. And then they add insult to injury by calling those who seek treatment "neurotic" or even worse.

[JodieJ]

I hear you.  It's my understanding that there are currently no APPROVED treatments for floaters.  (It was only a couple of years ago that patients who complained about their vision with ReZoom IOLs were labeled "neurotic" and "obsessive."  Now we blame the poor technology of ReZoom.)

I don't have floaters (yet, anyway) but I've had a vitrectomy to peel an ERM.  This is not painful surgery.  The major side effect is accelerated cataract development.  I've seen statistics for the risk of retinal detachment ranging from 1% to 5%, related somewhat to the skills of the surgeon.  If you're interested, find the most experienced surgeon around and discuss the risks/benefits of this option in your case.  Do the same for Vireolysis.

[BUTTERCUP109]

I agree with you that something needs to change in the ophthalmology field as a whole. Step one would be to have floaters taken more seriously in med school so that doctors do not learn here that "floaters are no big deal"...those patients that complain are, ya know, "complainers!" Then maybe there would be some serious research that could help people who have large dense opacities near the retina that truly obstruct vision. What is crazy to me is that doctors like Karickhoff and Geller have been removing these things with lasers for two decades, writing and documenting outcomes, YET, no one in the established university communities will undertake any scientifically-based studies to give it any credibility. This is what needs to change! I think that we will see this in the future. A doctor James Johnson in California is a young doctor who treats floaters exclusively. If there was no success to this and patients went away unhappy, how could he make a living doing this? In fact,people flock to him from around the world! There is clearly an unmet need.

[east_coast_male]

In response to the physician:

Thank you for responding.

The opening part of your response is disappointing. The rest is encouraging and I appreciate your honesty.

I'm a computer network engineer, not a physician. My only motive for posting this message is my utter disappointment and disgust with the dismissive attitude of so many Ophthalmologists toward those who suffer from vitreous floaters. In fact, my brother is a well-known Ophthalmologist, who specializes in Glaucoma, and he is just as dismissive and insensitive as the average physician out there.

It is this attitude that has led to the lack of advancement in treating vitreous floaters. In my original post, I described my floaters in detail, yet you just glossed right over it and instead accused me of having some ulterior motive. This very behavior is exactly what Im talking about: dismissing a patient's suffering because you dont think it is something they should be suffering from.

My motive for posting this message is my frustration with the community of Ophthalmologists who have failed to give floater treatment the attention it deserves and who have instead written sufferers off as "kooks" and obsessive neurotics simply because they has failed so miserably to adopt a widely-accepted treatment and make it part of the standard of care. Instead they choose to tell a patient that its all in their head.

Lastly, my motive is to confront those physicians who flat out lie to their patients and say that there is no treatment for floaters, when in reality there are. Of course these treatments are not without their risks and a physician has the responsibility of informing the patient,  BUT IT IS UP TO THE PATIENT to elect whether to move forward with the surgery, not the physician's! The physician can advise, recommend -- strenuously, even -- but NOT hide the truth because they dont think the patients' problems are real or that they are intelligent or sane enough to make their own choices.

[malog]

On Dec 25th I had a vitrectomy for floaters in my left eye by Dr. Steve Charles. I have had a terrible time with floaters since age 23. I am 52 and -7 myopic. Everything has gone well except I don't get along well with steroid eye drops. The day after my surgery My VA was 20/20 and IOP was 16. The Dr. Dukey went to ( Dr. Brian Ward ) is also one of many retina specialists who realise this is a legitamate problem. His website for Retinal Dignostic Center explains his rational. In my case, enough was enough and if I get a cataract, I'll go for mono vision.

[malog]

My surgery was Dec. 15 th not Dec. 25

[JodieJ]

I would also enthusiastically recommend Dr. Charles.  He performed a vitrectomy to peel the ERM remaining in my eye after an initial (botched) surgery.  I also had 20/20 acuity and normal IOP in my affected eye the morning after surgery.

The major side effect of a vitrectomy is accelerated cataract development, but this is not necessarily a bad thing.  Cataract surgery eliminated my high myopia, and my Blue Cross paid for all of it (including the surgery on my fellow eye which did not have a cataract.)  What an unexpected gift!