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MEDICAL JOURNAL DOCUMENTS PEOPLE'S CONCERNS ABOUT FLOATERS

Jul 14, 2011 - 4 comments

FROM: JOHN C. HAGAN III MD, FACS, FAAO: THIS IS A SCIENTIFIC ARTICLE FROM THE JULY 2011 AMERICAN JOURNAL OF OPHTHALMOLOGY AND IT INDICATES HOW MUCH FLOATERS BOTHER SOME PEOPLE: THERE IS ALSO AN EDITORIAL ABOUT THE ARTICLE WHICH I HAVE POSTED TODAY ALSO.

Utility Values Associated With Vitreous Floaters
Ajeet M. Wagle
AffiliationsDepartment of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, SingaporeDepartment of Ophthalmology and Visual Sciences, Alexandra Hospital, SingaporeEye Clinic, Jurong Medical Center, SingaporeFaculty of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeInquiries to Ajeet M. Wagle, Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
, Wei-Yen Lim
AffiliationsDivision of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
, Tiong-Peng Yap
AffiliationsDepartment of Ophthalmology and Visual Sciences, Alexandra Hospital, Singapore
, Kumari Neelam
AffiliationsDepartment of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, SingaporeDepartment of Ophthalmology and Visual Sciences, Alexandra Hospital, SingaporeEye Clinic, Jurong Medical Center, Singapore
, Kah-Guan Au Eong

Purpose
To ascertain the health-related quality of life associated with symptomatic degenerative vitreous floaters.

Design
Cross-sectional questionnaire survey.

Methods
In this institution-based study, 311 outpatients aged 21 years and older who presented with symptoms of floaters were enrolled. Data from 266 patients (85.5%) who completed the questionnaire were analyzed. Utility values were assessed using a standardized utility value questionnaire. The time trade-off (TTO) and standard gamble (SG) for death and blindness techniques were used to calculate the utility values. Descriptive, univariate, and multivariate analyses were performed using Stata Release 6.0.

Results
The mean age of the study population was 52.9 ± 12.02 years (range, 21–97). The mean utility values were 0.89, 0.89, and 0.93 for TTO, SG (death), and SG (blindness), respectively. Patients aged ≤55 years reported significantly lower SG (blindness) utility values when compared with patients above 55 years of age (age ≤55 = 0.92, age >55 = 0.94, P = .007). Utility measurements did not demonstrate significant relationship with any of the other socio-demographic variables examined in this study. The utility values did not demonstrate any significant relationship with other ocular characteristics such as duration of symptoms, presence of a posterior vitreous detachment, and presence or severity of myopia.

Conclusions
Symptomatic degenerative vitreous floaters have a negative impact on health-related quality of life. Younger symptomatic patients are more likely to take a risk of blindness to get rid of the floaters than older patients.



Floaters are entoptic images of opacities in the vitreous cavity that usually occur as a result of degenerative changes in the vitreous gel such as vitreous syneresis, condensation of vitreous fibers, and posterior vitreous detachment (PVD).1, 2, 3 Degenerative vitreous floaters may become asymptomatic with passage of time. However, in some patients, symptomatic degenerative vitreous floaters persist for many years and can potentially affect health-related quality of life in several ways. Floaters can result in intermittent blurred vision, glare and haze attributable to migration of vitreous opacities into the visual axis, and interference with important activities of daily living such as reading, driving, and near work.3

Individuals with symptomatic degenerative floaters constitute a fair proportion of patients seen in ophthalmology clinics in Singapore. Myopia, which is often associated with degenerative floaters, is a growing public health problem with high prevalence rates in Singapore.3, 4, 5 The health-related quality of life associated with floaters is not well understood. Of note, Snellen acuity, the standard test of visual function in a clinical setting, is unable to quantify visual disability associated with vitreous floaters on day-to-day functioning and overall quality of life.1, 3, 6 Although surgical interventions such as Nd:YAG laser vitreolysis, deep anterior vitrectomy combined with cataract surgery, and pars plana vitrectomy are available, they have been offered to patients with symptomatic floaters only rarely.1, 3, 6

Health-related quality of life is playing a vital role in every specialty of medicine because of the increasing importance of patient preferences and escalating healthcare costs. Utility values, originally described by Von Neumann and Morganstern in 1940, allow an objective quantification of the functional quality of life associated with a specific disease state.7, 8, 9 By convention, a utility value of 1.0 implies a perfect health state whereas a value of 0.0 indicates the worst possible health state or death. The closer the value is to 1.0, the better is the perceived health-related quality of life. Currently, utility values modified by Brown and associates are used for measuring health-related quality of life in patients with eye diseases.10 Utility values are measured using a number of techniques. The time trade-off (TTO) and standard gamble (SG) methods represent 2 common techniques of eliciting preferences under the utility theory. The TTO utility measures the numbers of years of remaining life that an individual is willing to trade off for a hypothetical technology that restores perfect vision, whereas the SG utility assesses the risks associated with a hypothetical technology that the patient is willing to take to return to the perfect health state.

Utility values have been measured for a variety of eye diseases that affect health-related quality of life such as diabetic retinopathy, age-related macular degeneration, glaucoma, and myopia.9, 11, 12, 13, 14, 15 Understanding the impact of floaters on the overall health-related quality of life can be invaluable in deciding possible treatment options in specific subgroups of patients. In this study, we assess the utility values in patients presenting primarily with a history of floaters.

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Methods
In this questionnaire-based study, we enrolled consecutive patients presenting primarily with a history of floaters to the Department of Ophthalmology and Visual Sciences in Alexandra Hospital, Singapore, from April 1, 2006 to December 31, 2007.

Patients were eligible to participate in the study if they satisfied the following criteria: age 21 years and above, history of floaters in 1 or both eyes, best-corrected visual acuity (BCVA) better than 20/30 in the better-seeing eye, no significant coexisting retinal pathology, and willingness to give an informed consent. Patients with acute-onset floaters (defined as floaters of less than 4 weeks' duration), and high myopia (spherical equivalent equal to or greater than −6.0 diopters [D]) were also included in the study. Patients with floaters secondary to other eye conditions such as vitreous hemorrhage, vitreous inflammation, and ocular trauma were excluded from the study. Similarly, patients with dense corneal or lenticular opacities that hindered optimal visualization of the fundus or those with concomitant ocular diseases resulting in loss of vision were not eligible to participate in the study. Lastly, patients were not enrolled if they were unwilling to answer and/or unable to understand utility value questionnaires because of psychiatric problems or dementia.

A comprehensive eye examination including Snellen BCVA, slit-lamp biomicroscopy, and a dilated fundus examination using indirect ophthalmoscopy was performed for each patient. Additionally, in all participants, demographic and socioeconomic data, such as age, gender, ethnicity, educational status, occupation, housing, personal and family income, and total number of family members, were recorded.

A single trained research assistant interviewed the patients using a standardized utility value questionnaire.11, 12, 15 Where necessary, the questionnaire was interpreted by the interviewer in the patients' preferred language. During the face-to-face interviews, the research assistant encouraged the patients to ask questions if they were unable to comprehend the utility questionnaire.

Utility values were calculated using the commonly used techniques of TTO and SG for death and blindness. TTO utility value was calculated based on the time traded in years over the expected number of years of the respondent's remaining life that he/she is willing to give up for a hypothetical technology to restore perfect health (TTO utility = 1 – [time traded in years/estimated number of years of remaining life]). Standard gamble utility was calculated as the amount of risk (in percentage) of death or blindness that a respondent is willing to take for a hypothetical technology that may restore perfect vision respectively (SG utility = 1 – [amount of risk of death or blindness in percentage that the respondent is willing to take/100]).

Data Analysis
Descriptive, univariate, and multivariate analyses were performed using Stata Release 6.0 (Stata Corporation, College Station, Texas, USA). The mean and median TTO, SG (death), and SG (blindness) utilities were calculated for all patients with floaters. Utility values were compared across different age groups, socio-demographic groups, and patients' presentation characteristics using the Wilcoxon rank sum test and Kruskal-Wallis test. These nonparametric tests were used for statistical analysis because the normality assumption needed for parametric tests was not satisfied by our sample. All P values quoted are 2-sided and considered statistically significant when the values are below .05. Multiple linear regression analysis was performed after adjusting for the effect of confounding factors.

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Results
In this cross-sectional study, 311 consecutive patients presenting primarily with a history of floaters were enrolled. Of these, data from 266 patients (85.5%) who completed the questionnaire were analyzed. The details of demographic and socioeconomic characteristics are presented in Table 1.

TABLE 1. Demographic and Socioeconomic Characteristics of Study Population With Symptomatic Degenerative Vitreous Floaters (N = 266)
Demographic Characteristics Number (%)
Mean age (range), years 52.9±12.02(21–97)
Sex ratio (male:female) 0.78:1
Ethnicity  
Chinese (%) 239(89.9%)
Non-Chinese (%) 37(10.1%)
Housing type  
Public housing estates 215(81.4%)
Private housing 49(18.6%)
Education status  
No formal education/primary education 51(19.3%)
Secondary education 119(44.9%)
Tertiary education 95(35.8%)
Average number of family members (range) 3.48(1-7)
Employment status (%)  
Employed 174(65.9%)
Unemployed/retired 90(34.1%)
Average monthly income (USD)  
Personal 1665
Family 2371
USD = United States dollars.


Utility Values
The mean utility values for our study population were 0.89, 0.89, and 0.93 for TTO, SG (death), and SG (blindness), respectively.

Utility Values and Demographics
The details of utility values associated with various demographic factors are shown in Table 2. Time trade-off and SG (death) utility values did not differ significantly with age in patients with floaters (TTO: age ≤55 = 0.89, age >55 = 0.89, P = .16; SG [death]: age ≤55 = 0.88, age >55 = 0.90, P = .07). However, patients aged ≤55 years reported lower SG (blindness) utility values when compared with patients >55 years of age (age ≤55 = 0.92, age >55 = 0.94, P = .007).

TABLE 2. Utility Values Associated With Various Demographic and Socioeconomic Factors in Patients With Symptomatic Degenerative Vitreous Floaters
Characteristic n TTO Mean (Median) P Value n SG (Death) Mean (Median) P Value n SG (Blindness) Mean (Median) P Value
All 266 0.89(1.00)  266 0.89(1.00)  266 0.93(1.00)  
Age   .16   .07   .007a
≤55 years 146 0.89(0.96)  146 0.88(1)  146 0.92(1)  
>55 years 120 0.89(1)  120 0.90(1)  120 0.94(1)  
Gender   .52   .20   .39
Male 117 0.89(1)  117 0.88(1)  117 0.92(1)  
Female 149 0.90(1)  149 0.89(1)  149 0.94(1)  
Race   .57   .26   .54
Chinese 239 0.89(1)  239 0.88(1)  239 0.93(1)  
Non-Chinese 27 0.92(1)  27 0.92(1)  27 0.92(1)  
Personal income   .26   .29   .65
No income 121 0.90(1)  121 0.89(1)  121 0.93(1)  
US$ 1–1333.3 62 0.87(0.9)  62 0.86(1)  62 0.94(1)  
US$ >1333.3 83 0.90(1)  83 0.90(1)  83 0.91(1)  
Household income   .57   .77   .46
No income 113 0.89(1)  113 0.88(1)  113 0.93(1)  
US$ 1–1333.3 78 0.89(0.953)  78 0.90(1)  78 0.94(1)  
US$ >1333.3 75 0.90(1)  75 0.89(1)  75 0.92(1)  
Education   .13   .93   .59
No formal education/primary education 51 0.92(1)  51 0.87(1)  51 0.91(1)  
Secondary education 119 0.87(1)  119 0.88(1)  119 0.93(1)  
Diploma/degree 95 0.90(1)  95 0.91(1)  95 0.95(1)  
Housing type   .44   .46   .57
Public (1–4 room flats) 120 0.88(1)  120 0.90(1)  120 0.92(1)  
Public (>5 room flats) 95 0.89(1)  95 0.87(1)  95 0.93(1)  
Private 49 0.91(1)  49 0.90(1)  49 0.96(1)  
Occupation   .13   .19   .48
Employed/student 174 0.89(1)  174 0.88(1)  174 0.93(1)  
Housewife/retired/non-employed 90 0.90(1)  90 0.90(1)  90 0.93(1)  
SG = Standard gamble; TTO = time trade-off; US$ = United States dollar (1 US$ = 1.50 Singapore $).


aSignificant P value 1 month 124 0.90(1)  124 0.89(1)  124 0.93(1)  
Laterality of presentation   .89   .36   .75
Unilateral 113 0.89(1)  113 0.89(1)  113 0.93(1)  
Bilateral 153 0.90(1)  153 0.89(1)  153 0.9391)  
Myopia   .55   .26   .92
No myopia 107 0.90(1)  107 0.86(1)  107 0.91(1)  
Myopia in at least 1 eye 159 0.89(1)  159 0.90(1)  159 0.95(1)  
Severity of myopia   .41   .35   .58
SE less than −6.0 D 100 0.92(1.00)  115 0.92(1.00)  116 0.94(1.00)  
SE greater than or equal to −6.0 D 59 0.88(0.96)  64 0.88(1.00)  67 0.95(1.00)  
PVD   .79   .57   .42
Absent 131 0.90(1)  131 0.90(1)  131 0.93(1)  
Present 135 0.88(1)  135 0.88(1)  135 0.93(1)  
D = diopter; PVD = posterior vitreous detachment; SE = spherical equivalent; SG = standard gamble; TTO = time trade-off.


Utility Values and Acute-Onset Floaters
The mean (± SD) duration of presence of vitreous floaters was 54.8 ± 6.12 weeks, ranging from 1 week to 5 years and 10 months (300 weeks). Acute-onset floaters were noted in 142 of the 266 patients (53.4%). Patients with acute-onset floaters did not report significantly different utility values from patients with long-standing symptomatic floaters (TTO: acute-onset floaters = 0.88, long-standing floaters = 0.90, P = .34; SG [death]: acute-onset floaters = 0.89, long-standing floaters = 0.89, P = .90; SG [blindness]: acute-onset floaters = 0.93, long-standing floaters = 0.93, P = .81).

Utility Values and Bilateral Floaters
A history of bilateral vitreous floaters was present in 153 of 266 patients (57.5%). Patients with bilateral floaters did not demonstrate significantly different utility values from those having unilateral vitreous floaters (TTO: unilateral = 0.89, bilateral = 0.90, P = .89; SG [death]: unilateral = 0.89, bilateral = 0.89, P = .36; SG [blindness]: unilateral = 0.93, bilateral = 0.93, P = .75).

Utility Values and Myopia
The prevalence of myopia, defined as spherical equivalent greater than −0.5 D in at least 1 eye, in our study population was 60% (159/266), with a third (59/159, 37%) of these patients having high myopia. Utility values did not differ significantly with presence or absence of myopia in patients with vitreous floaters (TTO: myopia present = 0.90, myopia absent = 0.89, P = .55; SG [death]: myopia present = 0.86, myopia absent = 0.90, P = .26; SG [blindness]: myopia present = 0.91, myopia absent = 0.95, P = .92). The severity of myopia also did not show a significant relationship with utility values (TTO: myopia equal to or higher than −6.0 D = 0.88, myopia lower than −6.0 D = 0.90, P = .41; SG [death]: myopia equal to or higher than −6.0 D = 0.88, myopia lower than −6.0 D = 0.92, P = .35; SG [blindness]: myopia equal to or higher than −6.0 D = 0.95, myopia lower than −6.0 D = 0.94, P = .58).

Utility Values and Posterior Vitreous Detachment
A PVD was observed in 135 of 266 patients (50.7%). The presence of PVD did not affect utility values significantly (TTO: PVD present = 0.90, PVD absent = 0.88, P = .79; SG [death]: PVD present = 0.90, PVD absent = 0.88, P = .57; SG [blindness]: PVD present = 0.93, PVD absent = 0.93, P = .42).

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Discussion
In this study, we assessed the health-related quality of life in 266 patients presenting primarily with a history of floaters using utility values. The results suggest that degenerative floaters have a negative impact on the health-related quality of life. Younger patients with symptomatic floaters exhibit relatively lower utility values for SG (blindness) when compared with elderly symptomatic patients.

Patients with floaters are willing to trade off an average 1.1 years out of every 10 years of their remaining life to get rid of the symptoms associated with floaters. Furthermore, these patients are willing to take, on average, an 11% risk of death and a 7% risk of blindness to get rid of symptoms relating to floaters. The mean utility values for patients with floaters are comparable to the utilities reported by patients with other eye diseases such as age-related macular degeneration, diabetic retinopathy, and myopia with similar visual acuity (visual acuity of 20/20 to 20/25) (Table 4). 9, 11, 12, 13, 14, 15 Interestingly, the mean TTO utility value for floaters is also comparable to TTO values reported for many other systemic diseases and health states such as hypertension, mild angina, mild stroke, colon cancer, and asymptomatic HIV infection (Table 5).8, 16, 17, 18, 19 Although floaters do not seem to affect quality of life to the same degree as more severe forms of ocular and systemic diseases, their impact is nevertheless noteworthy.

TABLE 4. Comparison of Utility Values for Symptomatic Degenerative Vitreous Floaters With Other Ocular Diseases and Health States
Ocular Disease/Health State TTO SG (Death) SG (Blindness)
Floaters 0.89 0.89 0.93
Myopia    
1. In teenage school students15 0.93 — 0.85
2. In medical students9 0.97 0.99 —
Glaucoma13 0.88 0.94 0.95
Diabetic retinopathy12 (BCVA 20/20 to 20/25) 0.85 0.88 —
Age-related macular degeneration11 (BCVA 20/20 to 20/25) 0.89 0.96 —
BCVA = best-corrected visual acuity in the better eye; SG = standard gamble; TTO = time trade-off.


TABLE 5. Comparison of Time Trade-off Utility Values for Symptomatic Degenerative Vitreous Floaters With Other Systemic Diseases
Systemic Disease/Health State TTO Utility
Floaters 0.89
Hypertension16 0.98
Mild angina8 0.87
Mild stroke17 0.87
Colon cancer18 0.88
Asymptomatic HIV infection19 0.87
HIV = human immunodeficiency virus; TTO = time trade-off.



Similar to other studies, we observed overall higher utility values for SG (blindness) when compared to the TTO and SG (death) values in our study population. This shows that compared to trading years of remaining life for a better health-related quality of life or taking a risk for immediate death, individuals are less willing to take a risk of blindness. This risk aversion with the SG technique has been reported by past studies investigating utility values in eye diseases.9

In our study population, younger patients (21–55 years) with symptomatic floaters were willing to take a relatively higher risk of blindness to get rid of floaters when compared with elderly patients (>55 years). Two previous studies have proposed that the higher utility values observed in teenage students (15-18 years) with myopia, in contrast with adults, suggests that students are less willing to take risks in return for perfect vision than adults because of differences in value of impact of the eye disease and life expectancy.15 Our finding suggests that younger patients, who belong to the economically active group, are more keen and less risk-averse to improve their health-related quality of life by opting for a therapeutic intervention to remove their floaters. This subgroup of patients may benefit from current treatment options to improve their health-related quality of life. The elderly symptomatic patients may have reported a relatively higher SG (blindness) utility value due to risk aversion when compared with younger patients.

We failed to observe a significant relationship between utility values and the socioeconomic variables. Results of previous studies that have investigated the relationship between socioeconomic variables and utility values in various eye diseases have been inconsistent. For instance, of the 4 studies that have examined the relationship between educational status and utility values in patients with eye diseases, 2 have failed to demonstrate a significant relationship between level of education and utility values.9, 11, 15, 18

We compared the utility values in patients with acute-onset floaters with those having long-standing floaters and did not find any significant difference in their utility values. This is similar to the findings of Brown and associates, which showed that duration of disease did not affect utility measurements in patients with age-related macular degeneration.11

Floaters are commonly reported in eyes with myopia. In our study, 59.7% of patients had myopia, with about a third of them having high myopia. Myopia itself is also known to affect quality of life.9, 15 Vitreous floaters are often perceived much earlier in myopic eyes as vitreous syneresis and PVD tends to occur at a younger age in these eyes.3, 4 The retinal magnification of the images associated with myopia also makes the symptom more pronounced. As myopia is a growing public health problem with high prevalence rates especially in several southeast Asian countries,5 the prevalence of patients with symptomatic floaters is likely to increase. This prompted us to compare the utility values associated with floaters in patients with and without myopia; however, we failed to demonstrate a significant relationship between utility values and presence (degree) of myopia in patients with floaters. Two previous studies have also shown no significant difference in utility values with different severity of myopia.9, 15

We are aware of certain potential limitations of our study. First, the results of this study may not truly reflect the impact of floaters on specific vision-related tasks because we did not use a vision-specific quality-of-life questionnaire. Second, we did not examine the relationship between utility values and detailed characteristics of vitreous floaters, such as number, size, and density of floaters as well as the area of visual field involved by the floaters. Other potential limitations that would preclude generalizing our study results are a relatively small sample size, a single-center study, and a predominantly Chinese study population.

In conclusion, symptomatic degenerative vitreous floaters have an impact on the health-related quality of life. Young symptomatic patients are more likely to take a risk of blindness to get rid of floaters.

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Publication of this article was funded by a National Healthcare Group – Small Investigator Grant, Singapore (NHG-SIG I/06/034). The funding organization had no role in the design and conduct of the research. The authors have no financial interests to disclose. Involved in design and conduct of the study (A.M.W., T.P.Y., K.G.A.E.); collection, management, analysis, and interpretation of the data (A.M.W., W.Y.L.); and preparation, review, or approval of the manuscript (A.M.W., W.Y.L., T.P.Y., K.N., K.G.A.E.). This study and the data accumulation were carried out with ethics approval from the Domain Specific Review Board of the National Healthcare Group, Singapore. Informed consent for the research was obtained from the patients. The study was conducted in adherence to the tenets of the Declaration of Helsinki and was HIPAA compliant.


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References
1.Mossa F, Delaney YM, Rosen PH, Rahman R. Floaterectomy: combined phacoemulsification and deep anterior vitrectomy. J Cataract Refract Surg. 2002;28(4):589–592
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2.Hikichi T, Trempe CL. Relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment. Am J Ophthalmol. 1994;117(5):593–598
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3.Yonemoto J, Ideta H, Sasaki K, Hirose A, Oka C. The age of onset of posterior vitreous detachment. Graefes Arch Clin Exp Ophthalmol. 1994;232(2):67–70
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4.Byer NE. Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology. 1994;101(9):1503–1514
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5.Wong TY, Foster PJ, Hee J, et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest Ophthalmol Vis Sci. 2000;41(9):2486–2494
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6.Schiff WM, Chang S, Mandava N, Barile GR. Pars plana vitrectomy for persistent, visually significant vitreous opacities. Retina. 2000;20(6):591–596
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9.Lim WY, Saw SM, Singh MK, Au Eong KG. Utility values and myopia in medical students in Singapore. Clin Experiment Ophthalmol. 2005;33(6):598–603
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10.Brown MM, Brown GC, Sharma S, Garrett S. Evidence-based medicine, utilities, and quality of life. Curr Opin Ophthalmol. 1999;10(3):221–226
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11.Brown GC, Sharma S, Brown MM, Kistler J. Utility values and age-related macular degeneration. Arch Ophthalmol. 2000;118(1):47–51
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12.Brown MM, Brown GC, Sharma S, Shah G. Utility values and diabetic retinopathy. Am J Ophthalmol. 1999;128(3):324–330
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13.Saw SM, Gazzard G, Au Eong KG, Oen F, Seah S. Utility values in Singapore Chinese adults with primary open-angle glaucoma and primary angle-closure glaucoma. J Glaucoma. 2005;14(6):455–462
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14.Brown MM, Brown GC, Sharma S, Landy J. Quality of life and visual loss from diabetic retinopathy and age-related macular degeneration. Arch Ophthalmol. 2002;120(4):489–484
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15.Saw SM, Gazzard G, Au Eong KG, Koh D. Utility values and myopia in teenage school students. Br J Ophthalmol. 2003;87(3):341–345
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Ajeet M. Wagle is a Consultant Ophthalmologist at the Department of Ophthalmology & Visual Sciences at Khoo Teck Puat Hospital, Singapore. He specializes in the management of diseases of the vitreous and retina. Besides clincal work, he has keen interests in clinical research. He is a teaching faculty at the Faculty of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and the Singapore Polytechnic Optometry Centre.

See Accompanying Editorial on page Dr. John Hagan's Blog

PII: S0002-9394(11)00064-X

doi:10.1016/j.ajo.2011.01.026

© 2011 Elsevier Inc. All rights reserved.



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by biplob214, Jul 19, 2011
dear sir, John C Hagan III.
i am from Bangladesh.i am 36 years old .my name is nazmul bari khan. i am not rich people to go doctor all time. and another things is i don`t believe our country doctors, that`s why i find google help and i find you. please help me for good health. now i describe my symptom`s.

every some day`s after my body have pain, fever, my tong pain, from b4 one week started my ear disease, i was meet with doctor he give me medicine it is little ok now,some hearing problem now right ear coz of my only my right ear problem,from today i have too much pain in my tong and pain also my body.please give me advice and tell me some medicine name for this. my mail is ***@****.

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by lost_in_despair, Dec 13, 2011
"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.3 Despite claims on the Internet and in the lay literature, eye drops have no effect on floaters. Neodymium:yttrium–aluminum–garnet laser treatments also are not effective. Vitrectomy is effective and needs to be safe. An important consideration in this regard is the recent finding that in a study of 695 vitrectomy cases, the risk of RRD was reduced from 4.9% to 1.1% (P = .04) by using small-gauge vitrectomy instrumentation.5 Thus, until pharmacologic vitreolysis is able to meet the demands of patients with floaters, minimally invasive, sutureless vitrectomy using small-gauge instruments without PVD induction seems to be an effective and safe approach.6"

Correspondence
Safety of Vitrectomy for Floaters

Christianne Wa, Jerry Sebag


Available online 21 November 2011.

http://www.sciencedirect....le/pii/S0002939411006830

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by Dorit1710, Mar 12, 2012
Dear Doctor,

I am Dorit from India,

My 2 yrs son looking slightly side using his right eye, I suspected because of sequent eye. When I met the eye doctor they examined my son and told me there is scar in his right eye (center of the eye) by birth (They suspected because of toxoplasmosis, when he is fetus) as per doctor he is trying to see with rest of his eye and doctor told me eye vision will not drop from now and It would be same as it is,

Kindly suggest me what I have to do now? I am scared about this... Please help me

Regards
Dorit

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by Ironbear, Mar 19, 2013
Dear Doctor,

I am a 41 yr old male marathoner and triathlete recently sidelined.  I initially experienced floaters, had laser surgery to "weld" and strengthen some parts of my eye after which the vitreous eventually detached.  My doctor has asked me to go on high-back rest and return after a week.

He has high hopes that I can still go back to swimming, biking, and running, although, I personally would be more laid back to excerting too much effort. What are your thoughts on this?

Secondly,  when I return to my passion for the sport,  I was thinking of tying up with an organization to raise awareness for eye injuries...may they be floaters, retinal detachment, vitreous tears, macular degeneration...or any of the terminologies I have come across these past weeks.  Would you know of any foundation or organization whom I could talk to maybe to both raise awareness and even raise funds for further research.  I mean,  if there are athletes who join races for cancer, or aids...I would like to know if there is for the eye.

Feel free to PM should you have any information.

Thanks.

Ironbear

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