John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

Specialties: Ophthalmology

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Jul 14, 2011 - 42 comments

FROM: John C. Hagan III MD, FACS, FAAO   This is a reprint of an editorial in the July 2011 American Journal of Ophthalmology and represents the latest information on floaters. It references a second article from the same issue which I will also post.


In 1976, Dr Ernst Wynder, founding president of the American Health Foundation and founding editor of the journal Preventive Medicine, stated that “It should be the function of medicine to help people die young…as late in life as possible.”1 However, medicine in general, and ophthalmology in specific, are disease-oriented disciplines. In the former case, this is due to the fact that “Disease is a living experience for the man of flesh and bone. In contrast, health is a disembodied concept. It stimulates no emotional response because it is an inhuman, fleshless abstraction” (René Jules Dubos, The Silliman Lectures, Yale, 1965).1 As ophthalmologists, we are trained to evaluate eyes by seeking evidence of disease using biomicroscopy and ophthalmoscopy, as well as with diagnostic testing. When we rule out pathology by these modalities, we advise patients that they are free of disease. Such advice is apparently a frustrating and unfulfilling experience for patients with “floaters.” From their point of view, the consulting ophthalmologist who sought evidence of disease and found none has nonetheless failed to address their health and quality-of-life issues.

In youth, vitreous is a solid and clear gel filling the center of the eye, firmly attached to the retina. The exquisite transparency of vitreous allows unhindered transmission of light to the retina for photoreception.2 Other than “exogenous” sources, such as hemorrhage and inflammation, there are 2 main causes of the entopic phenomenon called “floaters,” which result from light scattering by structures within the vitreous body and/or at the posterior vitreous cortex. Although devoid of liquid during infancy, the vitreous body begins to liquefy in childhood due to molecular rearrangement of the constituent macromolecules hyaluronan and collagen. Part of this molecular alteration involves cross-linking and aggregation of vitreous collagen fibrils. If advanced, fibrillar aggregation can cause sufficient interference of photon transmission to induce chronic and progressive floaters. In myopia, the process of vitreous gel liquefaction and fibrillar aggregation appears to be accelerated, a manifestation of myopic vitreopathy.3

Concurrent with vitreous gel liquefaction, there is weakening of vitreoretinal adhesion. When both processes advance in tandem to a critical threshold,2, 3 there is separation of the posterior vitreous cortex from the retina, perhaps initially only in the perifoveal region.4 Displacement of liquefied vitreous into the developing cleavage plane between the posterior vitreous cortex and the internal limiting lamina of the retina collapses the posterior vitreous away from the retina, an event called posterior vitreous detachment (PVD). While it has long been taught that PVD is abnormal, it may well be that PVD is the salubrious result of evolutionary progress. This concept arises from the growing awareness that in a variety of diseases, such as diabetic retinopathy5 and age-related macular degeneration6, 7 (AMD), PVD is a far safer condition. That notwithstanding, entopic phenomena resulting from this event induce acute floaters. These arise from the posterior vitreous cortex itself as well as tissue that is sometimes adherent to the posterior vitreous cortex, typically parapapillary fibro-glial in origin. When attributable to myopic vitreopathy,3 PVD occurs 10 to 15 years earlier in life.

The subjective experience of sudden floaters is very common after PVD. While many patients complain that this is bothersome, ophthalmologists tend to pay little heed to these symptoms other than to rule out anomalous PVD3, 8 manifesting as either peripheral or posterior retinal pathology. Once the absence of disease has been assured, the typical eye care professional ceases to be concerned about the issue of floaters. While the Hippocratic principle of “primum non nocere” has guided our approach to date, it may well be time to reexamine our perception that floaters are simply an innocuous, indeed curiously desirable, manifestation of the “normal” aging process.

In this issue of the Journal, Wagle and associates9 present fascinating new information concerning the utility value of floaters, as expressed by patients. Utility values allow an objective quantification of the functional quality of life associated with a specific “disease” state. A utility value of 1.0 implies a perfect “health” state, while death has a utility value of 0.0. The findings of this study indicate that the utility values of floaters are equal to AMD and lower than diabetic retinopathy and glaucoma. According to this study, floaters have lower utility values than mild angina, mild stroke, colon cancer, and asymptomatic HIV infection. This indicates that floaters have a significant negative impact on the quality of life as compared to ocular as well as systemic diseases. It is interesting to note that there was no difference between acute (less than 1 month) and chronic (mean duration of more than 1 year) floaters. This finding throws into question our long-held belief and oft-offered counsel to patients that their symptoms will lessen in severity, either due to settling of vitreous opacities below the optical axis or because of neuro-psychological adaptation. Surprisingly, the investigators claimed that 49.3% of the study group had no PVD. This is suspect, since subjects only underwent an examination and not diagnostic testing, such as ultrasound or optical coherence tomography. Furthermore, 56% of the subjects were women and 59.7% were myopic—both known to predispose to PVD. On the other hand, the authors appropriately point out that the retinal magnification of the images associated with myopia can make floaters seem more pronounced, perhaps explaining how a large number of subjects in this study complained of floaters in the absence of a PVD.

Most remarkably, the investigators of this study found that these patients were willing to take an 11% risk of death and a 7% risk of blindness to get rid of symptoms related to floaters. As the authors state, patients with floaters are willing to trade off 1.1 years out of every 10 years of their remaining lives to get rid of the symptoms of floaters. To some extent that explains the willingness of patients to undergo unproven attempts at mitigating their symptoms, such as YAG laser vitreolysis, for which there is no evidence of efficacy. Definitive treatment is available with vitrectomy, which has been rendered faster, less invasive, and safer by the advent of 25G instrumentation. Yet, there are small risks associated with this invasive procedure and in phakic patients there are lens-related considerations. To obviate the cost and risk (albeit small) of surgery, the future will likely see the development of drug therapy for floaters, via pharmacologic vitreolysis.10 Caution must be exercised, however, for some agents may induce or aggravate floaters as opposed to dissolve them.10, 11

Future advances in our ability to promote health and not just treat disease will depend upon a paradigm shift in philosophy and the development of technologies for health evaluation. We should first accept health as its own diagnosis1 and not just the absence of disease. Improving our understanding and management of conditions such as age-related vitreous degeneration,2, 3 diabetic vitreopathy,12 and myopic vitreopathy3 will then depend upon developing new diagnostic nanotechnologies, such as dynamic light scattering (DLS). This noninvasive, laser-based nano-detector is able to quantitate particle sizes in the cornea, lens, aqueous, and vitreous13 as small as 3 nm in diameter. DLS has been used to determine an alpha-crystallin index in 380 lenses of human eyes14 as well as demonstrate the effects of diabetic vitreopathy11 and pharmacologic vitreolysis.15, 16 In the meantime, however, we need to be aware of and sensitive to the fact that there continues to be a proliferation of floater websites on the internet and the formation of international floater organizations, as expressions of patient frustration with our inability or unwillingness to help them die young, as late in life as possible.

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The author indicates no funding support. The author has been a consultant to Pfizer, Shire, Storz, Alcon, ISTA, Vitreo-Retinal Technologies, and ThromboGenics, and is a shareholder in ThromboGenics, Ltd. The author (J.S.) is solely responsible for the conceptualization of this article; collection, management, analysis, and interpretation of data; and preparation, review, and approval of the manuscript.

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1.Sebag J. The diagnosis of health (First Prize, National Essay Competition). Preventive Medicine. 1979;8(1):76–78
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2.Sebag J. The Vitreous—Structure, Function and Pathobiology. New York: Springer-Verlag; 1989;
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3.Sebag J, Yee KMP. Vitreous—from biochemistry to clinical relevance. In:  Tasman W,  Jaeger EA editor. Duane's Foundations of Clinical Ophthalmology, Vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2007;p. 1–67
View In Article
4.Johnson MW. Perifoveal vitreous detachment and its macular complications [thesis]. Trans Am Ophthalmol Soc. 2005;103:537–567
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5.Akiba J, Arzabe CW, Trempe CL. Posterior vitreous detachment and neovascularization in diabetic retinopathy. Ophthalmology. 1990;97(7):889–891
View In ArticleAbstract
6.Krebs I, Brannath W, Glittenberg K, et al. Posterior vitreo-macular adhesion: a potential risk factor for exudative age-related macular degeneration. Am J Ophthalmol. 2007;144(5):741–746
View In ArticleAbstractFull TextFull-Text PDF (1237 KB) CrossRef
7.Robison C, Krebs I, Binder S, et al. Vitreo-macular adhesion in active and end-stage age-related macular degeneration. Am J Ophthalmol. 2009;148(1):79–82
View In ArticleAbstractFull TextFull-Text PDF (916 KB) CrossRef
8.Sebag J. Anomalous PVD—a unifying concept in vitreo-retinal diseases. Graefes Arch Clin Exp Ophthalmol. 2004;242(8):690–698
View In ArticleCrossRef
9.Wagle AM, Lim W-Y, Yap T-P, Neelam K, Au Eong K-G. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011;152(1):60–65
View In ArticleAbstractFull TextFull-Text PDF (573 KB) CrossRef
10.Sebag J. Pharmacologic vitreolysis [guest editorial]. Retina. 1998;18(1):1–3
View In ArticleCrossRef
11.Sebag J. Pharmacologic vitreolysis—premise and promise of the first decade [guest editorial]. Retina. 2009;29(7):871–874
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12.Sebag J. Diabetic vitreopathy [guest editorial]. Ophthalmology. 1996;103(2):205–206
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13.Ansari RR, Dunker S, Suh K, et al. Quantitative molecular characterization of bovine vitreous and lens with non-invasive dynamic light scattering. Exp Eye Res. 2001;73(6):859–866
View In ArticleMEDLINECrossRef
14.Datiles MB, Ansari RR, Suh KI, et al. Clinical detection of precataractous lens protein changes using dynamic light scattering. Arch Ophthalmol. 2008;126(12):1687–1693
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15.Sebag J. Molecular biology of pharmacologic vitreolysis [thesis]. Trans Am Ophthalmol Soc. 2005;103:473–494
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16.Sebag J, Ansari RR, Suh KI. Pharmacologic vitreolysis with microplasmin increases vitreous diffusion coefficients. Graefes Arch Clin Exp Ophthalmol. 2007;245(4):576–580
View In ArticleCrossRef

A graduate of Columbia & Harvard, Jerry Sebag is considered a leading authority on vitreous. He is Founding Director of the VMR Institute in Huntington Beach, California (www.VMRinstitute.com), Professor of Clinical Ophthalmology at the Doheny Eye Institute of USC, Fellow of the American College of Surgeons, and Fellow of the Royal College of Ophthalmologists (United Kingdom). In 2005, Dr. Sebag was inducted into the American Ophthalmological Society, and in 2010 he was designated a Fellow of ARVO.

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Avatar universal
by malog, Jul 15, 2011
I am glad you posted this. For 17 years ( begining in 1980 ) I struggled with the symptoms of vitreous traction and floaters. If I looked at the face of a person, it seemed as if one eye was missing. After the PVD ( without a tear )  14 years ago  this symptom slowly went away. This is a total of 31 years with floaters. I am -7 myopic with a very liquid vitreous.  I had  a weiss ring as well as numerous small and very mobile floaters, including a string that would settle into the center of my vison and stay there for hours.
I finally made a decision to pursue treatment and traveled to Memphis 2 years ago and have an excellent outcome. I was told that I had a definite PVD which helped with a successful result. I may consider the other eye as well but this is  currently a condition which requires the patient to just do what they feel must be done and hope for the best with almost no support from anyone.

Glad things worked out well for you. It is very difficult to recommend vitrectomies for floaters that merely annoy people because of the truly enormous expense of previous health care dollars and the amount of time this would take from precious resources (retina surgeons, retina equipped operating rooms and staffs) plus the inevitable eyes that have infections, develop cataracts, have retinal detachments, are still bothered by floaters, have macular swelling (edema).

Glad it went well in your case.


Avatar universal
by lost_in_despair, Jul 19, 2011
Dr. John C Hagan III,

Your concerns regarding complications are valid, however, it does not mean that just because there are risks associated with vitrectomy, no advancements should be made to develop a safer technique for patients suffering with floaters. Yes vitrectomy for floaters will take away precious resources from "retina surgeons and retina equipped operation rooms and staffs" but those resources have the reason to exist, in the first place, to help patients, no? As a scientific study backed with shattering evidence published in this 2011 issue show that floaters can be a debilitating condition for many people, and hence they are patients. Such resources should help patients following the principle of "doing no harm," which includes psychological harm that comes to patients who suffer with floaters.


Avatar universal
by lost_in_despair, Jul 19, 2011
And I am a medical student, only I know how much I am suffering day in and out with those floaters as well as lattice degeneration while I try to balance my work and study responsibilities with my personal life. I have not gotten vitrectomy yet, but I am hoping that soon there will be safer techniques to help me, God willing.

Avatar universal
by km12321, Jul 26, 2011
I can't understand why the medical community doesn't really care about floaters when it is well known how many people around the world are suffering because of them.

The "ignore" solution doesn't work for me and for many others too. Floaters can ruin your life, when you can't ignore them, and especially can lead you to suicide when you see that what you're trying to do and achieve, can't be done, because there are some black dots flying around in your eyes, and not letting you concentrate

I don't get it, floaters ARE a huge problem, they maybe are not risky for your life or vision, but they LOWER your quality of life, this is the same as having a flu or a headache that won't go away. It's the same thing.

And for me, I would prefer to have a fatal disease that has actually a cure, than these little monsters in my eyes until I die.

I CAN'T ignore them I want them to LEAVE ME ALONE.

WHY don't you doctors care? why? can you tell me?

Avatar universal
by lost_in_despair, Jul 26, 2011
Km12321: Dense opacities in vitreous (severe floaters) that appear to us patients as dark dots, webs and strings distort light when they come into central vision axis, because of the changes in refractive index. Hence, such floaters are WORSE than having a chronic flu. Why? All my life, most of which is spent in wards looking at patients and doing physicals on them, involves the dire need for me to use my vision. I do not use my nose or throat to do a physical exam on patients. I use my eyes to look at their organs in question, to perform physical tests on them.

Of course chronic flu would decrease quality of life for me as well but at flying black dots, black cobwebs and black tube worms, which actually DISTORT light and colors, decrease my quality of life to such an extent that many a times Ive contemplated gorging my eye balls out for good.

Avatar universal
by km12321, Jul 27, 2011
I understand how you feel as I'm actually feeling the same, I'm a computer science student and I'm actually working all day long on my computer and these black things make it more difficult for me to work, I'm trying to just "live with them" but it's not possible..

as you say, I would also prefer to have anything else than these things....... I'm really mad at the doctors who don't care about the sufferers of floaters...

We have such a great technology..... since there are no medicine for these things, why don't they create some kind of "robots" that would remove all the floaters in the eyes? for example, a simple mechanism that could be put in the eye, can just scan it by moving around and removing anything that "seems" like a floater, it's not a medicine, but at least it can be done without a surgery but with a simple injection that would put this mechanism in the eye, and then after the procedure is finished, the mechanism would wither destroy itself, or it would find a way out through our inner system... there MUST be a way out, once you're in the eye.. maybe the floaters can't find this way, but maybe something made by us, would be able to find it...

well these are just assumptions.. I don't even know if this is even possible, but with the technology as it is today, EVERYTHING is possible..

I won't try FOV or laser, because both are not quite acceptable by everyone, there are always risks, and I don't feel like ruining my eye by removing the gel using fov, because I'm just 20 and maybe in 10 years I will get some more serious eye problem... about the laser, I don't feel like it is effective, since after researching for a while I've read that 50% of patients are pleased with the results, other 50% say they are not pleased etc..

i don't know what to say...... maybe a real sufferer like us one day will just open a book and start a solid research in order to find something that would cure these little monsters... but until then, we can only hope and wait...

Avatar universal
by Anoopms, Jul 30, 2011
The best solution is try to learn to live with it.I had floaters for  one years.Now i get adjusted to floaters.Does floaters have any relation with strength training(heavy weight training).I read somewhere that weighttraing increases IOP pressure.So i stopped my weight training .Nice post doctor

From Dr. Hagan: If it's any consilation to readers, I have floaters in both eyes. Have had since childhood. In the last two years I've had a huge Weiss ring floater in my right eye. Anytime I talk to a patient about them or type a message on the Eye Forum I become aware of them. Nevertheless I would never consider a vitrectomy because of the risks and that usually that procedure causes cataracts to develop or progress.

Any postings about the ophthalmology profession not caring about floaters indicates the poster has either not read the two articles I posted on this blog or fails to comprehend what is saying. One article documents the deep concern some people have about their floaters, other articles outline the research being done for them: surgical I(vitrectomy) and disolving (vitreolysis); lasers have been tried but were not successful.

John Hagan MD

Avatar universal
by Rich1024, Sep 13, 2011
@ John C Hagan,

"Nevertheless I would never consider a vitrectomy because of the risks and that usually that procedure causes cataracts to develop or progress. "

This shows that you only have mild floater symptoms as anyone with serious floaters would trade their floaters with cataract any day.

Avatar universal
by Paul1977, Sep 14, 2011
Its good to see that the medical profession is taking this condition more seriously. Hopefully there will be more research done and a safer less invasive solution will be found. There is no doubt that with a growing population (and an aging population) that there will be increasing numbers of people who suffer. I am learning to live with mine but one cannot help but think that I will never completely get used to them. It has negatively affected my productivity at work and my enjoyment of life. A pharmaceutical solution would be a money spinner for sure.

Avatar universal
by mnskeptic, Nov 21, 2011
I cope with persistant floaters everyday and have for years.  I know many people that have had them for decades and are still bothered by them.   On tv, and in the news, I see new treatments developed for more benign conditions.  I am told my floaters are not serious enough to justify vitrectomy.  You imply your profession cares about this problem.  Can you post any current research or development into better treatments for floaters? Surely for something that affects millions in the U. S alone it would deserve funding, but I don't know of any active studies into better treatment options, prevention or etiology.

Avatar universal
by Shelia428, Apr 05, 2012
With all the medical technology today I am surprised that no one has come up with a (non invasive) solution you can inject into the eye that could dissolve the "gel" floaters.  Flosters are just gel.....why is this so difficult?  

I've lived with floaters for the past 10 years and now I have one floater that stays in my central vision and is driving me crazy.  I am very nearsighted (-10 and -14) so I would never have them removed, the risk is just too great.

Avatar universal
by kathryn241, May 09, 2012
I had ONE black dot in one eye after using an inversion machine.  It went away.  Then I had a mass of floaters flood in that eye, and found I had a tear in my retina.  The tear was lasered.  

A few doctor appts later, the doc decided I needed MORE laser.  I thought I had another tear.  I didn't.  My employee benefit statement said  "Preventative laser surgery."

4 months later, I was told my retina was detached, although I had no symptoms.  I underwent surgery for RD, after surgery I had a huge pool of blood under my eye.    I later found in my records that a hyphema was created. ( I was never told the word hyphema, so I looked it up.  It is when blood fills up the FRONT of the eye, due to blunt force trauma. (blunt force trauma?-when, during surgery?) My hyphema was clotted.  It was written, but I was never told.

After THAT surgery, I had and have floaters in my other eye, and the operated eye sees to the left and down and is very distorted, and looks to the right and up. It is disgusting looking.  My pupil is irregular and so is my whole eye.  My iris is cut. The other eye is still 20/20.  

My doctors did not tell me anything.  And I did not know much about the eye, PVDs, floaters, etc.  But I sure do now!

I found out later, after researching for MYSELF what had happened.  I had an acute PVD that caused a tear.  (with flashes and floaters)  The eye needed laser because fluid got under the tear.  The second time my eye was lasered, I thought there was another tear.  

Lasers do not always fix or prevent.  Sometimes too much laser CAUSES a bigger problem.  

And our doctors need to tell us EXACTLY what they are doing and why, not write everything in our records with a note that says they discussed this with the patient, and the patient agrees, when they surely did NOT.

Just my thought for the day.

Avatar universal
by Bartsrock, Jun 08, 2012

Loved ur post. My son 23, has been severly near sighted and boom with no warning he had detachment. Why did no Dr. ever warn us this could happen? I ask this because he was out of state on an oil rig in the middle of nowhere and had no idea what was happening. Hence, to late. He finaly 2 days went in for emergency appt. was then put on a plane home and 2 more days before surgery. He must have dep preception ect. to continue on his career path and somw vision. We now do not know if he will ever see again. If he or I had known anything about this we would have taken care and had the freeze done the same way we had his other eye done so this will hopeful never happen to it. Any answers or help would b much appreciated. For at 45 i can or could function but at 23 it is so much different.

Avatar universal
by TrapperV, Aug 03, 2012
I'm certainly glad to have stumbled on this thread, as I was just going to post some questions and comments to a new thread regarding floaters.

Of all my eye problems (glaucoma, ERM, visual field defect, IOL implants), floaters are by far the worst thing I'm enduring.

My floaters are not "black specks and dots, or cobwebs", but large blobs of translucent material that totally obscure my vision at times. My vision literally changes from second to second. The result is I can NEVER focus on text, detail, and now even faces or gross objects. My eyes both see something radically differently, due to an ERM in one eye that bends and twists all images, and when the blobs obscure the better eye, the eye with twisted images takes over for a moment, then the clear eye takes over again. Imagine this happening every second, 24 hours a day. It is unbelievably frustrating. My job and hobbies are now becoming almost impossible to do, and I've given up trying to read a newspaper. Post cataract surgery, there was a brief respite from the floaters, but now there appears to be more of them then before, and with PCO happening in each eye, and the resulting diminishing vision, they are back with a vengeance.

The advice to "ignore them", "the brain will get used to them", "they will settle to the bottom (I personally think that's a hoot)", "they are benign and MERELY an annoyance", are just so much drivel. They are life changing, paralyzing and in some cases dangerous (driving, for example).

I am also firmly convinced mine were initially the result of PVDs which were the result of SLT procedures for glaucoma. My ophthalmologists dispute the connection between SLT and PVD, but in my case, the first PVD occurred in the eye that had SLT done approximately 1 month post procedure, and the PVD in the second eye also happened 1 month post SLT in the other eye. Also, knowing what I know now, I believe it may have to do with the fact I was giving no anti-inflammatory meds post the SLT procedures, and the PVD, ERM and floaters were the result of an anti-inflammatory response. Again, I find no agreement with my hypothesis among the Dr's Ive asked about this, but I have no doubt it was at least a contributing factor. Connecting the dots between eye trauma, inflammatory response, and vitreous with some simple google searches add up to my conclusions. I also wonder about the constant dumping of chemicals in my eyes for many years for glaucoma. That has to have some effect on the vitreous.

I'm immensely frustrated, and now among those who if polled would accept risks to be rid of them. I am going to have a vitrectomy to try to improve the ERM situation, so that eye may be helped, but the other eye has more floaters by far.

Again, it is the constant CHANGING of vision that is such a big deal. A permanent visual field defect is something you can get used to for example, but if the "visual field defect" is a transitory thing changing constantly every minute of your life, there is absolutely no way the brain ca adjust to that.

Avatar universal
by victoria982, Apr 20, 2013
I have recently developed floaters in my left eye. In the past I have had them sporadically but they have gone away. Just the past week or so they have not gone away. It went to eye doctor and he basically said the same thing that they will eventually go away or the brain will get used to them. Does anyone know if the yag laser treatment is still considered risky? I am wiling to try I drive everyday for sales and it is hard to function. I have also heard of home remedies to get rid of floaters an suggestions?


Avatar universal
by AshleyJG, May 18, 2013
The YAG laser should not be risky when correctly used.  However they cannot treat floaters close to the retina.  I've been for a consultation in the UK and my floaters are not treatable with this method, because of this.


Avatar universal
by stevemoss, Aug 04, 2013
I developed bad floaters following posterior vitreous detachment (PVD)  in both eyes at age 60 (I am also myopic).  I read all the literature about vitrectomies and yag laser treatments and was very scared to do anything about my condition.  All the (many) doctors I consulted all said the same thing - vitrectomies are too dangerous and there is no evidence that yag laser treatment works.  They all advised me to "grin and bear it"

In the end, after a lot of research and investigation in the US, Canada, England and Latin America, I decided that the to have the yag laser treatment done (three years ago) It was a very difficult decision, made more so by the generalised scepticism that exists with regard to it throughout the medical community.

In my case the yag laser treatment helped a lot.  I managed to eliminate about 75% of the mess in my eyes and restore the ability to read and enjoy my life.  If your floaters result from PVD, like mine, and if they are located away from the retina, as most are, then the yag laser procedure can be very effective.

My own opinion is that the yag laser treatment is safe and highly worthwhile.  It is, however, a very difficult procedure for the physician and the few doctors who offer it are putting in a lot of work for not much money.  I don't know why the medical establishment is in general so negative about it, but I recommend to everyone to keep an open mind and not be discouraged.  Floaters can be a completely debilitating and depressing life experience.  It is worth a lot to get rid of them, especially if there is a safe and available procedure such as yag laser treatment (unlike vitrectomies which are very high risk)

I believe that it is NEITHER TRUE NOR ADVISABLE to tell floater victims that "you should learn to live with your floaters" or that "floaters will go away with time" or that "there is no effective treatment".  

I realise that what I am saying here is heretical to the opthamologists of the world, and it will be discounted as just another unscientific testimonial, but if anyone is interested, I am ready to share my own experience in full detail  

Avatar universal
by Loopdilou, Oct 05, 2013
I just experienced my first PVD five days ago.  I am a soon to be 60 year old nearsighted, otherwise very healthy female.  I have a circle, that appears like someone drew it with a pencil an sometimes it turns sideways.  I've thought of finding ways to learn to like it since I can't get rid of it.  Like maybe I can play a game with it on the computer screen by trying to toss it around a word, so I can think of it as something to use to draw a circle around a word like you would do when studying something in school.  

I have had floaters since I was a teenager.  The first time I got one I remember we were on a family vacation and I told my mom about seeing this spot moving around.  It seemed huge to me, kind of cellular appearing.  Well that was making me very anxious. Then I learned what it was and finally learned to just live with it.  Over time I didn't even notice it.  Then as I got older I noticed I had a lot more of the floaters but they were kind of stringy and the only time they bothered me was when I was looking down at a clean sheet of paper.  Other than that they didn't really bother me.

But this PVD is different for me because the flashing light was very frightening.  It was a black and white curved line zooming across the top and side of my left eye, back and forth.  What was going on I wondered?  I called a doctor and they got me in that afternoon.  By then that flashing had stopped but then I noticed the circle.  Thank goodness the circle isn't solid and also that it is mostly slightly off center of my vision. It does float to the center however and that is what is the most annoying part of this.  Also the following day I noticed an area of about the size of a quarter of a postage stamp that seems like a blurred area, kind of like when you have a smudge on your glasses.  And think about how often we may go around with dirty glasses and not even notice and then when we do notice we think, oh my gosh, I've been looking through these dirty glasses all day.  Then we clean them and everything is nice and crisp.  Oh, how I wish I could clean my eye.  I went back to the doctor and they examined the eye again and they said there was no retina tear and that it appeared to be floaters.  What I don't know is if I had those floaters already and just hadn't been noticing them or of they just came about.  Now I don't notice any of those other old floaters I used to have because this new one  is king of the floaters.  But I do have that blur that is an extra aggravation.  

As I type this post I am having such a hard time concentrating because of the floater.  I have to really focus hard in order to continue my sentence and not watch the spot move around.  This is such a shame since I enjoy so much doing genealogy research using my computer and staying in touch with my friends and family on Facebook.  I've tried adjusting the brightness on my monitor and it seems to help to turn it down.  I also turn off the lamp next to me.  Thankfully it doesn't bother me too much to watch television because my eye doesn't move as much.  

One little trick I'm learning is finding ways to hold my eyes steady while I type and just move my head instead of my eyes across the page.  I can kind of hold my left eye steady and then sort of zone the eye out.  You know how you can do that if you stare at something long enough?

I sure wish there was a magic pill to rid my eye of these floaters and maybe one day there will be one.  Before this happened I was having such a good day and then bam, there was the flashing lights as I was on the phone with my sister.  I am now fighting hard to keep from freaking out, I've already had four good cries.  I keep reminding myself that so many others are dealing with health issues far worse than this, even though this is something that effects my quality of life.  But I can still walk, talk, hear, see, eat, sleep, work, drive, travel, laugh, and be a good friend, wife, daughter, sister, mother, and grandmother.  I must learn to accept it and to be thankful that it wasn't something worse, to enjoy the health that I have and to tell myself that this is an annoyance that I just have to try to accept and ignore as much as possible.  I'm hopeful that what the nurse at the doctor's office who had this told me is true for me, that she hardly even notices her floater anymore. She was afraid at first when she saw the flashes but she called the doctor and he told her what it was.  Because she works for an eye clinic she knew what it was and she knew that if she got a retina tear it could be repaired, she wasn't too afraid.  What I think too is that it was a while ago and her telling me of her experience now reflects the fact that her brain has adjusted to it, making it less noticeable.  

I thought it was nice that the doctors can actually see the floaters because imagine if they couldn't, you may think you are just imagining them, but they are real and they are just things floating around your eye and they can't kill you or blind you.  

So this is me, letting you know how I feel today.  I'm hoping that six months from now I will be coping well with my new little floating friend and his sidekick, the blur.  Maybe I'll name them Looped de Lou and Shadow.  

On a serious note, I do hope the scientists will understand the impact this condition has on a person and even their family and also the effect it can have on society so that they will get the funding needed to come up with a cure or better yet, a prevention.  People with vision free of floaters will be happier and more productive and society will benefit from this as well.  

Avatar universal
by Hope196900, Jan 11, 2014
I agree something has to be done to increase research to find a better cure for this disease, I have had floaters for only 3 months now and am on short-term disability. I cannot concentrate and am always swaying from a vitrectomy to laser surgery, I live in Canada where there is no sympathy for someone with this condition. I am on anti-depressants and anxiety pills. My worst regret is the devastating effects its having on my wife and 3 children. I wish there was help out there but realise I will probably lose everything because I cannot cope with this delibitating disease.


Avatar universal
by tanipatushi, Jan 14, 2014
hlw everyone.i m a future ophthalmologist,i already complete FCPS part-1 on ophthalmology and complete 1 yr of training on it.I m 27 yrs and myopic(-3.5 on both eye) i see floaters since my childhood nd for last 2 months i develop photopsia(2 or 3 times in a day)my proffesor(retina specialist)after examining me with indirect ophthalmoscope said thai i have lattice on both eye(but no tear or hole yet)..now my question ie that could i be able to continue my proffesion as ophthalmologist//If yes.,could i perform cataract surgery under microscope or b a retina specialist?some tell me that it should b wise not to give pressure on my eye and not to do microscopic surgery,rather than put interest on occuloplasty..if there any chance to have retina detachment on future??plz let me inform/\.THANKS                                                                                                                                                                   DR TANZIN TUSHI(from BANGLADESH)

Microscopic surgery does not put stress on your retina and will not cause any eye disease to worsen.  I have lattice degeneration and have used the surgical microscope for 42 years without problem. The biggest problem for microscopic surgeons long term is musculoskeletal problems like degenerative joint disease. It emphasizes the point of good posture during surgery.

Go where your interests lie.


Avatar universal
by jmarino, Jul 20, 2014
Dr. Hagan,

I am going to apply to medical school next year and noticed many crystal worm like floaters one year ago, at age 23. I have always had 20/20 vision and no eye issues at all. However, a few of these floaters are now grey, more prominent and constantly shooting across my central vision field as I read on a computer or book, moving my eyes left to right and back. It is constantly difficulty to focus and I don't understand how I am supposed to just "adapt" to them. How did you go through medical school if you had floaters since childhood, without going crazy? Thanks in advance.

Floaters are extremely common:  20% by age 20; 50% by age 50; 75% by age 75

The great majority of floaters are benign and merely annoying.   Most people, me included, learn to ignore and not see their floaters. This is called neuroadaptation.   If someone asked you if you could feel your shoes, or your shirt if you directed your attention to it you could. However it fades off into the background in most people and is ignored (like tuning out your heartbeat).  From sound damage to my ears (no ear protection while hunting and working in factory during summers) I have ringing in both ears (tinnitus)  I can go months and months and not be aware of this. If I stop to think about it or the stress level in life is high than I become aware of the ringing.

Floaters are much more problematic for people with anxiety, especially untreated anxiety or hypochondriasis.

First see an ophthalmologist to be sure your eyes are healthy. If you are a high anxiety person and it is not treated consider seeing a psychiatrist as treatment of anxiety and depression is one of the great success stories of modern medicine.  Good luck In medicine


Avatar universal
by erankin, Aug 31, 2014
I'm 58 years old and a week ago I woke up with many floaters in the central part of my right eye.  I also was seeing flashes off to the right of my eye.  I called the doctor immediately and everything was fine.  The doctor said that I will learn to live with it and couldn't be bother listening to my concerns.  He said "there are more important things to worry about... get over it".  I will never go back to him again!!!!  

In only a weeks time I feel like I'm going to loose my mind and I can't imagine living with this.  I have found that wearing my reading glasses while walking around makes things fuzzy enough so that the floaters blend in.  I know that this is going to cause me more harm in the long run.

My quality of life is going to drop tremendously.  I have always been very upbeat, love going places and doing things with my family... I have not left my house for 2 days.  Words can't explain how annoying this is and I can't concentrate on anything else.  I can't wait till it's night time when I don't have to look at these.

Unless you have them, you have no idea what's it's like.  I hope they can come up with something soon and make doctors aware that this is a very serious condition that needs attention.

I also have tinnitus and have learned to live with it, but your sight is completely different.  There are so many floaters and they move with my eye and I've had a headache for a week now.

My heart goes out to anyone that has floaters.

Avatar universal
by Pete_09, Sep 09, 2014
I started noticing floaters about 8 years ago. They were very annoying & was not sure how I would cope! However after about a year I started to get used to them & for the next 7 years I barely noticed them at all (even though I am sure they were there)  

About a week ago I got a new big bright computer screen & since then I have seemed to notice them again & they are driving me crazy one again.

They seem to be the same floaters as 8 years ago so I am not sure why I am noticing them so much again (when I have had 7 great years ignoring them)

Has this happened to anyone else?

Avatar universal
by Hudsongrl, Dec 04, 2014
I have been going through a PVD in my right eye since July. It began with tons of gnat like floaters and then flashes. The gnat like floaters finally subsided only to be replaced by a Weiss ring in my central vision. It bobs like it is on a bungee cord.

Contrary to what eye specialusts proclaim ( i have seen 4 of them) it is impossible to ignore and my brain is not tuning it out. I wear sunglasses indoors all day long to tune out light and make the Weiss ring less visible.

I saw my opthalmologist today and he said whatever i am left with in January is probably permanent. So, no falling to the bottom, fading etc. just " sorry, it is what it is".

I really resent Dr. Hagan's sentment that patients bothered by these floaters are either anxious or hypochondriacs. I WAS neither. But, having something large, circular and dark swinging in and out of your central vision is quite debilitating. Driving, reading etc, is all compromised. I am only 59 and have no other serious health issues, but this condition has slowed me down and sucked life from me:(

it is a true shame more research isn't being done to help people with this condition. Btw, my flashes at night still occur occasionally, but less than before. I was told today they may be permanent like the Weiss ring. Ugh. My heart goes out to anyone enduring...yes, enduring ...this condition. While i am grateful i have not had a retinal tear or detachment, these last 5 months with the PVD have been challenging. To know there is literally no end to these symptoms is just discouraging beyond belief.

Before you become resentful go back and do a careful reading of what I said.
"Floaters are much more problematic for people with anxiety, especially untreated anxiety or hypochondriasis. " And that is a true statement. I did not say that people that are bothered by them are ALL anxiety prone or hypochondriacs. I have floaters in both eyes and have a huge Weiss Ring in my right eye for the past 3 years. I have learned to live with it and for the most part can tune them out. Hopefully you will get better with time.

If you fail to make any adjustment to your Weiss ring in the next 3-6 months you might see a retina surgeon about your surgical options.  The risks are significant especially cataract formation or more floaters developing.

Best of luck


Avatar universal
by BlackOne, Sep 24, 2015
The frustration of severe floaters can cause anxiety. I live with mine and try to adapt, but having this glob in my line of vision makes reading and working at a computer harder. I have to break more often or I end up with headache. Hypochriasis is usually a label used for either lazy healthcare providers or those unable to explain how learning stress reduction techniques like meditation can help deal with a chronic, incurable problem. I've worked in healthcare for over three decades and see how easy it is for docs to "dismiss" patients they cannot help or how hard it is to simply admit they can't help.


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by JohnHaganMD, Sep 24, 2015
Well best of luck

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by Abdool, Oct 18, 2015
I start noticing floaters about 4weeks ago, am  29 years old and also a final year student in the university, I have everything that money could buy the best in life, I have the best education life can offer,  but this floaters are driving me crazy. I call them depressing eye floaters, because am losing hope in my future. I can sacrifice all what I have to get my floaters gone. a times I feel alone, deserted, hopeless, useless, its hard, really hard. It becomes a boundary to my life. Living with eye floaters is worst than dying.

Avatar universal
by Abdool, Oct 18, 2015
Am totally not myself bcos of this eye floaters, they kill faster than any disease. It coms to the extent that I can remember what I have done five minute previously due fear and tension. Oh my God, I need a miracles.

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by JohnHaganMD, Oct 18, 2015

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by JohnHaganMD, Sep 21, 2016

Avatar universal
by rob841, Sep 25, 2016
Dear Doctor Hagan,

Thank you for your comprehensively research and thoughtful paper. As a recent sufferer of vitreous floaters, I found much of the content enlightening, and the empathetic tone refreshing.

My vitreous floaters have been progressing for the last three months, with no sign of leveling off. This, coupled with aura symptoms have me concerned. Would you be able to direct me to resources on the latest work on inhibiting formation of vitreous opacities, or even the latest work into the development of chemical or surgical options? I'd like to be as proactive as possible in taking steps to limit the degree of my degeneration, or if that proves impossible, increase my understanding of the options available to me.

At 30 years of age, this sudden progressive degradation in my vision is greatly disconcerting.

Thank you for taking valuable time to read this! I appreciate any consideration you'd give this post.

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by JohnHaganMD, Sep 25, 2016
There is no way to prevent the gel vitreous from turning into liquid vitreous. The process is called vitreous syneresis and its a normal part of aging. Think of it as hair graying and skin wrinkling.

By age 50 more people have floaters than don't have them. Fortunately most of us tune the floaters out using neuroadaptation.

There is no medication that dissolves floaters that works. Many homeopathic stores sell worthless notions and potions claiming to prevent or get rid of floaters.

Medication injected into the eye to liquify the vitreous and allow floaters to settle has not proved safe or effective enough to warrant the risks and costs.

Various laser treatments have been tried in the past with minimal success. Hope springs eternal and a new lasers are constantly being advertised.  At present none of them have proved successful enough to warrant widespread use and adoption.

The most radical treatment is vitrectomy. I would never recommend this to a patient as the risks are extreme: cataract formation is frequent, infection, bleeding, retinal detachment and persistence of floaters.

I have flaoters in both eyes including a huge Weiss ring in my right eye. I have not sought any treatment. I never thought I would get use to the huge weiss ring but over 6-9 months my brain learned to almost complete tune it out and now I am not aware of it unless I go looking for it.

Avatar universal
by rob841, Sep 26, 2016
Dear Doctor Hagan,

Thank you very much for the reply!

It's good to hear that you and some others have adapted to the floaters you see. I hope I will one day be able to adjust similarly.

Are you aware of any underlying conditions that could cause vitreous floaters to form earlier and more rapidly? I have experienced as strange confluence of symptoms all onsetting in the last 2-3 months, including persistent visual aura, headache, and ocular pains. In both eyes, but several times stronger in/around the eye that is presenting the increasing number/density of floaters. The increase in aura and floaters are going hand in hand.

This leads me to believe that I'm dealing with some underlying condition.

I've been evaluated by several optometrists, an ophthalmologists, and a neurologist over the last three months but they have been unable to find anything outside of a b12 deficiency and low D + creatine levels. Retina appears healthy. Optical nerve appears healthy. Nothing that should cause this particular confluence of symptoms.

If you've ever heard of anything like this, I'd very much appreciate the information! My next step is trying to see a neuro-opthalmologist.

Thank you very much Doctor.

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by JohnHaganMD, Sep 26, 2016
Well there are a lot of things that can cause floaters that are abnormal such as bleeding into the eye. However your previous exams should have shown these. Going to a neuro-ophthalmologist would be a good 'next step"

Avatar universal
by jack1231, Apr 15, 2017
This is quite a complex issue. I don't believe there is a point to say that "I have floaters too, and I got used to them", because as we can't see out of each other's eye, we do not know what each of us are actually experiencing.

I have many, many floaters (some pretty large!) for a very long time and lived with them just fined. It is only in the recent few years that the floaters have gotten so bad that I'm now afraid to drive. Indeed, I cannot drive long distances like I used to only a few years ago due to the immense eye strain created in trying to see past the swirling mass of floaters.

So why do they bother me now? It is not simply the fact that the floaters have increased that is the problem, it's their behavior, position and the secondary effects that have made things a lot worse.

It's actually very interesting that it is not the large/dark floaters that bother me most. Rather, it's the position and behavior of the floaters that are actually bothersome. By far the most bothersome ones I have are the ones that are pretty transparent, move really quickly and constantly cause a disturbing light shimmering effect as they move across my vision.

I do not think it is wise to compare "my" floaters with "your" floaters unless there is some sort of extremely high fidelity simulation that can show how the floaters look, and more importantly, how they move and how they are positioned, in addition to secondary effects they cause such as hazing or glare. Subjective comparisons really serves no purpose and creates an atmosphere of speculation, which is not useful in science and medicine.

Avatar universal
by jack1231, Apr 15, 2017
By the way, I'm not sure what a Weiss Ring floater looks like because I don't have one of those. So I don't know what you mean by "large". Your large could be my small, vice versa.

In any case, my large floaters consist of one group that covers the area an entire sheet of A4 paper from about 30 centimeters viewing distance. In itself, it's actually not very annoying because it's rather transparent. It's the shimmering and haze effect it creates as it swirls around that is the actual annoyance.

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by JohnHaganMD, Apr 15, 2017
Since you are interested only in your own impressions and how they affect you which cannot be affected by what ophthalmologists, or other people say. there is nothing to add

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