Floaters are very common for the population and can occur at any age and for multiple reasons. Yet seldom shared with the public the existence of a PVD (Partial Vitreous Detachment) which begins with flashing and anomalies as the vitreous tugs on the retina during the process of separating from the rear. This natural process happens once per eye and is more common after the age of 60. Since few are prepared for this event, the aftermath is a shock: gel blobs, tiny specks, dots, and strands which are constantly visible. In addition to blocking vision they increase astigmatism, add glare to oncoming headlights and light sources like TVs can have a strong glow around them. And despite it being considered harmless, it's normal at an eye exam for an MD to tell you with a straight face that it's a normal part of aging and to "deal with it". The subject is then quickly changed. The clinical script is that sufferers are expected to endure them for life and nothing can be done, "your brain will adapt, learn to live with it".
It's as though the Ophthalmic world decided a century ago that nothing could be done for floaters and medical school students were taught canned responses to tell patients. Yet I don't know of any other condition where a person is expected to endure it for life with no intervention. This is upsetting because of the 5 senses Hearing, Taste, Touch, Smell, and Sight all have long lists of therapies and interventions that are well-proven and mainstream. To be told that your vision is permanantly affected and nothing can be done seems contrary to the purpose of Translational Research, which is the "the process of turning scientific discoveries made in the laboratory or clinic into practical interventions that directly improve human health and well-being ". Why is there so little empathy or curiosity in the field to try and champion a solution?
This happened to me when two years ago I had a PVD in each eye spaced a month apart. The result was a gel-like tumbleweed in both eyes, constantly flipping like having a piece of lace dangling in front of my face. At both exams I was told it was normal and I would learn to live with it. This didn't seem very easy as I sat staring at dual PC monitors all day, blinking and shaking my head to try to clear my vision of the blurring. Small details and text were obscured, reading a book was very difficult as was doing any event in low light. Life was MUCH less enjoyable. Because of AI and the lack of accurate information about how to proceed I decided to document what I have gleaned from reputable sources. My personal solution involving floater removal is detailed.
SO WILL FLOATERS GO AWAY?
Vitreous is like egg-drop soup and with little mass, floaters tend to remain stuck in place and unaffected by gravity. The Aqueous fluid surrounding the eye chamber recycles regularly but the vitreous doesn't. This means the body doesn't effectively cleanse or filter the vitreous over time which is disappointing. Yet floaters can sometimes settle out of your vision, and glare and particle "condensation" or blurring can sometimes decrease with time (months). Over time the brain can blot out floaters partially or make you feel less worrisome as they move. This "adapting" appears to be the brain deciding the floater is normal because it sees it constantly, reducing stress despite it being visible. Ultimately, once the tiny floaters appear pretty much the only hope is they eventually move out of view. Because the eye sees upside-down any floaters that settle to the bottom seem to go up and vice-versa.
SOME REMEDIES
COMPUTER TRICKS
Windows and MACs can have their themes set to Dark Mode, MSOffice and browers can all have the backgrounds set to black. This is much more restful and easy to use, even without floaters. My office has a dimmer switch and I keep the overhead lights low. Between all these I can go stretches when I almost don't notice the floaters. Almost.
BROMELAIN
Bromelain is a pineapple enzyme that has long been used as a folk remedy and anecdotally has been claimed to reduce floaters. Taken orally bromelain is absorbed by the gut without losing its biological properties according to the NIH, who also state it has a wide range of anti-inflammatory properties. As you would expect there is no legitimate research concerning bromelain and floaters.
However, before discounting the effect natural compounds can have on the body consider these: Omega-3 fatty acids lower triglycerides and reduce platelet aggregation. Turmeric contains curcumin, which has anti-inflammatory effects and may help with joint pain and mild arthritis. Garlic contains allicin, which has cardiovascular benefits and can modestly lower blood pressure and cholesterol. And catechins in green tea are known to improve function of the endothelium (lining of blood vessels). This doesnt mean that Bromelain has an effect on the Eye, but claiming that it has no biological effect is incorrect.
Since bromelain is cheap I bought a reputable brand with 2400 GDU/g at 500mg and started taking one three times a day at my 3 month mark. I had no GI issues and reports were that it may not reduce floaters but could cause more movement in the vitreous. After 3 days I did notice my large floater seemed more mobile and shifted around more easily when I moved my eye. A couple of tiny black specks started zipping from side to side randomly as well. Suprisingly, after 2 weeks when looking into the sky the background starfield of dust seemed to have diminished in intensity. Maybe my brain had adapted a bit, maybe they diminished naturally, maybe the bromelain had an effect, or maybe I was imagining it. So while bromelain didn't dissolve my floaters I got the feeling that it may have had a mild effect on their mobility and possibly an effect on background clarity, or maybe I was imagining it. Considering how annoying floaters are even if Bromelaine acts as a placebo it's a welcome sense of control and relief.
HEAT MASK
I bought a USB eye heat mask with the vague
notion that it might help improve circulation and cleanse the eye somewhow. After several uses I didn't see any change but the comfort and serenity it offered was very nice.
VIBRATOR
I used a small finger vibrator with a high-intensity buzz on my bad eye several times one day. I did it for a for a few seconds at a time in several spots on the closed eye. It didn’t alter the floater position and I got the impression that my glare increased slightly for a few hours afterwards. Because the floaters are so small I doubted it would have any effect anyway and decided it was too risky to try again. However, the Ophthalmic field really should take a position on whether using a vibrator on an eye is good or bad. The reason is the internet sells several vibrating eye masks without warnings, and people likely buy them for floaters. Some guidence from an authority would be nice.
CENTRIFUGE
It occurred to me that lying prone on a spinning merry-go-round or some sort of large centrifuge could have the effect of pulling the floaters out of view. I ran this idea past an Opto MD who said the correct method would be to lie face down with head out. Floaters are very tiny and have nearly the same mass as the surrounding vitreous. So as feasible as this fix seems it likely doesn't work or it would have been offered for relief years ago. Or perhaps no one ever thought to test it properly?
SURGERY and LASER
Aside from basic remedies there are two solutions available: Vitrectomy and Vitreolysis. Both have resistance from the Ophthalmic community for different reasons.
FLOATER-ONLY VITRECTOMY (FOV)
Over 200,000 Vitrectomies are done each year in the US, typically for diabetic retinopathy, retinal detachment, macular holes, and to prepare for eye surgery. This routine surgery is highly effective to remove floaters but its taboo to suggest it to an Ophthalmologist as a solution. Because aside from it being intrusive a Vitrectomy is known to accelerate the onset of cataracts. This is not a fully valid reason to avoid the procedure however. Cataracts are a normal part of aging with the average age of onset at 65. As a result, the field of cataract replacement is mature and robust with an estimated four million cataract surgeries done per year in the US. In addition, Refractive Lens Replacement (RLE) is a procedure used by younger people to replace normal lenses to get rid of glasses or contacts. Surprisingly, cataract and RLE surgery are the very same procedure but are marketed differently. The first is treated as a boring and routine surgical event while the other a hip, exciting procedure for active adults. This reveals a double-standard in the industry: Cataract surgery due to age (and RLE) is normalized and freely offered. While cataract surgery caused by a FOV is 'different' and should be avoided. Of note is the small but real complication of Retinal Detachment from a FOV. Conveniently forgotten is that detachment is also a common complication of cataract surgery, yet this doesn't slow the millions of lenses being replaced each year.
When discussing a FOV there's confusion about the 40-year old procedure. Known as a PPV (Pars Plana Vitrectomy) it involves removing material through the white sclera with small-gauge needles. A FULL removes all the vitreous and in the case of foreign-body damage or hemorrhage is replaced with saline. If retinal healing is needed a temporary gas or oil bubble is injected. In both cases the eye slowly replaces the saline or bubble with aqueous fluid. The FULL is the default version used for surgery which is why it's one imagined by Ophthalmologists and eye specialists who are horrified when asked by patients if it can be used to remove floaters.
A CORE version removes only the central/rear vitreous also going by the name LIMITED depending on the amount of vitreous removed. With 27 gauge needles, sutureless, and no bubble, saline replaces the vitreous. In other words, you can get a "Floater Only Vitrectomy" using a Full. Or you can get a "Floater Only Vitrectomy" using the Core/Limited.
Yet obtaining a Core Floater-Only vitrectomy can be tricky. In the US, Medicare will only cover a vitrectomy if it has underlying eye issues, not for floaters-only. Since a FOV (by itself) isn't standard of care insurance companies also won't reimburse it. This is why finding testimonials on a Core FOV is difficult. The group willing to pursue getting one is small to begin with. And of that group the number who were willing to pay out of pocket for a Core is even smaller. Compounding this is the scarcity of surgeons who specifically perform Core FOVs. The point being when exploring a Floater-Only Vitrectomy it's important to use the right terminology to find a surgeon who offers the least intrusive version.
VITREOLYSIS
The Laser solution involves a procedure called Vitreolysis which vaporizes floaters with 20-30 nanosecond laser pulse. However, the only laser procedure taught in med school is Laser Retinopex (photocoagulation) which is used to repair retinal tears. Oddly, Vitreolysis and Lasik are not taught in med school and are learned hands-on in the field. Neither of them require the Opthalmologist be board certified. This is puzzling because Retinopex, LASIK, and Vitreolysis are all moderately invasive, use lasers to modify the eye, and have similar complications. So it's unclear why special training and certification are required for one procedure but not the other two. Its not as though lasers are fringe or unknown: Eye Centers across the country use lasers many times a day. In fact 600-800,000 Lasik procedures are done in the US each year and Retinopex on torn retinas is estimated at several hundred thousand a year. Just like Vitreolysis, LASIK is elective meaning insurance doesn't cover it. This has likely contributed to Vitreolysis remaining "not standard of care" in Opthalmology. The Canadian company PULSEMEDICA is working on a Femto-laser based solution similar to Vitreolysis that looks highly promising but is not available yet.
MY PLAN
I decided that I had two choices: Do nothing and live with Obscured Vision by Floaters (OVBF) for the next few decades. Or seek relief. I searched for a board-certified Opthalmologist with experience in Vitreolysis who displayed the curiosity to become a functional expert. Nearby I found a board certified, laser-experienced Opthalmologist who performed it. However, at the exam the MD felt that for my large gel-type floaters the results may not be what I was seeking.Next I spoke to my own Ophthalmologist about a Vitrectomy. He was open minded and recommended a Core which he said had become more common in the US in just the past few years. He wasn't concerned about accelerating cataracts or its effectiveness. His worry was the small but real chance of retinal detachment afterwards. He said I should ask a FOV surgeon about the percentage experienced by their patients and said it was up to me to weigh the risks.
So I began researching whether a FOV was to be my solution. My experiences are documented on the next pages.