What Are Floaters? | Causes and Treatment

6/12/14

Floaters can be anything seen in your vision that moves “to and fro” with your eye movement. The movement is not stationary compared to a blind spot which is fixed or stationary in your field of vision.

Example of floaters
Example of floaters
The key is that the position changes with eye movement. Size, shape, color, etc. don’t matter. Anything that moves in your vision is called a floater.

Remember, if you experience new floaters; please see an eye doctor for an examination.

Here are some common causes of floaters:

  • Posterior Vitreous Detachment (PVD)
  • Retinal Tears
  • Blood (Vitreous Hemorrhage) can be caused by;
  • Advanced Diabetic Retinopathy
  • Retinal Tears
  • Retinal Vascular Occlusions
  • Inflammation or Infection
  • Asteroid Hyalosis

Posterior Vitreous Detachment
A posterior vitreous detachment (PVD) is a common cause of floaters. A PVD occurs when the vitreous separates from the retinal surface. This is a normal event and will eventually occur in everyone. Retinal tears are more likely to occur right after a PVD has started.

The vitreous is usually a clear watery gel. As we age, enough of the proteins in the vitreous liquefy and degenerate. Eventually, there is a physical separation of the vitreous from the retina due to this liquefaction.

“Floaters” can develop due to opacities/haziness due to the aging gel which is no longer absolutely clear due to changes in the optical properties of the gel or the interface between the vitreous and water inside the eye.

Tears in the Retina
Retinal tears can cause floaters by either causing a small vitreous hemorrhage, or by dislodging cells into the vitreous which are normally located underneath the retina.

Vitreous Hemorrhage
Blood in the vitreous can also cause floaters. A so-called vitreous hemorrhage may result from either a retinal tear or advanced diabetic retinopathy. Occasionally, retinal vascular occlusions can also lead to bleeding in the vitreous.

Blood in the eye often absorbs, but only your doctor can determine the exact nature of the floaters and if they are associated with a retinal tear. It’s impossible for you to tell the cause of floaters without a proper dilated eye exam.

Inflammation
Certain types of inflammation or infection can cause significant floaters. Actually, these are white cells which migrate to the retina and vitreous and can be seen a floaters.

Asteroid Hyalosis
This is a common entity where lots of fine white opacities are suspended in the vitreous. In most cases, these are not noticed by the patient. Sometimes, however, the so-called asteroid bodies are so dense they prevent good examination of the retina. Other times, especially after a PVD, the asteroid bodies are noticed and patients may complain of floaters.

New Floaters: Evaluation
All new floaters must be examined by your eye doctor within 24-72 hours after occurring. Even if the floaters disappear in that time frame, you should be examined to look for a possible tear in the retina.

Again, you, the patient, can NOT tell the cause of the floaters or if you’ve sustained a retinal tears. Retinal tears can cause a retinal detachment – a potentially blinding problem.

Treatment of Floaters
There are no medicines or eye drops to treat floaters. Most doctors advise simply putting up with the floaters.

For patients who have chronic problems with floaters, I recommend a vitrectomy. A vitrectomy is an eye operation, performed by a retinal specialist. The operation is comparable to a cataract operation in terms of safety and possible complications.

There are a handful of doctors who perform Yag laser to break up floaters.

Randall E. Wong MDRandall V. Wong, MD
Retina Specialist
Fairfax, Virginia

The Costs of Eye Care

5/6/14

**Update 6/16/14 – New estimate on the cost of vision problems just came out in the new Prevent Blindness America report showing they could reach $717 billion by 2050.

This past week I attended a dinner where a topic of discussion was the cost of chronic disease on healthcare – 75% of healthcare dollars go to the treatment of chronic diseases. This led me to explore the costs chronic eye diseases such as age-related macular degeneration, cataract, glaucoma and diabetic retinopathy.
PBA 2012 booklet
In 2007 Prevent Blindness America (PBA) published a report, The Economic Impact of Vision Problems that was updated in 2012, which explored the economic burden related to people 40 and older and the conditions of, age-related macular degeneration (AMD), cataract, diabetic retinopathy, primary open-angle glaucoma and refractive error, as well as the economic impact of vision problems and blindness.

They looked at direct medical costs including inpatient, outpatient and prescription costs; direct non-medical costs, which include nursing home care, guide dogs, and government programs for the blind and visually impaired; and loss of productivity, which includes lower labor force participation and lower wages for those with vision problems as opposed to the same age group with normal vision.

Direct Medical Costs $16.2 billion
Direct Non-medical Costs $11.2 billion
Productivity Losses $8.0 billion
TOTAL ECONOMIC IMPACT $35.4 billion

Looking more closely at the direct medical cost with regards to age-related eye diseases, the costs per patient broke down as follows:

AMD Cataract Diabetic Retinopathy Glaucoma
Medical Costs $797 $12,625 $6,012 $3,552

A year later, the NORC at the University of Chicago presented their findings, but also included the age groups of children 0-17 and adults 18-39 in a publication titled, Cost of Vision Problems: The Economic Burden of Vision Loss and Eye Disorders in the United States. It was interesting to see how the estimates varied in the two approaches when I only focused on the group of age 40 and older, as they did in the PBA study.
Noca booklet
The reclassification of the costs into two line items, from the previous three of the PBA report, presented a challenge and is one reason for discrepancies.  They went into more depth and were broken down as follows: direct costs included medical care, medical vision aids, low vision aids, special education, school screenings and Federal assistance programs; and indirect costs included loss of productivity for adults and caregivers, long-term care and transfer payments.

Direct Costs $52.58 billion
Indirect Costs $58.49 billion
TOTAL ECONOMIC IMPACT $111.07 billion

And when I looked more closely at the medical cost with regards to age-related eye diseases, the costs per patient broke down as follows:

AMD Cataract Diabetic Retinopathy Glaucoma
Medical Costs $4,457 $10,570 $4,005 $5,617

Regardless of the data sources and reporting classifications, one thing is clear – the direct medical costs of eye disease is high and growing each year.

Both reports contained a wide variety of information that is very interesting.  Links for both studies have been included so you can review the numbers and draw your own conclusions.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Welcome to the Discovery Eye Foundation Blog

discovery eye foundation_logoWelcome to your blog, where you will find the most important information about eye health and sight-threatening eye diseases.

The Discovery Eye Foundation team has more than four decades of knowledge, experience and relationships to help you better understand your eye disease and discuss it with your eye doctor — so you can make more informed decisions and lifestyle choices.

You will find information from leading ophthalmologists, optometrists, eye researchers, low-vision specialists, nutritionists and other professionals who are interested in helping you keep your eyes as healthy as possible, and/or deal with eye disease and vision loss.

We will be posting twice a week, with a guest post from an eye-care professional every Thursday addressing an issue important to our constituents.

We want to hear from you. What information do you find useful? What topics are important to you? And while we will respond to general questions about eye diseases, we will not be able to address patient-specific questions that can best be answered by your own eye doctor.

For more in-depth information, please visit one of our three websites to learn about specific eye diseases, view videos, listen to recorded presentations and interviews, and discover disease-specific research and resources.

•   DiscoveryEye.org offers information on age-related macular degeneration (AMD), cataracts, diabetic retinopathy, glaucoma, keratoconus (KC), ocular herpes and retinitis pigmentosa, along with other eye conditions. For help with positive lifestyle choices, check out Eye Cook for delicious eye-healthy recipes.
•   AMD.org was one of the first online sources for information focused solely on age-related macular degeneration (AMD). This site is continually updated with the latest news on potential treatments. It fully explains the role of vitamins in eye health and offers insight into AREDS II. It has helpful information for caregivers and a national directory of resources.
•   NKCF.org is your one-stop site for in-depth information on keratoconus (KC). In addition to providing you with the latest on KC treatments and clinical trials, it has two free online support groups for people diagnosed with KC and their families.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation