What are the medical treatments for vitreous floaters?

From the Guidelines

Floaters in the eye typically do not require medical treatment, but in severe cases where they significantly impact vision, pars plana vitrectomy is an option, as it has been shown to improve contrast sensitivity function and patient satisfaction. According to the study published in Ophthalmology in 2020 1, posterior vitreous detachment symptoms, such as flashes and floaters, usually diminish over time, and appropriate reassurance and precautions regarding the symptoms of retinal detachment should be given. However, some patients may be debilitated by floaters, and their quality of life may be affected.

Some key points to consider in the management of floaters include:

• The impact of floaters on vision-related quality of life can be significant, and treatment options should be considered in severe cases.
• Pars plana vitrectomy has been used for removal of floaters and has been shown to improve contrast sensitivity function and patient satisfaction 1.
• Laser treatments and pharmacotherapies have been proposed to decrease symptoms, but currently lack sufficient evidence to support their use, except for YAG vitreolysis which has shown some promise in reducing symptoms 1.
• The goal of treatment is to improve the patient's quality of life, and the risks and benefits of each treatment option should be carefully considered.

In terms of treatment options, the study suggests that:

• Pars plana vitrectomy is a viable option for patients with severe symptoms, as it has been shown to improve contrast sensitivity function and patient satisfaction 1.
• YAG vitreolysis may also be considered, as it has been shown to yield greater improvement in symptoms than sham laser 1.
• However, the risks and benefits of each treatment option should be carefully considered, and the decision to treat should be made on a case-by-case basis.

From the Research

Medical Treatment for Floaters in the Eye

• Floaters are a common ophthalmic issue that may be a sign of benign, age-related changes of the vitreous or more serious retinal detachment 2.
• Patients presenting with flashes and floaters must be referred to an ophthalmologist to rule out sight-threatening conditions 2.
• Key examination features include the nature of the flashes and floaters, whether one or both eyes are affected, and changes in visual acuity or visual field 2.

Risk Factors for Retinal Tears and Detachments

• The presence of isolated flashes is associated with the development of retinal tears in 5.3% of symptomatic eyes 3.
• Floaters alone have a stronger association with retinal tears (16.5% of eyes) compared to flashes 3.
• The association with retinal tears is even greater for patients reporting both flashes and floaters (20.0% of eyes) 3.
• Patients with more than 10 floaters or a cloud in their vision have a high risk of developing retinal tears (OR 19.8, p-value 0.032) 3.

Symptom-Based Risk Factors

• Symptom-based predictive factors for retinal tears and detachments include the presence of subjective visual reduction (SVR) or subjective field loss (SFL), and the absence of either floaters or flashes 4.
• The number, duration, and timing of flashes and floaters may be less relevant in the triage of patients with posterior vitreous detachment symptoms 4.

Examination and Referral Practices

• Optometrists' examination and referral practices for patients presenting with flashes and floaters vary greatly 5.
• Mydriasis is utilized routinely for examination in approximately half of the patients presenting with flashes and floaters 5.
• There is a relative lack of confidence amongst optometrists with regards to the detection of vitreous pigment and the prognostic implications of this finding 5.