From the Guidelines
A workup for eye floaters typically begins with a comprehensive eye examination by an ophthalmologist, including a dilated fundus exam to evaluate the retina and vitreous, as this is the most effective way to distinguish harmless age-related changes from potentially sight-threatening conditions that require treatment. The doctor will check for signs of retinal tears, detachment, or vitreous hemorrhage which can cause floaters. Additional tests may include optical coherence tomography (OCT) to image the retina in detail, B-scan ultrasonography to visualize the vitreous if the retina cannot be seen clearly, and intraocular pressure measurement 1. Most floaters are benign and result from age-related vitreous degeneration, requiring no treatment beyond monitoring. However, sudden onset of numerous floaters, especially when accompanied by flashes of light or vision loss, requires immediate evaluation as these may indicate a retinal tear or detachment requiring urgent intervention 1. Patients with benign floaters should be educated about warning signs that would necessitate prompt re-evaluation.
Key elements of the workup include:
- Comprehensive eye examination by an ophthalmologist
- Dilated fundus exam to evaluate the retina and vitreous
- Optical coherence tomography (OCT) to image the retina in detail
- B-scan ultrasonography to visualize the vitreous if the retina cannot be seen clearly
- Intraocular pressure measurement
- Patient education on warning signs for prompt re-evaluation The goal of the workup is to identify potentially sight-threatening conditions, such as retinal tears or detachment, and provide timely treatment to prevent vision loss, as supported by the most recent and highest quality study 1.
From the Research
Eye Floaters Workup
- The assessment and management of patients presenting with eye floaters is crucial to rule out sight-threatening conditions such as retinal detachment 2.
- A comprehensive workup for eye floaters includes evaluating the nature of the flashes and floaters, whether one or both eyes are affected, and changes in visual acuity or visual field 2.
- Patient-reported outcome measurements (PROMs) are essential in measuring the impact of floaters and treatment on an individual's quality of life, with many PROMs available, although most are not specifically developed for patients with floaters 3.
Examination and Referral Practices
- Optometrists play a significant role in examining and referring patients with eye floaters, with a great deal of variability in examination technique and referral practice 4.
- Mydriasis is utilized routinely for examination in approximately half of the patients, and there is a relative lack of confidence amongst optometrists in detecting vitreous pigment and its prognostic implications 4.
- Educational measures such as study days may help improve the level of understanding and appreciation of the implications of flashes and floaters and the various clinical signs encountered 4.
Treatment Options
- Ocriplasmin is used to treat vitreomacular traction (VMT) with or without full-thickness macular hole (MH), with higher rates of vitreomacular adhesion resolution (VMAR) and MH closure compared to control 5.
- Enzymatic vitreolysis with ocriplasmin is a therapeutic option for symptomatic focal VMT with or without macular holes (≤400 μm), although surgical treatment with vitrectomy is associated with better outcomes in certain cases 6.
- The choice of treatment depends on various factors, including the size of the VMT and macular hole, the presence of epiretinal membrane (ERM), and the patient's overall condition 6.