Sometimes they sit out of sight in the corner of your eye. Other times, they loom over your field of vision, and when you shift your gaze to look at them, they are out of sight. These annoying obstructions, commonly known as floaters, are a visual phenomenon caused by small clumps of collagen in the eye called vitreous opacities.
Although floaters are very common, they are usually so subtle that people ignore them. However, floaters can sometimes be so dark and numerous that they obscure much of a person's vision. These heavy floaters interfere with people's ability to drive, work, and just enjoy life, which often leads to this.Depression(1).
"There are millions of people around the world who suffer from floaters," said Yannis Paulus, a vitreoretinal surgeon and clinical scientist at the University of Michigan. "Right now, they're stuck with bad options," he added. The only available treatments come with a significant number of risks.
These treatments include vitrectomy, the surgical removal of the clear, gelatinous vitreous humor of the eye that contains clumps of collagen, and laser vitreolysis, which uses high-energy light pulses to separate the fibers. Vitrectomy is more effective than laser vitreolysis, but patients have experienced retinal tears, retinal detachments, and vitreous hemorrhage with both treatments.
As scientists investigate how laser vitrectomy and vitreolysis can be made safer and more effective, they are also developing new nanobubble-based technologies that could be even safer and less invasive than current treatments and improve the quality of life for many people in everyone. the world that suffers from annoying floaters.
The most common cause of floaters is simply aging. In young eyes, collagen fibers attached to hyaluronic acid molecules hold together the gelatinous structure of the vitreous body. As we age, collagen and hyaluronan begin to dissociate and the gel becomes more fluid, causing the collagen fibers in the vitreous to collapse on top of each other, forming clumps that feel like floaters.
People over the age of 60 often begin to see more floaters as the vitreous separates from the back of the eye in a phenomenon called posterior vitreous detachment. However, because this compensation process is faster in people with myopia, nearsighted people in their 20s, 30s, and 40s can also experience floaters.
In people who notice a sudden rash of many new floaters, ophthalmologists first look for signs of retinal detachment or injury to the eye. But after ruling out an acute cause, doctors usually suggest that patients wait a few weeks or months to see if their floaters seem to go away or become less noticeable. Usually, people undergo some neuroadaptation, and the brain shuts off the floaters. But when floaters don't get better and continue to interfere with daily life, people turn to their doctors for help.
"Unfortunately, the most common form of treatment is to rule them out and ignore them, sending the patient home frustrated and unhappy," said Jerry Sebag, a vitreoretinal surgeon and floater researcher at the Vitreous Macula Retina (VMR) Institute. "I realized that these patients are being discharged because we couldn't determine if they really have a problem or if they're just overreacting to something we're all experiencing."
Sebag and his colleagues developed quantitative assessments to measure how floaters affect people's vision. They showed that they could use itquantitative ultrasoundcharacterize the density of the entire vitreous, with floaters appearing as points and lines of greater density (2). Sebag's team also reported that floaters reduced thecontrast sensitivity, meaning that people with swimmers were less able to distinguish differences in shading and pattern (3).
"With a quantitative component, you can classify conditions as mild, moderate, and severe," Sebag said. "It allowed me to select patients for treatment."
Surgical incisions remove floaters
The most effective way to treat floaters is to physically remove them. In an operation called a vitrectomy, surgeons remove the vitreous from the eye and replace it with a clear gel.
While there are risks of retinal tears and detachments with vitrectomy, “you can usually identify these problems during surgery. If you see a torn retina, you can laser it during surgery," said Jason Hsu, a vitreoretinal surgeon and researcher at Thomas Jefferson University.
Recently, vitreoretinal surgeons have made improvements to vitrectomies to make these retinal tears less likely. For example, they now use smaller instruments to perform surgery, which means they can make smaller incisions. Sebag adapted his vitrectomy procedure with this modification and improved the method so that there is no posterior vitreous detachment during the operation. With these security modifications, the Sebag team reported in aclinical studyof 195 eyes of 145 patients, vitrectomy resulted in a 94.1% reduction in vitreous echodensity, indicating successful removal of the vitreous opacities that cause their appearance (4). The patient's contrast sensitivity also improved postoperatively to the level of healthy control eyes. Of the 195 operated eyes, there were three retinal tears and three retinal detachments, but these were successfully repaired during surgery.
Although vitrectomy is relatively safe and effective in treating severe floaters, it increases the risk of developing them.waterfalls(5). For this reason, and because other long-term risks of vitrectomy are unknown, Sebag and other vitreoretinal surgeons are reluctant to operate on younger patients.
"I just haven't followed people in 30 years, so I can't answer that question," Sebag said. As an alternative to vitrectomy, some ophthalmologists have turned to a risky and somewhat controversial treatment: laser vitreolysis.
An explosion in the eye
Rather than physically remove the vitreous opacities that floaters cause, some optometrists have attempted to destroy them with pulses from a yttrium aluminum garnet (YAG) laser.
"It's not like a typical laser beam that we think of in Star Wars or anything where it burns tissue. The YAG laser is like a little explosion in the eye," Hsu said. "It's almost like vaporizing a piece of tissue with this highly concentrated energy." This process breaks large collagen aggregates into smaller pieces, reducing the occurrence of floaters.
Ophthalmologists have used YAG lasers for decades to remove cloudy layers of scar tissue that form after cataract surgery and when treating certain types of glaucoma, but their use to treat floaters is relatively new and somewhat controversial.
in the onlyclinical studySo far, the efficacy of YAG laser vitreolysis in floaters has been studied. 54% of patients who received the YAG treatment reported an improvement in the appearance of floaters (6). None of the study patients experienced side effects.
However, YAG laser treatment carries significant risks. The laser energies required to destroy the fibers that cause floaters are double or triple the energies used for the other, more routine applications of YAG lasers. Even with the highest energy laser pulses, a person may need to go through several YAG laser treatment sessions to effectively remove a problem floater. In some cases, surgeons have focused the laser too close to the front or back of the eye, directly damaging the lens or retina.
Citing these concerns, Inder Paul Singh, an ophthalmologist at the Racine and Kenosha Eye Centers, explained that newer YAG lasers allow for better illumination of the vitreous, helping ophthalmologists more easily orient themselves in the eye and reducing the risk of damage vital structures.
"Not all floaters are good candidates for YAG laser vitreolysis," he said, but if, for example, "the floaters are in the middle of the vitreous, where signs and symptoms can be correlated well, it may be a fantastic opportunity to avoid something like a vitrectomy and not let [the patient] suffer if they live with it.”
While Singh has been very successful in treating floaters with YAG vitreolysis in his practice, many other physicians have not.
"There is no protocol for using the YAG laser, either in terms of patient selection or in terms of how to actually deliver the treatment in a scientifically reproducible way," Sebag said. She is organizing a study on how to make YAG vitreolysis more reproducible and safe by using quantitative ultrasound to measure results, among other methods.
Singh agreed that proper training on how to perform YAG vitreolysis is an essential part of successful floater treatment.
“The laser is not unsafe. We as clinicians can feel insecure," she said. "It's important for clinicians to understand where they are in the vitreous and learn how to maximize that view."
He and others are investigating the use of systems to more accurately track floaters in the vitreous and the use of the more efficient femtosecond laser instead of a YAG laser to treat floaters, which would reduce the number of laser sessions. needed to destroy floaters.
Given the current risks associated with vitrectomy and laser vitreolysis, researchers are looking for new strategies to treat floaters.
Nanobubbles explode floats
Before Stefaan De Smedt, a drug delivery researcher at Ghent University, presented his research years ago at the Belgian Academy of Medicine, he had never considered nanobubbles as the next frontier in eye blister treatment. He and his team were interested in using vapor nanobubbles, generated by aiming a laser at nanoparticles, as a method of delivering nucleic acids into cells.
When scientists shine a laser at a specific frequency at closely spaced nanoparticles, the nanoparticles absorb the energy from the laser, which heats the solution surrounding the nanoparticles, causing the liquid to vaporize and nanobubbles to form. These nanobubbles expand and then burst into dozens or hundreds.nanoseconds after they are formed (7), resulting in the generation of a mechanical force that can puncture a hole in a cell membrane.
"I spoke to an ophthalmologist, [and] he said it might also be useful to see if these types of nanobubbles might be of value in disrupting aggregates," De Smedt said.
Intrigued by this possibility, De Smedt and his postdoc Félix Sauvage began testing the ability of nanobubbles of vapor generated by different types of nanoparticles to destroy the collagen aggregations that cause floaters. in a new onelearnPublished innature's nanotechnology, De Smedt, and Sauvage, in collaboration with Sebag, Paulus, and others, reported the success of nanobubbles made of gold nanoparticles and an ophthalmic dye in breaking up collagen aggregates.livefor the first time (8).
The researchers demonstrated that both hyaluronan-coated gold nanoparticles and indocyanine green (ICG) ophthalmic dye preferentially bind to and disrupt human vitreous opacities isolated from vitrectomy patients in Sebag's practice. Because the particles are specifically bound to the collagen aggregates, nanobubble formation occurred only in the aggregates. This means that even if the laser shines on a spot in the eye without nanoparticles or dyes, it does not create nanobubbles that could damage other structures in the eye.
"The threshold for creating bubbles is very high," Sauvage explains. "We have a selective method to trigger bubble generation."
Emboldened by how well their technology worked on oneex vivosystem, De Smedt's team searched for the best animal model to test it.live. This proved challenging because, as Paul quipped, "you don't have a mouse telling you he has floaters in his vision."
The team ultimately ended up with rabbits, with their relatively large eyes that are more human-like, making them ideal models.
De Smedt, Sauvage and their colleagues injected collagen fibers into the rabbits' eyes to give them vitreous opacities, then injected gold nanoparticles, or ICGs, and shined laser pulses into the rabbits' eyes. They found that they only had to use an average of five laser pulses to completely remove the collagen aggregates.
"When we saw these data on its efficacy, I was pretty stunned," Paulus said. When the team tested the safety of his technique, he found that it had no adverse effects on the rabbits' retinas.
Because the nanoparticles and dye bind directly to collagen fibers, the researchers were able to remove vitreous opacities in places in the eye that would not be possible with a YAG laser, such as near the retina. Similarly, aggregating the particles allowed the researchers to use a lower energy laser to induce nanobubbles than would be needed for a YAG laser to disrupt the fibers, greatly improving safety.
This technology also improves vitrectomy as it does not require risky surgery, just an injection of nanoparticles or dye into the eye. Eye injections are a common procedure for vitreoretinal surgeons, Paulus added.
"It's about taking two things that we essentially do almost independently, these ocular injections and the laser, and combining them," he said.
In the future, De Smedt and his team are interested in studying the pharmacokinetics of their gold nanoparticles and ICG in humans. While both gold nanoparticles and ICG are biocompatible, only ICG is biodegradable, making it more likely to progress to future human clinical trials.
"Certainly we still need to do more clinical trials before this is available to everyone, but I think it would really be a game changer in terms of the ability to treat these floaters in a low-risk, minimally invasive way." And I think it would really transform our patient care," Paulus said.
Although De Smedt did not initially plan to develop new treatments for floaters, he now understands what a non-invasive and effective treatment would mean for people suffering from floaters. After his team released theirsfirst roleOn nanoparticles and buoyancy aids (9), he and Sauvage received hundreds of questions from people around the world about the potential of technology to treat buoyancy aids.
"I try to imagine how it feels to open your eyes and always be depressed because you can't really see," De Smedt said. "It can help people get their sight back, which means giving them back their quality of life."
- Kim, Y-K.et al.Psychological distress in patients with symptomatic vitreous opacities.Journal of Ophthalmology2017, 3191576 (2017).
- Mamu, Jet al.Ultrasound-based quantification of vitreous floaters correlates with contrast sensitivity and quality of life.Research Ophthalmology and Visual Science 56, 1611-1617 (2015).
- García, G.A.et al.Impaired contrast sensitivity function after a posterior vitreous detachment.american journal of ophthalmology 172, 7-12 (2016).
- Sebag, J.et al.Long-term safety and efficacy of limited vitrectomy for visual impairment of vitreopathy secondary to vitreous floaters.retinal ophthalmology 2, 881–887 (2018).
- Yo, K.M.P.et al.Incidence of cataract surgery after vitrectomy for vitreous opacities.retinal ophthalmology 1, 154-157 (2017).
- Schah, CP and Heier, JS Laser-YAG vitreolysis versus sham-YAG vitreolysis in symptomatic vitreous swimmers: a randomized clinical trial.JAMA Oftalmol135, 918–923 (2017).
- Xiong, R.et al.Comparison of gold nanoparticle-mediated photoporation: vapor nanobubbles overcome direct heating to deliver macromolecules into living cells.ACS-Nano 8, 6288-6296 (2014).
- save, f.et al.Laser-induced nanobubbles safely remove vitreous opacities in vivo.natural nanotechnology(2022).
- save, f.et al.Photoablation of human vitreous opacities by light-induced vapor nanobubbles.ACS-Nano 13, 8401-8416 (2019).
What is the newest treatment for eye floaters? ›
The in-office procedure is called “Laser Floater Treatment” (LFT) or Laser Vitreolysis. Using the FDA approved Ellex Ultra Q Reflex Laser, the procedure neither removes nor fragments your floaters, but vaporizes them into gas bubbles. These are then absorbed into your bloodstream.Can bromelain supplements help with eye floaters? ›
A study from Taiwan found a 70% decrease in floaters among participants who consumed pineapple daily for three months. Researchers attribute the treatment's success to the enzyme “bromelain” which is found in pineapple. They believe that the bromelain dissolves the collagen that creates floaters.What is the success rate of laser floater treatment? ›
In the present study, we used laser energy ranging from 5 to 9 mJ, which is safe and potent enough to vaporize floaters. Overall, 70.59% patients reported their floater symptoms significantly or completely improved, and in the PVD type group of patients that improvement was in 72.73%.How safe is vitrectomy for floaters? ›
Risks associated with vitrectomy include, but are not limited to, cataract formation, retinal tear and detachment, macular pucker, and macular edema (swelling). There is a small risk of vision loss. A laser is now available that can be used to try to break up large floaters into particles small enough to be ignored.How do you dissolve eye floaters naturally? ›
There are no natural, at-home treatments that are capable of entirely doing away with floaters. If the issue is severe and persistent, surgery may be needed.What are 3 ways to get rid of eye floaters? ›
- Ignore them. Sometimes the best treatment is nothing at all. ...
- Vitrectomy. A vitrectomy is an invasive surgery that can remove eye floaters from your line of vision. ...
- Laser therapy. Laser therapy involves aiming lasers at the eye floaters.
The risks of YAG vitreolysis include glaucoma, retinal tear, retinal detachment, cataract from striking the lens with the laser and retinal damage from striking the retina, says Dr. Shah.Can floaters make vision worse? ›
In very rare circumstances, eye floaters may disrupt vision and require surgical treatment. A sudden, very noticeable increase in eye floaters may also be a sign of other serious issues, such as retinal detachment, which could lead to blindness if a person does not receive prompt medical treatment.What vitamins are good for eye floaters? ›
40 mg Vitamin C: Guards against intraocular oxidative stress by consuming oxygen released at the vitreoretinal interface. 26.3 mg Vitis Vinifera: Grapeseed extract. Of which 25 mg are Proanthocyanidins, which reduce glycation. 5 mg Zinc: Helps reduce processes that lead to vitreous degeneration.Does vision get worse after vitrectomy? ›
You might have some pain in your eye and your vision may be blurry for a few days after the surgery. You will need 2 to 4 weeks to recover before you can do your normal activities again. It may take longer for your vision to get back to normal.
Will I get cataracts after vitrectomy? ›
Vitrectomy can lead to the formation and accelerated progression of cataracts, most commonly, the nuclear sclerotic (NS) type. A meta-analysis of 51 studies found that the incidence of post-vitrectomy cataract varies considerably from 6-100%.Is a vitrectomy high risk? ›
A vitrectomy is a low-risk procedure with a high chance of success that can treat many eye conditions. In some cases, your vision may improve if substances or blood in your vitreous were causing you to have clouded or blurry vision.When should you not take bromelain? ›
Pregnant women and people with bleeding disorders, high blood pressure, and liver or kidney disease should not take bromelain. Bromelain may increase the risk of bleeding during and after surgery. You should stop taking bromelain at least 2 weeks before surgery.How much bromelain should I take for floaters? ›
Doses range from 80–400 milligrams per serving, two to three times daily. Your doctor may recommend that you take bromelain with meals in order to aid digestion, or on an empty stomach to reduce inflammation.Can bromelain dissolve eye floaters? ›
Conclusion: We demonstrated that mixed-fruit-enzyme including bromelain, papain and ficin may excise SVOs and even eliminate intraocular hemorrhage by cleaving the collagen fibrils and cellular debris that may induce ocular floaters.Can Chinese medicine cure eye floaters? ›
Acupuncture on the spleen and liver meridians balances the yin and yang, which eliminates the floaters. In most cases, the floaters can be improved or eliminated in about 30 minutes of acupuncture. If they have not disappeared within this period of time, a few visits will eliminate them entirely.What is the main cause of eye floaters? ›
What causes floaters? Floaters usually happen because of normal changes in your eyes. As you age, tiny strands of your vitreous (the gel-like fluid that fills your eye) stick together and cast shadows on your retina (the light-sensitive layer of tissue at the back of the eye). Those shadows appear as floaters.What foods can cure eye floaters? ›
Introduce healthy foods in your diet such as leafy vegetables, citrus fruits, and fatty fish. These have essential nutrients to improve eye health and reduce floaters. Improving your lifestyle can significantly reduce eye floaters.Does turmeric help with eye floaters? ›
Substances rich in anti-oxidants like turmeric and rose hips have provided relief to many. Rose hips are most commonly found in tea, and turmeric can be located in the spice aisle at your supermarket. This is one of the most effective ways to rid yourself of eye floaters.What supplements help vitreous detachment? ›
Ageing is inevitable, but damage from vitreous deterioration is not. Be sure to consume essential fatty acids, bioflavonoids, amino acids, hyaluronic acid, glucosamine sulfate, silica, vitamin C.
What are the risks of laser therapy? ›
- Redness, swelling, itching and pain. Treated skin may swell, itch or have a burning sensation. ...
- Acne. Applying thick creams and bandages to your face after treatment can worsen acne or cause you to temporarily develop tiny white bumps (milia) on treated skin.
- Infection. ...
- Changes in skin color. ...
High-power lasers can damage the retina by shooting a powerful light current into the eye that penetrates the organ's deepest layers in fractions of a second. The eye's protective blink reflex is not fast enough to shut out the laser beam.Can lasers cause permanent eye damage? ›
Above 5 milliwatts of power, a laser can potentially permanently damage the eyes in under 10 seconds. For especially strong lasers, this damage can be almost instant. This harm is mostly the result of the sensitive light-sensitive cells in the eye's retina becoming overloaded and damage done to the macula.How long is too long for eye floaters? ›
The floaters often subside starting within a few days, and all but a few settle to the bottom of the eye and disappear within a 6-month period. Some residual floaters can be seen for life.Can eye drops cure floaters? ›
There are no eye drops, medications, vitamins or diets that will reduce or eliminate floaters once they have formed. It's important to continue your annual eye exam, so your eye doctor can identify any eye health issues that may arise. If floaters continue to bother you, visit your VSP network doctor for advice.Can screen time cause floaters? ›
Can screen time cause eye problems such as floaters? Floaters are not associated with screen time. Floaters are caused by changes to the jelly inside the eyeball called the vitreous humour and are unrelated to screen time.What vitamin deficiency causes floaters in the eye? ›
Uveitis Linked to Vitamin D Deficiency
Sensitivity to light, blurry vision, floaters, pain, and/or redness are symptoms of uveitis. A study looked at non-infectious uveitis patients. The researchers measured the levels of Vitamin D in the blood, as well as Vitamin D intake and exposure.
There are no eye drops, medications, vitamins or diets that will reduce or eliminate floaters once they have formed. It's important to continue your annual eye exam, so your eye doctor can identify any eye health issues that may arise.What is the best treatment for eye floaters? ›
A vitrectomy is the primary treatment for eye floaters. This procedure involves removing the vitreous in order to totally eliminate the collagen fibers that are causing the eye floaters.Will floaters go away after YAG laser? ›
Some of the increased floaters are due to small pieces of the capsule floating around in your eye. For most patients, seeing more floaters after their YAG laser capsulotomy is temporary. They should decrease after a few weeks while you continue recovering from the procedure.
Can cataract surgery eliminate floaters? ›
Cataract Surgery & Floaters FAQs
No, cataract surgery will not get rid of floaters in the eye. Removal of the cataract may make floaters more noticeable.
If you already have eye floaters, then smoking can worsen them. If you don't already have them, then this habit is a likely cause. Similarly, excessive drinking of alcohol can cause premature aging to the vitreous humour, which can trigger the development of floaters.What medications cause eye floaters? ›
Floaters and other visual disturbances.
Flashes of light or color, floaters and other visual disturbances can occur for a host of reasons, including as a side effect of a drug. Medications linked to visual disturbances include Benadryl (for allergies), Cardizem (heart disease), Elavil (depression) and Xanax (anxiety).
Although Nd:YAG laser treatment is largely safe, it still has complications, such as transient increase of intraocular pressure, anterior uveitis, intraocular lenses pitting, cystoid macula edema, endophthalmitis, and retinal detachment.Can I watch TV after YAG? ›
You may hear it's okay to watch TV after Laser Eye Surgery as long as you avoid watching it for long periods of time. But to improve your chances of a speedy recovery and allow the cornea to progress through the acute stages, we recommend avoiding all screens for the first 24 hours.Will I need new glasses after YAG? ›
YAG capsulotomy generally does not alter your glasses prescription, but if you are due for an eye test you can see your optometrist for refraction (glasses check) around 4-5 weeks after YAG capsulotomy.Why is my vision getting worse after cataract surgery? ›
Sometimes blurry vision is caused by PCO, a fairly common complication that can occur weeks, months or (more frequently) years after cataract surgery. It happens when the lens capsule, the membrane that holds your new, intraocular lens in place, becomes hazy or wrinkled and starts to cloud vision.Can dry eyes cause floaters? ›
Are Dry Eyes and Floaters Connected? Experts have not found a link between dry eye disease and floaters. Eye floaters are age-related changes caused by deteriorating vitreous humor, resulting in tiny floating particles, and dry eye disease is linked to inadequate tear production.Can an opthamologist remove floaters? ›
An ophthalmologist aims a special laser at the floaters in the vitreous (vitreolysis). This may break up the floaters and make them less noticeable. Some people who have this treatment report improved vision; others notice little or no difference.