28 EyeWorld Asia-Pacific | December 2024 ASIA-PACIFIC PERSPECTIVES Lee Mun Wai, MD Medical Director, LEC Eye Centre 44-46 Persiaran Greenhill, 30450, Ipoh, Perak, Malaysia munwai_lee@lec.com.my “Floaters” is a term often used to describe the visual phenomena associated with vitreous opacities and is most commonly caused by posterior vitreous detachment (PVD). The traditional thinking amongst ophthalmologists is that these are often transient, innocuous and inconsequential hence, we reassure our patients that no treatment is required and that the floaters will “settle down” and they will “get used to it”. More recently, we have become more aware of the vision problems floaters may present. This may have a significant impact on quality of life and psychological distress associated with floaters1 has been previously reported. The term Vision Degrading Myodesopsia2 has been coined to refer to patients with clinically significant vitreous floaters. In the current climate of refractive cataract surgery with presbyopia correcting intraocular lenses (PCIOLs), dissatisfaction with vision postoperatively is a source of distress for the patient as well as the surgeon. We should consider the presence of floaters as a cause for dissatisfaction as it can result in significant reduction in contrast sensitivity and removal of these floaters has been shown to improve quality of vision.3 I personally have had patients who were very troubled by their vision despite successful cataract surgery (with PCIOLs) and subsequently reported a marked improvement after vitrectomy for symptomatic floaters. Treatment for floaters would include pars plana vitrectomy (PPV) and there are some amongst the vitreoretinal community who will perform a complete PPV with PVD induction (if not already present) whilst others may just perform a core vitrectomy. Vitrectomy is not without its risks but small gauge vitrectomy is minimally invasive and generally well tolerated and effective in removing symptomatic floaters.4 More recently, YAG vitreolysis of floaters has become a popular and less invasive alternative and has been shown to be safe and effective.5 However, this may not be successful in all cases as treatment is often limited to floaters which are not too dense, situated in the midvitreous and not too near the retina and in some instances, several sessions may be required. In unsuccessful cases, a vitrectomy is the next option. The practice of personalised medicine involves the delivery of appropriate care to the individual based on his/her specific needs. With that in mind, patients with symptomatic floaters should be given the option for treatment. A change in mindset towards recognising vision degrading myodesopsia would go a long way to ensure that we do the best for our patients. Editors’ note: Dr. Lee Mun Wai disclosed no relevant financial interests. Reference: 1. Kim YK, Moon SY, Yim KM, et al. Psychological distress in patients with symptomatic floaters. J Ophthalmol 2017;3191576 2. J Sebag. Vitreous and vision degrading myodesopsia. Prog Retin Eye Res 2020 Nov;79:100847 3. Nguyen JH, Yee KMP, Nguyen-cuu J, et al. Vitrectomy improves contrast sensitivity in multifocal pseudophakia with vision degrading myodesopsia. Am J Ophthalmol 2022;244:196-204 4. Sommerville DN. Vitrectomy for vitreous floaters: analysis of benefits and risks. Curr Opin Ophthalmol 2015 May;26(3):173-6 5. Lin TZ, Cheng S, Yang X, et al Long-term efficacy and safety of YAG laser vitreolysis for vision degrading myodesopsia. Int J Ophthalmol 20223 Nov 18;16(11):1800-1805 CATARACT
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