How to get rid of floaters in 2 MINUTES. (BUT IS IT SAFE?) | Ophthalmologist @MichaelRChuaMD

how do you feel if I told you that you can get rid of those pesky floaters with a quick two minute procedure would you be interested now what if I told you that procedure also has the risk of causing permanent vision loss would you still do it I'm Dr Michael Chua I'm a board certified ophthalmologist with Puente Hills Eye Care and in this video I'll be discussing all the latest advancements in the treatments for floaters we'll review the medical literature and go through which treatments work which don't and at the end of the video I'll discuss my recommendations on how to best manage these floaters first let's discuss what floaters are and what causes them here's a cross-section of the eye inside the eye is a jelly-like substance called the vitreous with time the vitreous begins to soften Liquid Fire into smaller pieces and Clump together these small clumps can cast Shadows onto the retina which we can see as spots or blobs floating around these are floaters they can be more apparent when we look at bright backgrounds like at a White Plain wall or the sky fortunately with time most of these condensations settle down to the bottom of the eye and become hardly noticeable in general most floaters become less bothersome over the course of about two to three months but for some people these floaters can persist and cause disruptive visual symptoms so let's discuss what treatments are available for those suffering with persistent loaders the first treatment I'll discuss is laser vitriolysis and Laser vitriolysis your ophthalmologist uses a liag laser in the office and aims it at the floaters floating around in your vitreous shooting the laser at those floaters can dissolve them or at the very least displace them so they're less noticeable in recent years yag laser vitriolysis is becoming more widely offered by ophthalmologists but because of very real risks of causing potential harm to patients eyes and vision the procedure Still Remains controversial among eye doctors so let's take a look at the literature to see what evidence is out there regarding their procedure there's actually only two randomized control trials in the medical literature which looked at the use of yag vitriolysis for floaters in this study from 2017 ophthalmologists took 52 patients with symptomatic floaters and randomized them to receive either yag laser vitriolysis or sham laser in the yag treatment group patients were given dilating and numbing drops then they sat down at the yag laser the ophthalmologists use the contact lens to keep their eye open and then use the laser to shoot at all the visually significant floaters and kept increasing the energy of the laser until the ophthalmologist saw that all the floaters were vaporized patients in the Sham group would undergo the same process the only difference was that for the Sham treatment there was a special lens filter glued to the surface of the contact lens so no laser energy would pass through this way patients wouldn't know whether they received a laser or not one key criteria for patients in this study though was that their floater had to be located centrally individious at least three millimeters from the retina and five millimeters from the lens in order to minimize the risk from inadvertent laser damage to nearby structures we know that in real life things aren't so perfect these floaters can be anywhere they can be close to your lens and if your eye doctor accidentally lasers the lens then they can cause a cataract and an open capsule which would require a cataract surgery with higher risk than a typical cataract surgery would have or these floaters can be located closer to the retina or the optic nerve and if your ophthalmologist accidentally lasers the retina it can cause damage to the retina and that damage is usually permanent after the patients in the study receive their lasers the researchers checked up on them after six months to see if there was any Improvement in their symptoms and to check for any adverse side effects the researchers found that 53 percent of patients in the laser group reported significant or complete resolution of their symptoms after treatment compared with none in the control group and looking at that question a different way researchers asked research subjects by how much were their visual symptoms improved on average subjects who receive the yag laser reported a 54 percent Improvement in their floater systems compared with a nine percent Improvement in symptoms in the subjects who received the Sham laser first of all that control group result is a little bit interesting these patients didn't receive any real laser treatment yet they reported a nine percent Improvement in their symptoms it's possible that with time the symptoms just improved on their own or perhaps there's a component of the placebo effect that is because the control group thought that something was being done to treat their floaters they noticed them less afterwards there was also one other interesting finding from the study six months after the laser treatment was done the researcher just took retinal photos of each subject ophthalmologists reviewed the photos and saw that the floaters had significantly improved in 94 percent of patients and that's interesting because even though based on the photos alone you would think that 94 of patients would have reported significant Improvement in their symptoms but only 53 percent of patients did this shows that there can be a discrepancy between what your eye doctor sees on examination or testing versus what symptoms or visual problems you or the patient see So based on the findings from the study if you're considering yag laser vitriolysis you have about a coin flip chance of enjoying significant Improvement in your visual symptoms but what about side effects well in this paper they actually reported zero adverse effects in the laser vitriolysis group no retinal tears no retinal detachments and no spikes in intraocular pressure the following year after this paper was published though the researchers presented longer follow-up data at one of our national Ophthalmology conferences and they reported that after 2.3 years of follow-up three out of 35 or about 8.6 of patients who received laser vitriolysis had developed retinal tears now it's impossible to say whether these retinal tears were from the laser or maybe they would have developed naturally over time in order to answer that question you need another randomized control trial with longer follow-up periods of both the laser and the control group which unfortunately at this time hasn't been done yet the key thing here with this study though is that in the original paper which had a follow-up of six months there were zero complications reported but if you lengthen the follow-up period to 2.3 years you then saw retinal tears in 8.6 percent of patients this is why details absolutely matter in clinical research studies because things like length of follow-up time can have large effects on your final reported outcomes the results from this first study were supported by results from a later study this one published in 2020 from a research team in Brazil they performed a double-blinded randomized control trial in 24 patients with 13 receiving yag laser vitriolysis and 11 receiving a sham leaves they followed these patients for six months and found that 77 percent of patients who received the AG laser reported pronounced or complete Improvement in their symptoms compared with 25 in the control group after six months of follow-up they also reported no adverse outcomes no retinal tears or detachments no intraocular pressure spikes and no cataracts the percentage reported in this study 77 percent of patients who received the AG vitrolysis reporting significant Improvement in their visual symptoms was quite higher than the 53 percent reported in the first study but given the lower number of research subjects in both of these studies your box would see some variation in the results okay now that we see the possible benefits of yagli's or vitriolysis let's look more deeply at the risks in this study Retina Specialists from around the United States compiled a list of patients who suffered complications from yag laser vitriolysis they reported 16 complications in 15 patients they saw five cases of focal cataracts from ophthalmologists who accidentally lasered the lens five cases of prolonged intraocular pressure spikes with three of those cases eventually requiring glaucoma surgery two retinal detachments one retinal tear and two cases of accidentally lasering the retina and subsequent retinal Hemorrhage unfortunately we don't know the actual rate of these complications because the investigators didn't know how many laser vitrolysis procedures were actually done they were simply reporting the adverse complications that were referred to them as Retina Specialists so at this point in time I don't think we have enough large-scale randomized control studies with long enough follow-up times to get a clear picture of the rates of complications that is what percentage of patients who receive yag laser vigilysis actually go on to suffer adverse effects so here's my bottom line on yag laser visualizes for floaters given the current state of research and lack of long-term safety data for laser vitriolysis I don't currently offer it or recommend it to my patients the next treatment option that patients with floaters may consider is vitrectomy now vitrectomies are surgical procedures in which a retina specialist makes two small ports and the sides of the eye then uses instruments to clean out the vitreous jelly inside the eye they're done in operating rooms with sedation or anesthesia given by an anesthesiologist Studies have shown good results with vitrectomy for floaters this review published by ophthalmologists from Denmark in October 2022 reviewed all the prior studies on vitrectomy for the treatment of floaters it was published pretty recently so it's the most up-to-date overview of the latest research about this procedure in this study researchers reviewed 18 prior studies conducted on vitrectomy for the treatment of floaters which included 2077 eyes they found that after averaging the studies together more than 90 percent of patients who receive vitrectomy surgery floaters were satisfied or had relief of symptoms safety wise they found that cataract occurred in 31.7 percent of patients who still had not yet received cataract surgery prior to vitrectomy retinal tears and 2.92 percent vitreous bleeding or Hemorrhage and 1.97 retinal swelling or edema and 1.7 percent retinal detachment and 1.54 glaucoma and 1.04 and endophthalmitis or a severe eye infection in 0.18 so besides cataract formation which we'll talk about more in a little bit you can see that the risk of these complications are around one to three percent which are pretty low in my opinion but you have to remember no matter what the risk of complication will never be zero for this surgery or any other medical procedure if you happen to be The Unlucky One percent who developed a retinal detachment or glaucoma after vitrectomy at that point the statistics of complications don't really matter because these kind applications can cause permanent damage to your vision but now that you're armed with the data you can start to weigh the risks and benefits yourself whether this procedure makes sense for you the one result from this study I found interesting was the rate of cataract formation which was only 31.7 frankly I expected that rate to be much higher closer to 60 to 80 percent which would be more in line with previous studies which looked at the rate of cataract formation after vitrectomy for example this study showed a 63.2 percent rate of cataract formation after vitrectomy for a retinal condition called vitriomacular traction and this study showed an 80 rate of cataract formation after vitrectomy for the treatment of epiretenal membranes this study from the journal Ophthalmology retina helps to explain these seemingly discrepitate results in this study researchers reviewed 96 eyes who received vitrectomy for the treatment of floaters investigators split up these eyes based into two groups based on one key difference the technique for vitrectomy in one group the surgeons performed what's called an extensive vitrectomy in which they basically cleaned out as much of the vitreous as possible including the vitreous close to the lens and the vitreous close to the retina in the other group surgeons performed what's called a limited or core vitrectomy in which they only removed the central portion of the vitreous they found that in patients who received an extensive vitrectomy after two years of follow-up 87 percent of eyes required cataract surgery thereafter which is more in line what I expected but interestingly they found that in patients who receive just the core of vitrectomy only 35 percent required cataract surgery within two years the theory they proposed had to do with oxidation the researchers used a computational model to show that performing extensive vitrectomy doubled the levels of oxygen behind the lens and this increased oxygen speeds up the oxidative processes that lead to the formation of cataract in one of my previous videos here I explained how oxidation is one of the key processes in cataract formation so you can check that out if you want to learn more so if you're having a discussion with a retina specialist about possible featurectomy for the treatment of floaters this particular detail whether it's an extensive or limited vitrectomy matters a lot that's because if you've never had cataract surgery before and they perform a full extensive vitrectomy chances are you're not really only signing up for one surgery you're signing up for two you'll be getting that first retrectomy for your floaters but you'll also be needing cataract surgery soon after if you've already had cataract surgery previously then this risk of cataract formation doesn't really apply to you because you've already had your cataract taken at okay now the next intervention I'll talk about for the treatment of floaters is much less invasive it's eating pineapples this study from Taiwan in 2019 looked at whether eating more pineapples could decrease the symptoms of eye floaters since the study has been published it's received quite a bit of media attention I will tell you right off the bat this study left me with more questions than answers it was published in the Journal of American Science which doesn't seem to have any sort of rigorous peer review process you can see that their website has a bunch of broken links and looks like it was designed maybe 20 years ago and let's start with an excerpt from the abstract of the paper the famous beneficial and delicious pineapples were supplied by the local farmers selling to the world since 1900. that's an unusual sentence to write in a scientific paper and reading through the paper it becomes apparent very quickly that this study would never be published in a legitimate peer-reviewed scientific journal but let's go through the study and see what we can learn in this study researchers took 190 patients and split them up into two groups based on how many floaters that the researchers saw on examination and with eye Imaging they had 120 patients with one floater and 70 patients with multiple floaters the researchers then had each research subject eat 100 grams of pineapple per day for three months after three months they examined the research subjects again and reported that in the patients with one floater only 35 out of the original 120 had floaters on examination or Improvement in 70.8 percent of subjects and in the patients with multiple floaters only 19 out of the 70 had floaters on examination or an Improvement of 72.8 percent of patients these numbers only reflected what they saw in exam in this part of the study they didn't measure or report if there was any significant Improvement in patient symptoms in the next part of the study they wanted to examine if there was a dose dependent effect of pineapple intake on floater symptoms they took three groups of 66 research subjects and gave the first group one 100 gram piece of pineapple per day the second group two pieces of pineapple per day and the third group three pieces of pineapple per day after three months they found that 54.5 percent of research subjects who ate one piece of pineapple per day reported Improvement in their floater symptoms 66.7 percent of subjects to ate two pieces of pineapple per day reported Improvement in their symptoms and 74.2 percent of subjects who ate three pieces of pineapple per day reported Improvement in their symptoms at the surface these results look appealing but remember that there is no control group in the study to compare with the researchers from the study theorized that bromelain which is an enzyme found in pineapples can break down the collagen in arvitreous to decrease the appearance of floaters but biologically even if you ate enough bromelain in your diet why would it only be delivered to your eye to break down collagen in your vitreous why wouldn't it break down the collagen in your skin or cartilage or muscles if it did people might start to look like they're melting another reason why I'm skeptical of these results is that they have not been replicated in any other study from different researchers so does the pineapple a day keep the floaters away the answer is sadly no following the pineapple study there have been a few more studies published which looked at different supplements and their possible use in the treatment of floaters this study is a double-blinded randomized control trial out of Europe which investigated the efficacy of one of these new supplements in this study researchers took 61 subjects and randomized them into either a treatment group or a control group the treatment group took a daily supplement consisting of L-lysine vitamin C Vitus vinifera extract and citrus arantium while the placebo group took Placebo pills these last two ingredients in the supplement Vitus vinifera and citrus arantium sound like fancy ingredients but they're really not Vitus vinifera is a scientific word for the common grape Vitus vinifera extract is basically just taking grape seeds drying them and crushing them Citrus aranzium is the Latin name for the bitter orange those last two ingredients they're just fruit extracts so after randomization 31 subjects took the supplement while 30 subjects took the placebo pill these research objects were Then followed for six months to see if there was any effect on vitreous floaters from the supplement now the research subjects Had Each research subject complete a floater disturbance questionnaire both at the beginning of the study and after six months of treatment the questionnaire assessed the subjective effects of floaters on each patient's quality of life the investigators also checked each subject's visual Acuity contrast sensitivity and took pictures of each subject's floaters before treatment and after six months of treatment the results after six months of treatment were actually pretty interesting let's take a look at this table and dive into the results in terms of visual discomfort from floaters the placebo group had a baseline score of 3.69 in this case larger numbers meant more discomfort from floaters after six months of taking Placebo pills the average score was 3.35 not a significant change now looking at the supplement treatment group the average score at Baseline was 3.90 and after supplementation for six months the average discomfort score decreased to 2.10 which was a statistic significant decrease and based on eye Imaging the researchers saw a significant decrease in the appearance of these floaters and the supplement group while they didn't see a significant change in subjects who received the placebo remember though from the yag laser study that there can often be a discrepancy between what the doctors or researchers see on examination or in photos and What patients report in their subjective complaints now given these promising results would I recommend these supplements to patients who suffer from floaters the answer is no not yet for several reasons first this is a small study they only gave the treatment to 31 subjects and with such a small sample size it's hard to tell if these results would be generalizable to everyone with floaters I would need to see similar results in a larger scale study perhaps from an independent third party before even considering this as a viable treatment option okay the last method for managing floaters I'll discuss is the one I recommend the most often and that's observation I know this may be disappointing for some and when I recommend to my patients to watch these floaters for now I don't want them to feel like I'm dismissing their complaints and symptoms if there's one thing I learned from this deep dive into the medical literature on floaters it's that floaters can be very disruptive and significantly affect quality of life one study from Singapore found that patients with floaters were willing to trade away an average of 1.1 out of every 10 years of the remaining life to get rid of their floaters and they were willing to take an 11 risk of death and a seven percent risk of blindness to rid themselves of symptoms associated with floaters I actually find it interesting that people were willing to accept a higher risk of debt 11 than blindness seven percent secure their floaters there's no question that the visual problems from floaters can wreak havoc on a patient's daily life and that's where the art of medicine comes in our job as doctors is to listen and to help our patients weigh the risks and benefits of the different treatment options that are currently available and as much as I want to cure every one of their floaters patients need to understand that if they're considering a laser procedure or surgery for the treatment of their floaters there are risks just like every other medical procedure or surgery that exists after reviewing these studies though on all the medical literature regarding the treatment for floaters I hope that you can now have more informed conversations with your ophthalmologist about the best treatment for you one last thing I'll mention about floaters if you notice new floaters flashes or Shadows over your vision make sure to see your eye doctor as soon as possible because that might be a sign of a retinal tear or retinal detachment which can cause permanent damage to your vision especially if it's not treated right away okay I think that's enough for this video but if you found the information in this video helpful please give us a thumbs up and subscribe to our channel for future updates and if you live in the Los Angeles Orange County or Inland Empire area and want to get your floaters checked out feel free to visit our website or give our phone number a call to make an appointment today I'm Dr Michael chuo with Puente Hills eye care see you next time

Channel: Michael Chua, MD

Views: 612,326

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Length: 21min 37sec (1297 seconds)

Published: Sat Feb 18 2023