Seeing occasional eye floaters can be unnerving, but they are usually harmless. Floaters are typically bits of vitreous humor, the gel-like fluid filling the middle eye chamber, that solidify as we age and the fluid volume begins to shrink. We notice floaters when they drift into the center of the eye, casting a shadow over the retina. In this brief video, Florida-based ophthalmologist Ahad Mahootchi, M.D. discusses two surgical options for the treatment of floaters.*

Two kinds of floaters, two surgical treatments

There are two types of floaters, Mahootchi explains, each with a preferred treatment approach:

• Solid particulate or ring-like floaters for which YAG laser surgery is effective. Matoochi says 60% of his patients only need one treatment to resolve the problem, though that can depend on the number of floaters.

• Cotton candy-looking, string-like floaters which, in small amounts, can be effectively treated with laser therapy. In large amounts, however, a floaters-only vitrectomy (FOV) may be a better approach, if the condition is negatively affecting your quality of life.  

YAG laser surgery 

Mahootchi says that all the major brands of YAG lasers “do a very good job of focusing,” which can help doctors see through small pupils that don’t dilate well (which is common in men). YAG is a painless and “very, very safe” procedure. The odds of a serious treatment complication are “less than one in a thousand.” Nevertheless, he advises using an experienced doctor, particularly if you haven’t had cataract surgery and still have your natural eye lens.

Vitrectomy 

The surgical method for FOV is called pars plana vitrectomy, in which the vitreous humor is removed by entering the eye through the pars plana, a flat structure in the eye. Mahootchi says there is some debate over when and where vitrectomy should be done. In people who’ve already had cataract surgery, however, “it’s pretty easy to do” with “very, very low risk of problems and a very complete fixing of the problem.”

Mahootchi says that there is also debate about how much fluid to remove. Removing all of it can be problematic if medications for macular degeneration or diabetic retinopathy are later needed. Consequently, it may last just days instead of months. On the other hand, removing all the fluid may help prevent issues like retinal detachment later on.

Surgery is “very specialized” in people who haven’t had cataract surgery and still have their natural lens. The surgery “can help a lot,” Mahootchi says, but it will produce a cataract a year or two later. It’s “fairly easy to fix,” though, and could allow a person to get rid of both their floaters and their glasses.

Smoking 

Smokers are advised to permanently quit prior to undergoing these procedures, because smoking raises the risk of macular degeneration. 

Insurance coverage

Medicare covers these procedures. Plans that often don’t cover them are:

• Medicare Advantage, and
• Commercial insurances 

Mahootchi says that commercial plans often view the procedures as experimental, even though they’ve been around for decades.

Speak with your ophthalmologist to learn more about these procedures and whether or not they may be appropriate for your unique situation. 

Responsum Health closely vets all sources to ensure that we always provide you with high-quality, reliable information. We do not, however, endorse or recommend any specific treatments, and the usage of a given source does not imply an endorsement of any treatment, medication, or procedure discussed within.

*Mahootchi, A. (2020, January 20). Laser vs. Vitrectomy for Floaters at the Florida Eye Clinic with Dr. Ahad Mahootchi [Video file]. Retrieved from https://www.youtube.com/watch?v=N3qKqiJ-HnU