Eye floaters after cataract surgery?

Cataract surgery is one of the most common surgical procedures around the globe in which the cataract is replaced by an intraocular lens in order to provide a clear sight.

Cataract surgery posses a high rate of success, patients achieve a good visual quality and there are very little post-operatory complications. Most patients operated from cataract with intraocular lens (or clear lens surgery) experience a high visual satisfaction although some of them affirm to suffer from eye floaters after surgery.

Are eye floaters a problem derived from the cataract surgery?

We may think at first that eye floaters are the result of a complication of the cataract surgery. However, their presence is not directly related to the surgery.

Logically, a person that has never suffer from eye floaters and experience them for the first time after surgery believes that the eye floaters are a direct consequence of the surgery. However, the truth is that almost every patient operated from cataracts has suffered eye floaters for the same reasons that those that have not been operated.

There is only an indirect relation between the experience of eye floaters and the cataract surgery. This is due to the possibility of a vitreous detachment after the surgery that may be originated by the surgery and that may cause eye floaters.

What for sure the cataract surgery does, is making its presence more evident. We must bear in mind that a translucent or opaque crystalline has been replaced by a transparent lens. For better or worse, the patient “sees better” and this includes eye floaters on the vitreous.

Next, we will try to provide further information about what causes eye floaters and what can we do about them.

Why do I see these shapes, filaments, fabrics, shadows…?

Eye floaters remain in the interior space inside the eyeball called vitreous humour. This space between the crystalline and the retina is in normal conditions, gelatinous and transparent.

However, the vitreous humour deteriorates when aging and it is common to suffer a process of liquefaction (it loses its gelatinous nature and become more watery) and internal disorganization. This process may lead to an interior condensation of fibers that causes condensations of threads, shapes, spiderwebs…floating in the vitreous humour.

When there is a relative lighting, those shapes create shadows on the retina that cause what are commonly known as eye floaters or myodesopsias.

In some other less common cases, the eye floaters appear caused by a separation of the vitreous from the retina. This may lead to tears and even some haemorrhage on the eye that gives rise to new shapes. In these cases, it is very important to complete a test and undergo treatment if needed, since it may cause a detachment of the retina.

To simplify, eye floaters are caused by:

  • a deterioration process of the vitreous humor.
  • the possibility of a posterior vitreous detachment (the vitreous separates from the retina).

Imagen Transversal del Ojo

Figura 1. Representación de las diferentes estructuras del globo ocular.

Simulation of eye floaters on the visual field.

Figure 2. Simulation of eye floaters on the visual field.

What can you do if you suffer from eye floaters?

Eye floaters may appear under different shapes and move inside the eyeball. They may be very annoying, especially when there is a lot of lighting.

It is advisable for people suffering from myodesopsias to avoid looking at very bright surfaces, such as the sky on a shinny day and they should wear sun glasses.

The main advice is trying not to follow the eye floaters, mainly because this may cause stress and obsession. Moreover, the brain usually adapts, making the eye floaters not so annoying. As in other annoying conditions (for example, noise on the ears), over time, the brain tends to “disregard” eye floaters to some extent.

In other cases, some of the eye floaters will move over time to the periphery or fall down and their presence will be unnoticed.

Who is at greater risk of suffering from eye floaters?

As we have seen earlier, aging causes a progressive loss of vitreous properties (process that also increases the probability of suffering a vitreous detachment). Apart from this factor, there are other variables that increase the probability of suffering from eye floaters. Among these factors stand out:

  • Diabetes.
  • High myopia.
  • Inflamatory processes inside the eyeball.
  • Eye trauma.
  • Detachments of the retina.
  • Endophthalmitis.
  • Uveitis.

Although symptoms are the same, the origin may be different and, as we can see, the presence of eye floaters may be caused by high myopia, diabetes, etc. Eye floaters may appear before and after cataract surgery.

When do I need to visit my eye doctor?

If the patient experiences eye floaters after surgery, even if the visual quality is very good, it is always advisable to have the patient’s retina evaluated by the ophthalmologist. In most cases, eye floaters do not mean complications whatsoever, but the patient should go to the clinic if:

  • Stops seeing the eye floaters drifting inside the eyeball and always appear in the same position.
  • Loses vision in an area of his visual field.
  • Percives bright flashes.
  • Gets a great increase of eye floaters.

During examination the ophthalmologist will dilate the patient’s pupil to check the state of the retina, verifying if there has been a retinal detachment or any small haemorrhage inside the eyeball.

What are the current treatments available for eye floaters?

Although eye floaters are annoying, they are only treated when the vision is harmed or when they may cause secondary complications.

Main treatments are:

– Vitreolysis through laser (non-invasive technique)

This technique uses Yag laser for division (also called vaporisation) of the eye floater in smaller pieces. After dilating the patient’s pupil and inserting a special contact lens into his eye, the doctor points towards eye floaters in such a way so as to not only divide them but also move them to other areas. After “shooting” the laser to the bigger eye floaters, other smaller ones may remain since they are very small to be divided by the laser.

There will be no incision or discomfort for the patient on this eye floaters treatment. Depending on the nature and amount of eye floaters, the treatment might take from 5 minutes to half an hour. There is no restriction whatsoever relating to post-operatory activities.

Sometimes, all eye floaters cannot be eliminated within a session due to:

  • The cornea surface and the contact lens become a little blurred. This prevents a precise shooting.
  • Experienced ophthalmologists do not recommend more than 500 laser shoots per session. This amount may not be enough to reduce all eye floaters but around 1000 shoots may sometimes increase intraocular pressure.

The success of this treatment will ultimately depend on the characteristics of the floating shapes.

Being a non-invasive treatment, vitreolysis is generally considered a safer process than the classic vitrectomy. Although there have been several studies describing this process as eye floaters treatment, there is no published conclusion regarding its safety and efficacy. This treatment is not widely used among ophthalmologists, maybe due to the following reasons:

  • Ophthalmologists consider that eye floaters do not have important consequences on the eye health of the patient and that people can get used to life with them.
  • It is a complicated technique since until now there is no accessible training for it.
  • There are risks involved in this technique due to the use of a laser and how sensitive the structures around the eye floaters are.

It is very important that the ophthalmologist that is treating you inform you clearly of the expectations after eliminating the eye floaters and risks of the treatment.

This treatment is very recent and there are little clinics that currently provide this technology (please contact us if you are interested in knowing a clinic that offers this service).

 

Laser treatment for floaters

Figure 3. Ultra Q Reflex Laser (resource: Ellex).

– Vitrectomya (invasive technique).

This technique is only used in severe cases. The vitreous humour is extracted and replaced by a gaseous substance. This substance is slowly absorbed by the eye over a period that can reach several weeks. The surgery usually takes between one and two hours long and among the risks involved are: retinal detachment, cataract, increase of intraocular pressure and post-operatory haemorrhage.

The risks and difficulty of this surgery make it to be used as an eye floaters treatment only when it is strictly necessary.

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