Most of us occasionally are aware of little dots or squiggly lines in our eyes. These vitreous opacities, known as floaters, do just that: They float through our field of vision. Most floaters that people develop are easily ignored and are rightfully considered by doctors to be completely benign.
“Ninety percent of people who develop floaters never find them to be a bother,” said Dr. Scott Geller, ophthalmologist and founder of the South Florida Eye Clinic in Ft. Myers. “But in 10 percent of patients, floaters are well beyond being merely annoying. They are visually impairing and debilitating.”
Frustratingly, for patients in the problematic 10 percent, many doctors do not take their condition seriously.
“People are told to learn to live with their floaters, that there’s nothing that can or should be done about them,” Geller said. “But I’ve seen patients with floaters so large and dense that they were literally forced to alter their lifestyles. I don’t consider that to be a benign condition.”
For the last 15 years, Geller, a graduate of Chicago’s Rush Medical College, has been performing a procedure at his Florida clinic using a laser to zap floaters into oblivion. The success rate is 85 percent, and the complication rate is near zero, but the procedure is still practically unknown within the medical community. Using a Swiss-made LASAG Neodymium Yag laser (which is different from that used by most ophthalmologists for cataracts or Lasik treatments), Geller dilates and anesthetizes the affected eye. He places a lens on the patient’s eye, locates the opacity, and the laser beam delivers shots to the floater that break up the mass. The microscopic bits are reabsorbed by the vitreous.
Depending on the size and density of the floater, the treatment may be repeated two to four times until the floater is no longer a problem.
“The laser I use is the Rolls-Royce of lasers,” Geller said. “The cost is more than three times the cost of most lasers being used by ophthalmologists. The LASAG laser is no longer being produced, but there is a modified version being made.”
Geller learned to use the laser from its Swiss designer, Dr. Franz Frankhauser. “The FDA approves equipment but doesn’t tell doctors what they can use the equipment for,” Geller said. “So with a laser designed to work safely in the vitreous, I was able to push the envelope even beyond what I originally learned from the professor, and I developed the technique to treat floaters. This was something that even Professor Frankhauser never expected.”
From the patient’s perspective, treatment involves seeing bright lights and hearing a snapping sound, but it is completely painless.
Kimmie Allender, Geller’s assistant, said the types of floaters for which the procedure is most successful are the large, dense, visually obscuring clumps.
“It’s really exciting to see someone’s vision improve several lines on the eye chart after having the floater treated,” she said. “On the other hand, the types Dr. Geller has the least success with are the floaters that most people wouldn’t seek treatment for in the first place: little dots and lines. In these cases, he discourages them from having the procedure and tells them upfront that chances are he’s not going to be able to help them. It’s hard to zap anything so tiny.”
Audrey Wood of Gurnee had seen several ophthalmologists in the last year for her floater. “None of them believed how bad it was,” Wood said. “It wasn’t just a little dot or a few lines; it was like a big glob of Vaseline on my eye. I could see trees, but I couldn’t make out the leaves. When you say ‘floater,’ people relate your complaint to their own floater, and most people don’t have anything like what I had.”
Big improvement
Wood experienced an 80 percent improvement after two treatments by Geller, with plans to return for a third.
One reason floaters often are dismissed is that ophthalmologists regularly see conditions that are far more serious and visually threatening. “They’re not interested in hearing about floaters when they’re dealing with retinal detachments and macular degeneration,” Geller said.
Dr. Thomas Weingeist, head of the ophthalmology and visual sciences department at the University of Iowa, is skeptical about treatment for floaters being readily available.
“I do have a problem with people seeing something on the Internet and running off to have the treatment without assessing all the risks involved with procedures in the eye,” he said. “There are so few cases where floater treatment is a medical necessity, why would anyone subject himself to risks just because of floaters?”
But Weingeist added, “If the floater is such an annoyance and people want it taken care of, then we perhaps do need to ask ourselves, ‘Aren’t we helping by making procedures available?’ even if we personally question the need for treatment.”
And therein lies the problem, according to Dr. Wayne Lopez, a dentist from Scarborough, Maine, who was nearly forced to give up his dental practice because of a floater.
“There seems to be a big difference between what the physician perceives and what the patient perceives,” he said. Lopez was even ready to subject himself to a surgical vitrectomy (removal of the eye’s vitreous and replacing it with a solution, thus eliminating the floater) because the floater had so seriously affected his life and livelihood.
Affected quality of life
“I didn’t want to live like that anymore,” Lopez said. “I’m not someone who was overly sensitive to an annoyance. This floater had really affected my quality of life. It was making it difficult for me to do my work, to drive, and I had even given up reading. I was willing to take all the risks of a vitrectomy, which can be serious. But when I heard of Dr. Geller’s laser procedure, I went, had it done, and I’ve gotten my life back.”
The complication rate for the laser treatment is minimal, Geller said. “While you always have to consider that any procedure involving the eye carries risks, I’ve treated around 2,000 eyes for floaters in 15 years, and the complication rate is near zero. A very few patients developed a retinal hemorrhage, but these sealed up immediately and spontaneously without causing any problems. And two or three patients developed a transitory high intra-ocular pressure, which we also treated.
“And though it is a potential risk, there has never been an incident of retinal detachment associated with this procedure and never any lawsuits connected with it,” he said.
Floater patients from as far as Singapore and South Africa have gone to Geller for treatment. Cost for treatment is $1,200 per eye. Insurance coverage varies.
According to Geller, most ophthalmologists remain unaware that there is anything that can be done for problematic floaters, though he has lectured on the subject at ophthalmic meetings since 1989.
How they form
Any new floaters should be checked by your doctor, as they may indicate a serious condition. Most, however, are benign and are caused by the natural aging process of the eye or by severe myopia (near-sightedness).
The vitreous, the gel inside the eye, can deteriorate by liquefying, leaving the clear spaces interspersed with stingy strands of the protein gel. It also can coagulate, forming clumps, which is a condition known as fibrillar degeneration. Or the gel can dislocate from the back of the eye, a condition known as a posterior vitreous detachment.
The resulting dots, strings or globs seen by the patient are all known as floaters
— L.G.
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Geller can be reached at 877-371-3937 or 941-275-8222, e-mail scottgellermd@vitreousfloaters.com.
