Many people experience increased floaters after cataract surgery. The vision is better after the operation, but floaters can affect the vision significantly despite the clearer view. In this article, we will explain why floaters are noticed more often after cataract surgery.
You need to know that floaters are also opacities. However, they are not present within the lens that was replaced during cataract surgery.
Floaters are often noticed more immediately after cataract surgery because they were hidden by the cataract preoperatively. Then, after surgery, with clear vision restored, they are even more distracting.
The opacities of your natural lens are then no longer present but opacities that you have, for example, in the vitreous body of your eye are also present after cataract surgery and were already there before.
A distinction is made between floaters, which are distributed in the vitreous body, and larger opacities. The latter occurs, for example, when the vitreous body in the back of the eye becomes detached. Many people notice floaters from the age of about 45 at the latest and can live well with them. Often the symptoms also disappear again as soon as the vitreous body has lifted off completely.
What to Do if You Recognize Floaters After Cataract Surgery?
If you notice floaters after cataract surgery, it is important to talk to your eye doctor about your observations. The ophthalmologist will then suggest different treatment options depending on the degree of suffering, the anatomy of the eye, and the position and size of the floaters.
One of the options that ophthalmologists have is laser vitreolysis. In laser vitreolysis, we irradiate the “flying flies” in the vitreous with extremely short (0.000000003 seconds) laser light pulses with pinpoint accuracy.
The laser energy shreds the collagen fibers in the vitreous body, which are compacted as clumps, resulting in “flying gnats” so that they dissolve. Laser vitreolysis cuts through and reduces troublesome tissue nodules so that “flying gnats” can no longer affect the field of vision.
Laser vitreolysis is performed as an outpatient procedure under local anesthesia.
During treatment, ophthalmologists direct extremely short pulses of laser light through a special contact lens to the “flying gnats,” which dissolve as a result. As the tissue nodules dissolve through the treatment, small gas bubbles may appear, but they quickly disappear.
One treatment will last between 20 and 60 minutes, and laser vitreolysis can be repeated depending on the severity of the “flying gnats”.
What Happens During the Treatment?
Before the treatment, mild drops are administered for local anesthesia. These also provide an evaluation of the pupils. From a laser source in a special microscope, laser light is directed into your eye through a contact lens.
During the treatment, you may notice small dark particles or shadows. This is where the floater dissolves. At the end of the treatment, your eye doctor may apply anti-inflammatory eye drops.
A laser treatment takes about 5 – 15 minutes, rarely longer. Sometimes two to three treatments are necessary, depending on the number of floaters and the severity of your visual impairment.
After Treatment of Floaters With Laser Vitreolysis
You may notice small, dark particles in your lower field of vision. These will dissipate quickly. Some patients experience mild discomfort immediately after treatment, such as redness or temporary blurred vision.
For particularly massive floaters, ophthalmologists may perform a vitrectomy.
Vitrectomy – An Alternative to Laser Vitreolysis
Vitrectomy has been considered only in particularly severe cases, as such procedures have a relatively high risk of complications (e.g., retinal detachment).
Pars plana vitrectomy is an operation performed inside the eye, primarily to remove the vitreous, a gel-like mass that fills the posterior segment of the eye.
In most cases, the operation is performed under local anesthesia, where the mobility and pain perception in the eye is switched off for a short time by an injection of anesthetic behind and next to the eye. In rare cases, the operation must be performed under general anesthesia.
The duration of the operation is generally between 30 and 60 minutes, depending on the severity. The surgery is generally performed under inpatient conditions with a length of stay of between three and seven days.
Access to the inside of the eye is through three small stab incisions, which serve as access points for the working instrument, an irrigation drain to maintain eye pressure, and the light source. In the following, this operation will be exemplified by the treatment of a retinal detachment.
Procedure of a Pars Plana Vitrectomy to Reduce Floaters
In the first step, after the creation of the accesses, the central removal of the vitreous gel with lifting of the vitreous body from the posterior part of the eye is performed.
In the second step, the anterior part of the vitreous body is cut out with the utmost care.
After the entire vitreous body is removed, in the case of retinal detachment, the fluid under the retina is squeezed out through the retinal hole by introducing a heavy fluid (oil) until the retina is completely reattached.
At the end of the operation, the heavy fluid is sucked out and replaced by a tamponade (air, gas, silicone oil). It is important to keep a certain position after the operation, which will be communicated to you by the surgeon, as consistently as possible for a limited time in order to influence the healing process favorably. A foreign body sensation is most likely to be experienced during the first few days.
If you have floaters after cataract surgery, your treating ophthalmologist is the right person to talk to. After examining your eyes, he or she can tell you which treatment method is best for your eyes, floaters and symptoms. Symptoms you describe.
Other options to reduce the symptoms of floaters include photochromic sunglasses or atropine drops. These provide dilated pupils. More light enters the eye and the amount of haze inside the vitreous is often less noticeable. Your doctor or optometrist will be able to advise you on these options.