﻿Of all the possible ways that sufferers might want to try and deal with their eye
floaters symptoms and signs, vitrectomy is probably one of the flow to treatment
options that almost universally scares and divides people the most.
This video will be looking at why vitrectomy operation should not be feared,
but instead should leave all floaters sufferers feeling less anxious about
their eyes and more hopeful for the future.
Hi, I'm optometrist Martin Oguzie and this is
Martin's Eye Tips, thank you so much for watching.
This channel dedicated to helping people
to see better, see more comfortably and to be less anxious about their eyes.
That sounds interesting. Then
please subscribe to the channel hit that notification bell as well.
So you get reminded every time I upload
a brand new video. Even though I sufferer from eye floaters
myself, it's never got so bad that I feel depressed, particularly about my floaters.
Although in the early days when I first
got my floaters round about 20 years ago, I did feel worried and concerned about
whether my eyes would last me into old age.
However, since starting this channel about
a year ago, it's been really sad to hear from viewers who have got it so bad,
really with their floaters that they feel suicidal or just constantly
worry about the impact of that floaters are having.
And effectively it's taken over their whole life.
Many people would no doubt have looked into the possibility of getting a vitrectomy
operation done as a way of instantly removing and dealing with their floaters?
But understandably, the risk might well have scared them off,
or perhaps they've spoken to another eye care professional
that they felt perhaps didn't fully appreciate what they were going through
and have kind of put them off completely from having the procedure done.
Now, all of this is very common place, and I think a lot of the fears stem
from a time when the use of vitrectomy for floaters was newer and had a lot more
associated risk with it. People haven't refreshed understanding of the procedure,
it's easy for optometrists like myself and family doctors and people reading old
articles on the Internet to totally discount vitrectomy, which, if done right,
can be a life transforming operation for the right individuals.
Now, this doesn't mean that it's right for everybody.
And in fact, I think it's not right
for most people, particularly if you only have a few floaters in your eyes.
But we'll come back to that later on,
uncover who I think this procedure is really for.
For those not familiar with what vitrectomy
for eye floater is, then please check out the short video
that I made previously to explain what that is in a bit more detail.
So you can catch that just over here.
In short, though, it's a procedure where the eye surgeon will remove part or all
of the vitreous fluid in the eye in order to remove the floating debris in the eye.
The vitreous is replaced with sterile water
known as saline to refill the space taken up by the vitreous.
Three probes are then placed
into the eyeball at specific locations to achieve this.
The first probe is a fibre optic light.
The second is an infusion probe that squirts the saline into the eye.
And finally, the third probe is called
vitrector, and it both grubs and suctions out the vitreous and floaters with it.
So traditionally the main cause of fear
and risk, vitrectomy has been the following;
the risk of serious eye infection, the risk of retinal detachment,
the risk of a cataract formation and after the procedure has been done
and forth, the risk of not removing all of the floaters completely.
So these are real concerns that have
prevented many people who could have benefited from getting the opportunity
to sit down and have a consultation with a surgeon about the individual
suitability for vitrectomy from doing so.
Now, the downside of this is that many of these people who would have benefited
the most have been left feeling that there is no
hope for the future as they've got nowhere to turn to.
I find this extremely sad and it's my belief that the tables have turned as
far as the safety and effectiveness of floaters
only vitrectomy is concerned. Now, with that in mind,
here are the reasons that I think that the four risk factors that we
mentioned earlier, one are not so much of the risk that they used to be.
First of all, the risk of serious eye infection.
And as with many our operations,
the risk of internal infection is very important to avoid.
And the key way that this is cause is
by allowing bacterial infections through the wound.
Now, over the years,
the three incisions that are made in the eyeball to allow the three probes
into the eye have got smaller and smaller with improving surgical technology.
So about 15, 20 years ago, vitrectomy would have been done
with what we call a 20 or 23 gauge probes in the eye.
The 20 gauge probe is about 0.9
millimeters in width, while the 23 gauge is about 0.7 millimeters in width.
And now, the smaller the gauge, the larger the size of the incision wound
and the more healing time and risk of infection is caused
as a result. Now modern vitrectomy now more likely used at 27 or 25 gauge probe size.
And for the three probes,
and this is a probe width of just 0.4 millimeters in the case of the 27 gauge.
And even with a 25 gauge probe,
the incision holes are so small that once the probe is removed,
no stitches are needed and the wound will heal without leakage in about 48 hours.
And on top of that, of course, you'll be given eye drops to take home
to help prevent infections and inflammation over the period while
your eye is healing. Regarding the risk of retinal tears and detachment.
This is the risk that may arise more from poor surgical experience or caution.
In the case of flow to only vitrectomy,
it's not usually the case
that the whole vitreous is removed unless this is absolutely necessary.
As this increases the risk of retinal
attachments significantly. It's more likely that a pocket
of a central vitreous will be suctioned out with floaters in that region,
and the fusion probe refills it straight away with saline solution.
So the risk of retinal detachment due to this change of fluid is a more unlikely.
Now a surgeon may decide to use a gas bubble in the vitreous as an extra
precaution to support the retina against detachment temporarily.
And the gas bubble will disappear of its own accord in about one week.
Now, currently, some of the biggest risks for retina attachment may arise
from surgeons getting a bit too close to the retina with a probe by accident or
out of necessity due to complications and causing unplanned damage.
This is probably not common these days, but it's where an experienced surgeon is
very important, just as in any other delicate surgery. The other
key important thing that helps to minimise the risk of retinal detachment
is the fact that the gold standard procedure is now a pause plan.
vitrectomy, this means that the three probes into the entry point enter into the eye
in the region of the eye that we call the pars plana.
What's important about that is the fact that the pars plana region is
a pigmented area in the eye that doesn't contain any retina.
So if the entry
was an area that involved coming through the retina, that would effectively be like
creating a three tier points in the retina with the probe.
So as a result, once the probes in the pars plana
area are removed, they seal straight away without extra risk to the retina.
And this is critical for floaters only
vitrectomy. Number 3 when it comes to the risk of cataract formation.
It appears that the main mechanism, apart from surgical trauma that causes it,
may be really due to oxidation of the crystalline lens.
So that means when the vitreous is
removed, particularly directly behind the lens, there may be an opportunity
for oxygen to come in contact with the crystalline lens,
causing a reaction that leads to the formation of cataracts.
Cataracts by the way, if you don't know,
is when the ordinarily transparent crystalline lens in the eye becomes
partially or fully cloudy and are blocking your view through the lens.
As I understand it, it's thought that,
some oxygen may come up from the retina if a lot of vitreous is removed directly
next to the retina and then the oxygen, they may come in contact with the lens if
the vitreous behind the lens has been mostly removed as well.
So it appears that the vitreous humor has a negative oxidative property.
So the way they understand that surgeons
have looked to minimize the risk of cataract is to leave a good portion
of the vitreous that is around the edges of the vitreous cavity so that the retina
and the lens are still lined by the original vitreous and only suction
out to the floaters, which hopefully are confined to the central area.
So that way no oxygen can be released
from the retina to get in contact with the crystalline lens.
Of course, it's not always going to be
possible and sometimes it may be necessary to remove a lot of the vitreous.
So cataracts are a possibility, but a lot of surgeons will probably tell
you now that it's not that common in their experience.
So in the worst case, you get a cataract, but that can be treated quite easily.
I think the biggest downside of a cataract
to be aware of, I think, is more for people under the age of 45
who may need to start using reading glasses for the first time after
a cataract operation because they will lose the ability to autofocus for reading.
In any case, the removal of your floaters should make a big enough lifestyle
enhancement that any negative impact of early cataract may cause number
4, the risk of not removing the floaters entirely.
So vitrectomy is really the only certain way that we have of being able
to remove all floaters in a person's eye today.
So naturally, when you go through such
a procedure, you expect nothing less than perfection.
However, everyone's different,
and sometimes it may not be possible to remove every single speck floating
in the eye unless you remove the complete vitreous.
Now, this may carry more risks that your
surgeon may not think it worth taking for floaters only vitrectomy.
So it's important to realize that sometimes you may still notice one or
two very small specks of floaters post surgery.
But compared to what life was like before, this really shouldn't impact your life
in a negative way compared to the pre surgical situation.
So while perfection will always be your surgeon's aim, I think it's wise to manage
your expectations a little bit down from complete perfection.
That's certainly what I would recommend.
So with that being said, who should
be considering looking into Floater Only Vitrectomy?
I think the criteria for suitability is
very similar to the criteria that I would use for cataract operations.
So if it can be demonstrated that floaters
are impacting you in the following ways, I think you may well be suitable.
So the obvious thing is that you should be
somebody who has vision being reduced significantly by these floaters.
And secondly, not so obvious is that
these floaters may well be impacting your contrast sensitivity significantly.
So this means in the test chart, you could be achieving 20/20 vision.
But in the real world, you because you contrast sensitivity is so
low and it could be reduced by as much as 80 percent.
It makes it very hard for you to do a lot of practical things because you can't
quite see the differences between subtle shades of black and white.
And, you know, that contrast, it gets really kind of blurred there.
So that's an important one to look out for.
And if you're struggling with floaters
and you feel that nobody believe in you, it may be worth getting your contrast
sensitivity checked just to make sure that is not being affected too much,
because if it is being impacted a lot,
then that's certainly one criteria that your optometrist could use to get you
referred or might be an indication that you need to have this procedure done.
And the other criteria is
that the floaters may well be causing you a significant glare.
And this may be both the type of glare that we call discomfort
and also a type of glare that we call disability glare.
So either one of those can be significant
and can be significantly impacted by having lots of floaters in your eyes.
So, again, another criteria that we
consider is whether it's making a life unsafe for you.
So, for example,
if you have a large floater that really comes into your vision at the wrong time,
such as when you're driving or if you're working with, you know,
fast moving machinery, then, you know, you don't want a situation
where your floater moves out of sight and then comes back into vision
at the wrong time, making it hard for you to do your tasks safely.
And then finally is a consideration to, you know, how much of an impact this
floater is having to your general lifestyle.
So if it's impacting you such a dramatic way that it's making it hard for you
to read, to cook, clean, remain independent or navigate your house,
then you may well be suitable for consideration.
And vitrectomy may be something that can really
transform the impact on your lifestyle. And also in the case of eye floaters,
I would add to that list that if they are causing mental health issues,
such as feeling a suicidal, depression, along with anything else on that list
of points, then that may well make you suitable.
It's important to know that even if you
meet all of the criteria here, the next step is to have a consultation
with a reputable specialist specialist clinic about, you know,
whether they are satisfied themselves that you meet eligibility criteria.
It's never a case of you really just walking in, or at least you should never
be a case of you just walking in, wanting to have a procedure done and they
just doing it without really giving you a thorough assessment.
So let me know in the comments section below if you think you would go ahead
and consider vitrectomy for floaters or if you have had one done yourself and want
to share your experiences for other people to read in the comments section.
So I started the video alluding to the fact that I think the option
of vitrectomy should now make flow to sufferers like you
and I feel less anxious and here is the reason why.
So when I first got floaters,
I remember feeling anxious about them because I didn't know how bad my eyes
would eventually get and how fast that would happen,
as well as feeling worried about whether my eyes would last into old age.
Well, for many floaters sufferers, the feeling of depression and anxiety may
well be for the same reasons as I had as well.
So that uncertainty is very worrying.
But probably the biggest worry is that if
things get really bad, you won't have an effective treatment
and your only option will be just to live with it.
Well, I think that if things do get really bad or if they are already really bad
for you and that you feel that you can't live with it, then vitrectomy is
a genuine solution that is worth considering.
Now, for many of us, we've heard so many bad things about
vitrectomy and everything we read about seems to be just so negative.
It's no wonder that it gets so many people down there.
Remember that vitrectomy are not actually
a rare procedures, but really are done every day all around the world.
And it's just that it's usually done as part of other treatments at the back
of the eye and not just as a floater only vitrectomy.
Now, with that said, if you're like most people,
you may well be holding out for a non invasive remedy one day in the future
and hope to never need to have to have a vitrectomy in the first place.
However, in my experience, it is reassuring to know that if it comes
to it, there is an option out there that has matured enough and can eliminate
your floaters even if you have to have surgery for that.
So I hope that if you are somebody out
there watching this and that you feel really down or even
suicidal about your floaters, then just knowing that there is a real
option out there gives you enough hope to stay positive for the future.
In the next video, I'll give you some important tips
and questions to ask your surgeon if you do decide to look into having a vitrectomy.
So please check that video out.
Also, if you found this video helpful
and you want to support the channel, then you can do so by liking and sharing
this video and also subscribing and hitting notification bell helps us
out and also reminds you whenever I release a new video.
So thank you for watching and I look forward to catching you in the next video.
Take care.