Vitreous is like thin jello and floaters tend to remain stuck in place and unaffected by gravity. The aqueous fluid surrounding the eye recycles regularly while the fluid in the vitreous doesn't. This means the body doesn't cleanse or filter the vitreous over time which is disappointing. Floaters can sometimes settle out of your vision, and glare and particle "condensation" or blurring can sometimes decrease with time (months). Over time the brain can blot out floaters partially or make you feel less worrisome as they move. This "adapting" appears to be the brain deciding the floater is normal because it sees it constantly, which reduces stress despite it being visible. Ultimately, once the tiny floaters appear pretty much the only hope is they eventually move out of view. Because the eye sees upside-down any floaters that settle to the bottom seem to go up and vice-versa.

Going into an eye exam hoping for a solution can be disheartening because the common and annoying response by the MD is "your brain will adapt, learn to live with it". It's as though the Opthalmic world decided long ago that nothing could be done for floaters and medical school students were taught canned responses to tell patients. This is puzzling. I don't know of any other condition where a person is expected to endure it for life with no intervention. Why is there so little empathy or curiosity in the field to try and champion a solution?

COMPUTER TRICKS
In MS Word if you go into Options you can invert the screen to a black background with white text. This is much more restful and easy to use, even without floaters. Browsers can also be set to dark mode as can the theme in Windows. My office has a dimmer switch and I keep the overhead lights low. Between all these I can go stretches when I almost don't notice the floaters. Almost.

HEAT MASK
I bought a USB eye heat mask with the vague notion that it might help improve circulation and cleanse the eye somewhow. After several uses I didn't see any change but the comfort and serenity it offered was very nice.

VIBRATOR
I used a small finger vibrator with a high-intensity buzz on my bad eye several times one day. I did it for a for a few seconds at a time in several spots on the closed eye. It didn’t seem to alter the floaters or Weiss Ring and I got the impression that my glare increased slightly for a few hours afterwards. Because the floaters are so small I doubt it would have any effect anyway and I decided it was too risky to try again. However, the Opthalmic field really should take a position on whether using a vibrator on an eye is good or bad. The reason is the internet sells several vibrating eye masks without warnings, and people likely buy them for floaters. Some guidence from an authority would be nice.

BROMELAIN
Bromelain is a pineapple enzyme that anecdotally has been claimed to reduce floaters. Its mainly used as a meat tenderizer and the NIH states that it has a wide range of anti-inflammatory properties. Its long been used as a folk remedy and as you would expect there is no legitimate research concerning bromelain and floaters. But just because there is little clinical proof doesn’t mean there is no effect.

Taken orally bromelain is absorbed by the gut without losing its biological properties according to the NIH. Since bromelain is cheap I bought a reputable brand with 2400 GDU/g at 500mg and started taking one three times a day at my 3 month mark. I had no GI issues and reports were that it may not reduce floaters but could cause more movement in the vitreous. After 3 days I did notice the floater seemed more mobile and shifted around more easily when I moved my eye. A couple of tiny black floaters started zipping from side to side randomly as well. Suprisingly, after 2 weeks when looking into the sky the background starfield of dust seemed to have diminished in intensity. Maybe my brain had adapted a bit, maybe they diminished naturally, maybe the bromelain had an effect, or maybe I was imagining it. Hard to say. So while bromelain didn't dissolve my big floaters I got the feeling that it may have had a mild effect on their mobility and possibly an effect on background clarity. Interesting.

CENTRIFUGE
It occurred to me that lying prone on a spinning merry-go-round or some sort of large centrifuge could have the effect of pulling the floaters out of view. I ran this idea past an Opto MD who said the correct method would be to lie face down with head out. Floaters and Weiss Rings are very tiny and likely have the same mass as the surrounding vitreous. So as feasible as this fix seems it likely doesn't work or it would have been offered for relief years ago. Or perhaps no one ever thought to test it properly?

SURGERY and LASER

Aside from folk remedies there are two solutions available: Vitrectomy and Vitreolysis. Both have resistance from the Opthalmic community for different reasons.

FLOATER ONLY VITRECTOMY (FOV)
Over 200,000 Vitrectomies are done each year in the US, typically for diabetic retinopathy, retinal detachment, macular holes, and to prepare for eye surgery. This routine surgery is highly effective to remove floaters but its taboo to suggest it to an Ophthalmologist as a solution. Because aside from it being intrusive a Vitrectomy is known to accelerate the onset of cataracts. This is not a fully valid reason to avoid the procedure however. Cataracts are a normal part of aging with the average age of onset at 65. As a result, the field of cataract replacement is mature and robust with an estimated four million cataract surgeries done per year in the US. In addition, Refractive Lens Replacement (RLE) is a procedure used by younger people to replace normal lenses to get rid of glasses or contacts. Surprisingly, cataract surgery and RLE surgery are the very same procedure but are marketed differently. The first is treated as a boring and routine surgical event while the other a hip, exciting procedure for active adults. This reveals a double-standard in the industry: Cataract surgery due to age (and RLE) is normalized and freely offered. While cataract surgery caused by a FOV is 'different' and should be avoided. Of note is the small but real complication of Retinal Detachment from a FOV. Conveniently forgotten is that detachment is also a complication of cataract surgery, yet this doesn't slow the millions of lenses being replaced each year.

When seeking a FOV there's confusion about the 40-year old procedure. Known as a PPV (Pars Plana Vitrectomy) it involves removing material through the white sclera with small-gauge needles. A FULL removes all the vitreous, a temporary gas bubble is injected if retinal healing is needed. If a bubble is not needed saline is used to replace the vitreous. In both methods the eye slowly refills with aqueous. A CORE version removes only the central vitreous and is more suited for floater removal. With 25-27 gauge needles, sutureless, and no bubble, a PVD is induced if needed. Then there is the LIMITED which is essentially a mild Core without inducing a PVD. Due to the less intrusive nature the Core/Limited are said to contribute less to cataracts and retinal detachment than the FULL.

In other words, you can get a "Floater Only Vitrectomy" using a Full. Or you can get a "Floater Only Vitrectomy" using the Core/Limited. Because a Full has been around for decades it makes sense it's the default version used by surgeons. From accounts it appears the Full is the version in the UK covered by the NHS, I don't know if a Core or Limited is offered. Here in the States, Medicare will only cover a Floater-related Vitrectomy if it has underlying eye issues. A FOV (by itself) isn't standard of care and insurance and Medicare won't reimburse it.

This explains why finding testimonials on a Core/Limited FOV is so difficult. The number of people who get a FOV is small to begin with. And of that group the number who were willing to pay out of pocket for a Core is even smaller. Compounding this is the scarcity of surgeons who specifically perform Core FOVs. The point being when exploring a Floater-Only Vitrectomy it's important to use the right terminology to find a surgeon who offers least intrusive version.

VITREOLYSIS
The Laser solution involves a procedure called Vitreolysis which vaporizes floaters with 20-30 nanosecond laser pulse. However, the only laser procedure taught in med school is Laser Retinopex (photocoagulation) which is used to repair retinal tears. Oddly, Vitreolysis and Lasik are not taught in med school and are expected to be learned hands-on in the field. Neither of them require the Opthalmologist be board certified. This is puzzling because Retinopex, Lasik, and Vitreolysis are all moderately invasive, use lasers to modify the eye, and have similar complications. So it's unclear why special training and certification are required for one procedure but not the other two. Its not as though lasers are fringe or unknown: Eye Centers across the country use lasers many times a day. In fact 600-800,000 Lasik procedures are done in the US each year and Retinopex on torn retinas is estimated at several hundred thousand a year. So I'm curious, who made the decision that only laser Retinopex gets taught in med school, while the other two laser treatments get less oversight?

Since there is no certification or required training this means an Opthalmologist can buy a laser device and simply set up shop to start doing the procedure. This Wild West approach and lack of oversight has likely contributed to Vitreolysis remaining "not standard of care" in Opthalmology. This is unfortunate because it means that insurance will not cover the procedure making it doubtful it would even be mentioned in an eye exam as a treatment. I wouldn't be surprised after it was originally marketed to Eye Centers a few years ago, when droves of people didn't call in to make appointments as expected, the lasers were moved to back rooms and forgotten. However, there are some skilled Opthalmologists who have decided to continue training to become experts in this procedure and it was here that my hope lay.

MY PLAN

After much thought I decided that I had two choices: Do nothing and live with Obscured Vision by Floaters (OVBF) for the next few decades. Or seek relief. I searched for a board-certified Opthalmologist with experience in laser treatments who displayed the curiosity to become a functional expert. Nearby I found a board certified, laser-experienced Opthalmologist who did Vitreolysis. However, at the exam the MD felt that for the large gel-type floater I had that the results may not be optimum. He said that targeting smaller, individual floaters produced better outcomes in his experience.

Next I spoke to my Opthalmologist about a Vitrectomy. He was open minded and recommended the Core/Limited version which he said had become more common in the US in just the past few years. He wasn't concerned about accelerating cataracts or its safety or effectiveness. His worry was the small but real chance of retinal detachment afterwards. He said I should ask a FOV surgeon about the percentage experienced by their patients and said it was up to me to weigh the risks.

So I began researching whether a FOV was to be my solution. My experiences are documented on the next pages.

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