Riva, L., Mazzoldi, E.L., Ginestra, P.S., Ceretti, E. and Giliani, S.C., 2022. Eye model for floaters’ studies: production of 3D printed scaffolds. Progress in Additive Manufacturing, 7(6), pp.1127-1140. https://doi.org/10.1007/s40964-022-00288-5

Summary: Medical implants are often produced by Stereolithography (SLA) to build complex geometries and meet the desired mechanical properties with high-dimensional accuracies. This paper focuses on the optimization of the printing parameters of an SLA structure to obtain a scaffold with the required characteristic for a proper 3D cell culture and investigation. The model will be the starting point for a future study regarding the etiology and formation mechanism of eye floaters in cell culture. The studied 3D printing parameters are layer thickness, exposure time, and light blocker content added to a biocompatible resin. Due to the final application, the main required property of the scaffold is transparency that allows visual inspection under optical microscope. The selected samples showed a good biocompatibility and visibility under optical microscope, both promising results for long-term cell cultures.

Barras, A., Sauvage, F., de Hoon, I., Braeckmans, K., Hua, D., Buvat, G., Fraire, J.C., Lethien, C., Sebag, J., Harrington, M. and Abderrahmani, A., 2021. Carbon quantum dots as a dual platform for the inhibition and light-based destruction of collagen fibers: implications for the treatment of eye floaters. Nanoscale Horizons. https://doi.org/10.1039/D1NH00157D 

Summary: Using carbon quantum dots (CQDs), a kind of nanoparticle, in combination with a low energy laser that distributes ~1,000 times less energy than the currently used YAG lasers, vitreous opacities resulting from collagen aggregation can be efficiently destroyed. In combination with other nanoparticle research, this study highlights the need to further explore these technologies in order to develop a safe, effective treatment of Vision Degrading Myodesopsia (VDM). Positive in vitro results were obtained for destroying opacities in vitreous material removed from floater patients undergoing vitrectomy.

Sauvage, F., Nguyen, V.P., Sebag, J., Fraire, J., Remaut, K., Braeckmans, K., Paulus, Y.M. and De Smedt, S., 2021. Gold nanoparticles for the treatment of eye floaters by light-induced vapor nanobubbles. Investigative Ophthalmology & Visual Science, 62(8), pp.3307-3307. https://iovs.arvojournals.org/article.aspx?articleid=2776180

Summary: Investigates the use of gold nanoparticles and low energy, pulse-based lasers for photoablation of opacities. The nanoparticles effectively bound to Type I collagen fibers stimulated outside of the eye. They also bound effectively to collagen fibers injected into the vitreous of rabbits. In both cases, opacities were effectively and rapidly destroyed following the use of low energy, pulsed-lasers. This study shows promise and supports further investigation of the method via human trials.

Sauvage, F., Fraire, J.C., Remaut, K., Sebag, J., et al.., 2019. Photoablation of human vitreous opacities by light-induced vapor nanobubbles. ACS Nano, 13(7), pp.8401-8416. https://doi.org/10.1021/acsnano.9b04050

Summary: This laboratory study explores the use of gold nanoparticles and low-energy lasers for destruction of vitreous opacities. This method requires ~1,000 times less energy than current methods employing YAG laser, theoretically enabling safer, faster, and more reliable cures than current laser-based methods. Although far more research and development are needed, this study suggests that this new method has the potential to be further developed as a treatment option, if experiments in animals (which have been completed) followed by human trials are successful.

Senra, H., Ali, Z., Aslam, T. and Patton, N., 2022. Psychological implications of vitreous opacities–A systematic review. Journal of psychosomatic research, 154, p.110729. https://doi.org/10.1016/j.jpsychores.2022.110729

Given that depression and anxiety can be comorbid to several treatable eye diseases, it is paramount to understand whether vitreous opacities are also associated with increased risk to well-being and mental health problems. Compared with healthy controls, patients with vitreous opacities showed significantly higher levels of symptoms of depression, perceived stress, state anxiety, and trait anxiety. Studies also suggested that patients are more likely to show low vision-related quality of life, and social functioning. Studies also suggested a significant positive effect of medical treatments [e.g. pars plana vitrectomy] on patients’ symptoms of depression and anxiety and on patients’ vision-related quality of life. The current systematic review summarises research examining psychological implications of vitreous opacities in adult patients. The topic of psychological implications of vitreous opacities is still relatively new in the literature with very preliminary evidence of mental health problems and reduced quality of life associated with this condition.

Webb, B.F., Webb, J.R., Schroeder, M.C. and North, C.S., 2013. Prevalence of vitreous floaters in a community sample of smartphone users. International Journal of Ophthalmology, 6(3), p.402. https://doi.org/10.3980/j.issn.2222-3959.2013.03.27

Summary: Researchers surveyed over 600 people using a smartphone app and discovered that 76% of them experienced floaters, and about a third said these floaters affected their vision noticeably. People with nearsightedness (myopia) and farsightedness (hyperopia) were much more likely to have significant floaters compared to those with normal vision. However, age, race, gender, and eye color didn’t seem to influence the presence of floaters. Overall, floaters are very common and tend to be more bothersome for those with vision problems like myopia and hyperopia.

Zou, H., Liu, H., Xu, X. and Zhang, X., 2013. The impact of persistent visually disabling vitreous floaters on health status utility values. Quality of Life Research, 22, pp.1507-1514. https://doi.org/10.1007/s11136-012-0256-x

Summary: This study aimed to evaluate how much having persistent, visually disabling vitreous floaters (DVF) affects patients' quality of life and to see if a specific method for measuring this impact, called the time trade-off (TTO) utility value, is reliable and valid. Researchers surveyed patients with DVF and a group of people with normal vision. They found that the average quality of life score for 107 patients with DVF was slightly lower than that of the 91 people in the normal vision group. Factors such as education level, vision in the worse eye, and employment status influenced these scores. When patients were surveyed again after 4-5 weeks, the results were consistent, indicating that the TTO method is reliable. The study concluded that DVF significantly reduces patients' perceived quality of life, and the TTO method is a reliable way to measure this impact.

Cipolletta, S., Beccarello, A. and Galan, A., 2012. A psychological perspective of eye floaters. Qualitative health research, 22(11), pp.1547-1558. https://doi.org/10.1177/1049732312456604

Summary:  Researchers examined 11 patients at a hospital in northern Italy, using eye exams, ultrasounds, and interviews. They discovered that how patients perceive and cope with floaters varies greatly and can depend on factors like their understanding of the condition, the solutions they have tried, their trust in medical advice, their views of themselves and the condition, and the ways they receive support. The authors suggest that healthcare providers could improve care by tailoring their approaches to each patient's unique experience with eye floaters.

Sebag, J., 2011. Floaters and the quality of life. American Journal of Ophthalmology, 152(1), pp.3-4. https://doi.org/10.1016/j.ajo.2011.02.015

Summary: Argues that ophthalmologists who examine patients presenting with floaters must consider that this as a disease which impacts the patient’s quality of life, regardless of the doctor’s perception of the problem.

Wagle, A.M., Lim, W.Y., Yap, T.P., Neelam, K. and Eong, K.G.A., 2011. Utility values associated with vitreous floaters. American Journal of Ophthalmology, 152(1), pp.60-65. https://doi.org/10.1016/j.ajo.2011.01.026

Summary: TBD

Marquez, M.A., Nadelson, A., Magraner, M., Haddock, L.J. and Fortun, J.A., 2023. Dynamic Infrared Imaging of Vitreous Floaters. Clinical Ophthalmology, pp.1169-1177. https://doi.org/10.2147/OPTH.S399684

Summary: Dynamic IR video capture of vitreous opacities is a new imaging technique that can qualitatively assess vitreous opacities in a way that correlates to a patient’s symptoms. This imaging modality can provide a qualitative assessment of the patient’s severity of symptoms based on the location, density, and movement of the visualized vitreous opacities in the video.

Jiang, S., Golding, J. and Choudhry, N., 2023. Practical applications of vitreous imaging for the treatment of vitreous opacities with YAG vitreolysis. International Ophthalmology, 43(10), pp.3587-3594. https://doi.org/10.1007/s10792-023-02765-4

Summary: To demonstrate the methodology and efficacy of using scanning laser ophthalmoscopy (SLO) and dynamic optical coherence tomography (OCT) to identify and treat symptomatic vitreous floaters using yttrium–aluminum garnet laser vitreolysis (YLV). Image-guided YLV facilitates the localization and confirmation of vitreous opacities. SLO and dynamic OCT of the vitreous can provide a real-time evaluation of floater size, movement, and morphology, to help clinicians target treatment and monitoring of symptomatic floaters.

Garcia-Aguirre, G., Henaine-Berra, A. and Salcedo-Villanueva, G., 2022. Visualization and grading of vitreous floaters using dynamic ultra-widefield infrared confocal scanning laser ophthalmoscopy: a pilot study. Journal of Clinical Medicine, 11(19), p.5502. https://doi.org/10.3390/jcm11195502

Summary: Explores the visualization of vitreous opacities using dynamic ultra-widefield infrared confocal scanning laser ophthalmoscopy. Study suggests that this technology allows for accurate visualization of the number, density, and behavior of shadows cast on the retina by opacities. Visualizations correlate well with patient perception of opacities.

Son, G., Sohn, J. and Kong, M., 2021. Acute symptomatic vitreous floaters assessed with ultra-wide field scanning laser ophthalmoscopy and spectral domain optical coherence tomography. Scientific Reports, 11(1), p.8930. https://doi.org/10.1038/s41598-021-88371-9

Summary: Explore use of ultra-wide field scanning laser ophthalmoscopy and spectral-domain optical coherence tomography for visualization of opacities and description of posterior vitreous detachment (PVD).

Karitans, V., Fomins, S. and Ozolinsh, M., 2021. Phase retrieval for studying the structure of vitreous floaters simulated in a model eye. Journal of Modern Optics, 68(15), pp.792-797. https://doi.org/10.1080/09500340.2021.1948624

Summary: Explores the use of software to track floaters, technology that could be useful in implementing real-time correction of the visual phenomenon that relies on reducing or canceling the resulting retinal shadowing using a phase retrieval method. The computational load is currently limiting.

Ruminski, D., Sebag, J., Toledo, R.D., Jiménez-Villar, A., Nowak, J.K., Manzanera, S., Artal, P. and Grulkowski, I., 2021. Volumetric optical imaging and quantitative analysis of age-related changes in anterior human vitreous. Investigative Ophthalmology & Visual Science,62(4), pp.31-31. https://doi.org/10.1167/iovs.62.4.31

Summary: This study explores the use of 3-D swept source optical coherence tomography (SS-OCT) for imaging the vitreous body in relation to assessing age-related changes. While imaging the entire vitreous body was the goal, only the anterior portion (the part of the vitreous in the front of the eye, nearer to the lens than the retina) could be evaluated. Nonetheless, this method offers a detailed means to image vitreous opacities that cause the visual phenomenon of floaters, and work is ongoing to images the entire vitreous body.

Hwang, E.S., Kraker, J.A., Griffin, K.J., Sebag, J., Weinberg, D.V. and Kim, J.E., 2020. Accuracy of spectral-domain OCT of the macula for detection of complete posterior vitreous detachment. Ophthalmology Retina, 4(2), pp.148-153. https://doi.org/10.1016/j.oret.2019.10.013

Summary: Can optical coherence tomography (OCT) imaging accurately diagnose posterior vitreous detachment (PVD)? This study suggests that when compared to discovery during surgery (considered the ‘gold standard’) spectral-domain OCT cannot accurately diagnose PVD (predictive value = 53%). The investigators suggested that diagnostic accuracy may be improved by employing ultrasound.

Mamou, J., Wa, C.A., Yee, K.M., Silverman, R.H., Ketterling, J.A., Sadun, A.A. and Sebag, J., 2015. Ultrasound-based quantification of vitreous floaters correlates with contrast sensitivity and quality of life. Investigative Ophthalmology & Visual Science, 56(3), pp.1611-1617. https://doi.org/10.1167/iovs.14-15414

Summary: Is it possible to quantify vitreous opacities and measure the impact of floaters on vision? This study investigates this question by using ultrasound to measure the density of the vitreous and evaluate vision by measuring the contrast sensitivity function. This study found that increasing vitreous density is associated with reduced contrast sensitivity function, offering a means to quantify the impact of floaters on vision. This approach is not only useful in quantifying the impact of the disease on an individual patient’s vision and quality of life, but can also be used to assess potential improvements following treatments of various types.

Castilla-Marti, M.; Van Den Berg, T.J.T.P.; De Smet, M.D. (2025). Effect of vitreous opacities on straylight measurements. Retina 2015, 35, 1240–1246. https://doi.org/10.1097/iae.0000000000000456

Summary: Light scattering can affect vision in a number of ways. It can result in a reduction of image sharpness, increase glare, and reduce contrast. The authors of this study investigated whether light scattering was higher in floater-affected eyes than in non-affected eyes. While the sample size is small (n = 15), the study uses a paired design, including only individuals with one affected eye and one unaffected eye, that increases its statistical power. This allows for control of internal factors like age, race, and biological sex, as well as external factors like UV exposure that might confound the results.

The authors find an approximately 40% increase in straylight in affected versus unaffected eyes. Additionally, it was observed that unaffected eyes of patients had higher light scattering measurements than the average for their age group. It was not possible to link the presence of a posterior vitreous detachment (PVD) to the presence of symptoms, and no differences in optical coherence tomography (OCT) results could be seen between affected and unaffected eyes. 

In conclusion, straylight measurement is an independent objective measurement of visual perception that is closely correlated with the patient experience. Straylight measurement was able to identify differences between affected and unaffected eyes that traditional OCT, and visual acuity tests, were not.

Sebag, J., 2004. Seeing the invisible: the challenge of imaging vitreous. Journal of Biomedical Optics, 9(1), pp.38-46. https://doi.org/10.1117/1.1627339

Summary: Review and discussion of the complexities of imaging the human vitreous body.

Sebag, J. Imaging vitreous. Eye 16, 429–439 (2002). https://doi.org/10.1038/sj.eye.6700201

Summary: This paper is a review of methods for imaging the vitreous at the time of publication in 2002.

Boneva, S.K., Nguyen, J.H., Gui, W., Hoerig, C., Mamou, J., Ketterling, J.A., Chong, L.P. and Sebag, J., 2022. Recurrent Floaters Following Limited Vitrectomy for Vision Degrading Myodesopsia. Retina, pp.10-1097. https://doi.org/10.1097/IAE.0000000000003781

Summary: Recurrent floaters after limited vitrectomy for vision degrading myodesopsia are caused by new-onset PVD, with younger age, male sex, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.

Goh, W.N., Mustapha, M., Zakaria, S.Z. and Bastion, M.L.C., 2022. The effectiveness of laser vitreolysis for vitreous floaters in posterior vitreous detachment. Indian Journal of Ophthalmology, 70(8), p.3026. https://doi.org/10.4103/ijo.IJO_3198_21

Summary: Explores effectiveness of laser vitreolysis in terms of contrast sensitivity function and vision-related quality of life for patients with posterior vitreous detachment (PVD). Generally suggests that Nd:YAG laser treatment is effective for this subgroups of suffers.

Morris, R.E., 2022. Vitreous Opacity Vitrectomy (VOV): safest possible removal of “floaters”. Clinical Ophthalmology, pp.1653-1663. https://doi.org/10.2147/OPTH.S361557

Summary: Outlines surgical methods to perform vitreous opacity vitrectomy (VOV) for the purpose of removal of vitreous opacities using the safest methods possible in regards to eye and retinal health.

Waseem, T.C., DaBreo, E.R., Douglas, J., Hasanzadah, Y. and Clawson, R., 2021. Pars plana vitrectomy for symptomatic vitreous floaters: another look. Int J Ophthalmol Clin Res, 8(1), p.124. https://doi.org/10.23937/2378-346X/1410124

Summary: Suggests safety and efficacy of pars plana vitrectomy for some myodesopsia patients.

Zeydanli, E.O., Parolini, B., Ozdek, S., Bopp, S., Adelman, R.A., Kuhn, F., Gini, G., Sallam, A.B. and Aksakal, N., 2020. Management of vitreous floaters: an international survey the European Vitreo-Retinal Society Floaters study report. Eye, 34(5), pp.825-834. https://doi.org/10.1038/s41433-020-0825-0

Summary: Retrospective survey study that suggests that pars plana vitrectomy for symptomatic floaters generally resulted in high patient satisfaction with relatively low rates of severe complications in a large group of patients (581 eyes operated on by 48 surgeons in 16 countries). The authors concluded that surgery may be safer with core vitrectomy, no surgical PVD induction, and moderately high cut rates (>1500 cuts/min). Proper patient selection and informed consent are important considerations as to whether or not to perform the procedure.

Rostami, B., Nguyen-Cuu, J., Brown, G., Brown, M., Sadun, A.A. and Sebag, J., 2019. Cost-effectiveness of limited vitrectomy for vision-degrading myodesopsia. American Journal of Ophthalmology, 204, pp. 1-6. https://doi:10.1016/j.ajo.2019.02.032

Summary: What is the cost effectiveness of limited vitrectomy in improving quality of life for floater patients? Based on results using the National Eye Institute Visual Function Questionnaire and measures of contrast sensitivity function before and after surgery, limited vitrectomy is more cost effective in improving quality of life than cataract surgery, amblyopia (i.e., lazy eye) therapy, or retinal detachment surgery.

Sebag, J., Yee, K.M., Nguyen, J.H. and Nguyen-Cuu, J., 2018. Long-term safety and efficacy of limited vitrectomy for vision degrading myodesopsia resulting from vitreous floaters.Ophthalmology Retina, 2(9), pp.881-887. https://doi.org/10.1016/j.oret.2018.03.011

Summary: What are the long-term effects of surgery for floaters? Limited vitrectomy to remove the vitreous opacities that cause the visual phenomenon of floaters was found to be successful in improving vision (contrast sensitivity normalized within 1 week of surgery in each of 139 consecutive cases) and patient well-being (standardized/validated NEI Visual Function Questionnaire). There were no cases of infection. Retinal tears and retinal detachments occurred in only 1.5% of cases, and cataracts developed in 16.9% of cases. Thus, this long-term study found that limited vitrectomy is an effective and safe treatment for floaters with minimal complications.

Lin, Z., Zhang, R., Liang, Q.H., Lin, K., Xiao, Y.S., Moonasar, N. and Wu, R.H., 2017. Surgical outcomes of 27-gauge pars Plana vitrectomy for symptomatic vitreous floaters. Journal of Ophthalmology, 2017. https://doi.org/10.1155/2017/5496298

Summary: Explores outcomes from 27-gauge pars plana vitrectomy for symptomatic floaters in 47 patients with a mean age of 34.7 years. Patient satisfaction was high (91.5%), although not evaluated with a standardized/validated questionnaire. 91.3% of patients felt their floaters were removed completely or only had an acceptable residual. No operative complications occurred. However, there was one case of endophthalmitis and one retinal detachment. Although the procedure was generally effective and safe, there are risks of severe complications, which suggest the procedure should be undertaken with caution.

Ivanova, T., Jalil, A., Antoniou, Y., Bishop, P.N., Vallejo-Garcia, J.L. and Patton, N., 2016. Vitrectomy for primary symptomatic vitreous opacities: an evidence-based review. Eye, 30(5), pp.645-655. https://doi.org/10.1038/eye.2016.30

Summary: This review article explores the impact of floaters on patients’ quality of life, psychological factors that correlate with patients seeking treatment, and safety and efficacy of existing treatment options. Only vitrectomy was found to be viable at the present time. The potential for reduced surgical risks associated with the development of smaller gauge instruments is highlighted.

Sebag, J., Yee, K.M., Wa, C.A., Huang, L.C. and Sadun, A.A., 2014. Vitrectomy for floaters: prospective efficacy analyses and retrospective safety profile. Retina, 34(6), pp.1062-1068. https://doi.org/10.1097/IAE.0000000000000065

Summary: Is it possible to improve vision in patients suffering from floaters? This study investigates this question by measuring contrast sensitivity function in individuals with floaters. In the short-term, vitrectomy improved contrast sensitivity function. This documents the effectiveness and safety of the procedure, but larger and longer studies are need.

de Nie KF, Crama N, Tilanus MA, Klevering BJ, Boon CJ. Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction. Graefes Arch Clin Exp Ophthalmol. 2013 May;251(5):1373-82. https://doi.org/10.1007/s00417-012-2205-3

Summary: This study looks at the outcomes of 20-gauge and 23-gauge pars plana vitrectomy (the current standard is 25-gauge) between 1998 and 2010, both from a clinical standpoint and from a patient satisfaction perspective. The authors report substantial changes in the patient experience, with nearly 99% of patients being bothered by their floaters most or all of the time before surgery, compared to 84% saying they are never bothered by floaters after the surgery. However, the study does report higher incidences of complications both during and after surgery, including retinal detachment in 10.9% of cases, but no cases of endothalmitis (infection). The authors conclude that the surgery can achieve high satisfaction rates (85% in this study), but complications were more common than previously reported, highlighting that patients need to be informed  of the risks.

Bamonte, Giulio, Clemente Maria Iodice, Rodolfo Mastropasqua, Elon H. C. Van Dijk, Andrea Appeltans, Maria Vittoria Cicinelli, Matteo Menean, Marcel Ten Tusscher, Stuart W. Harmer, Paola Marolo, and et al. 2024. "Symptomatic Vitreous Opacities: Exploring the Mismatch between Clinical Observation of Vitreous Alterations and Self-Reported Symptoms" Journal of Clinical Medicine 13, no. 20: 6052. https://doi.org/10.3390/jcm13206052

Summary:

Examining 60 eyes of 30 patients suffering from self-reported myodesopsia, the authors establish that the patient experience of their vision can be quite different from the clinically observable visual disturbances with common approaches in opththalmology. Evidence of significant vitreous abnormalities were only evident in 2 of the 60 eyes. The authors suggest part of the reason for this is the difference in intensity between the forward scattering of light (which results in floater symptoms) and the back reflection of light which is made use of in clinical examination. Recent mathematical modelling has shown the difference in intensity of these phenomena can be as much as 10,000 to 1,000,000 times. Additionally, the authors note that symptoms like stray-light caused by light scattering from the edges of floaters is hardly measurable during routine examination.

As a result, the authors believe that clinicians should meet with patients on more than one occasion, take subjective complaints of visual disturbance seriously, and use all available diagnostic methods (i.e., quantitative ultrasonography, contrast sensitivity, and light scattering evaluation). This approach is crucial to establishing clinical severity and properly selecting patients for therapy.

Finally, the authors make clear that a key focus of future research should be establishing why some patients develop the condition and others do not, and identifying which patients are most likely to benefit from surgical treatments.

Stanga, P.E., Valentin Bravo, F.J., Reinstein, U.I., Stanga, S.F.E., Marshall, J., Archer, T.J. and Reinstein, D.Z., 2023. New Terminology and Methodology for the Assessment of the Vitreous, Its Floaters and Opacities, and Their Effect on Vision: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities (SK VFO Test). Ophthalmic Surgery, Lasers and Imaging Retina, 54(5), pp.306-315. https://doi.org/10.3928/23258160-20230412-02

Summary: Explores measures of visual acuity, contrast sensitivity, and other anatomical-functional metrics and suggests new terminology and methods for assessment of floaters to aid in guiding personalized treatment and response to laser-based treatments.

Ngo, W.K., Keshet, Y., Salcedo-Ledesma, A., Walia, J., Ledesma-Gil, G. and Spaide, R.F., 2023. The Way Patients See Floaters: Widefield Dynamic Scanning Laser Ophthalmoscopy Imaging of Vitreous Abnormalities. Retina, 43(8), pp.1240-1245.https://doi.org/10.1097/IAE.0000000000003786

Summary: TBD

Nguyen, J., Boneva, S.K., Nguyen-Cuu, J., Yee, K.M., Hoerig, C., Mamou, J., Ketterling, J., Sadun, A.A. and Sebag, J., 2023. Vitreous Floaters Functional Questionnaire for Vision Degrading Myodesopsia. Investigative Ophthalmology & Visual Science, 64(8), pp.4237-4237. https://iovs.arvojournals.org/article.aspx?articleid=2788611

Summary: Evaluates self-administered questionnaires assessing visual quality of life (VQOL) in patients with symptomatic vitreous opacities causing clinically significant vitreous floaters known as Vision Degrading Myodesopsia (VDM). VFFQ assessment of patient VQOL correlates with vitreous structure and visual function, such that with denser vitreous and greater degradation in CS there was a lower VFFQ score, indicating decreased VQOL. Following limited vitrectomy, VFFQ improved substantially more than VFQ-25, more sensitively reflecting improved VQOL. Thus, VFFQ may prove useful as an outcome measure of various therapeutic approaches, as well as in screening for treatable Vision Degrading Myodesopsia and evaluating disease severity for individual patients.

Ankamah, E., Green-Gomez, M., Roche, W., Ng, E., Welge-Lüßen, U., Kaercher, T., Barbur, J. and Nolan, J.M., 2022. Impact of symptomatic vitreous degeneration on photopic and mesopic contrast thresholds. Clinical and Experimental Optometry, 105(6), pp.609-616. https://doi.org/10.1080/08164622.2021.1981116

Summary: Contrast thresholds under photopic and mesopic luminance conditions are compromised in subjects with vitreous degeneration. A plausible explanation is needed for the visual discomfort expressed by patients suffering from symptomatic vitreous degeneration. Subjects with vitreous degeneration have diminished photopic and mesopic contrast thresholds compared with controls. This finding highlights the negative impact of vitreous degeneration on the quality of vision.

Harmer, S.W., Luff, A.J. and Gini, G., 2022. Optical scattering from vitreous floaters. Bioelectromagnetics, 43(2), pp.90-105. https://doi.org/10.1002/bem.22386

Summary: The authors of this study undertake mathematical modeling of light transmission through the vitreous to characterize the physics underlying the phenomenon of floaters. They explore why the visual disturbances associated with vitreous opacities can be highly significant in a subjective sense even when viewed as insignificant by examining clinicians. They also discuss the impact of pupil size on floater perception and explain why pupil dilation can often help to alleviate symptoms.

Nguyen, J.H., Nguyen-Cuu, J., Mamou, J., Routledge, B., Yee, K.M. and Sebag, J., 2021. Vitreous structure and visual function in myopic vitreopathy causing vision-degrading myodesopsia. American Journal of Ophthalmology, 224, pp.246-253. https://doi.org/10.1016/j.ajo.2020.09.017

Summary: Is myopia (near-sightedness) in patients complaining of floaters associated with changes in vitreous and vision? This study links structural abnormalities that are common in myopic eyes with the presence of increased vitreous density and reduced contrast sensitivity function (CSF). It offers an explanation as to why myopia is associated with the development of Vision Degrading Myodesopsia (VDM ≡ clinically significant floaters) in young people. The worse the axial myopia, the denser was the vitreous body and the more degraded was CSF.

Garcia, G.A., Khoshnevis, M., Yee, K.M., Nguyen, J.H., Nguyen-Cuu, J., Sadun, A.A. and Sebag, J., 2018. The effects of aging vitreous on contrast sensitivity function. Graefe’s Archive for Clinical and Experimental Ophthalmology, 256(5), pp.919-925. https://doi:10.1007/s00417-018-3957-1

Summary: Is contrast sensitivity function (CSF) impacted by aging changes in the vitreous body? This study suggests that posterior vitreous detachment (PVD) causes substantial degradation of CSF. Furthermore, after PVD there are changes in the vitreous body that further increase vitreous density, as measured by ultrasound. Concurrently, CSF continues to worsen.

Garcia, G.A., Khoshnevis, M., Yee, K.M., Nguyen-Cuu, J., Nguyen, J.H. and Sebag, J., 2016. Degradation of contrast sensitivity function following posterior vitreous detachment. American Journal of Ophthalmology, 172, pp.7-12. https://doi.org/10.1016/j.ajo.2016.09.005

Summary: Does posterior vitreous detachment (PVD) reduce vision, specifically the ability to discern shades of gray (contrast sensitivity function; CSF)? Can this be normalized by limited vitrectomy? This study documents that individuals without floaters can develop them after experiencing PVD, which can result in substantial reduction of CSF. Limited vitrectomy cured the floaters in each case and restored CSF to normal levels. This supports prior studies which suggest that the CSF not only offers a measure of floater severity in the clinical setting, but also the very favorable response to surgery. The limitation in this study is the small number of subjects.

García, B.G., Orduna Magán, C., Alvarez-Peregrina, C., Villa-Collar, C. and Sánchez-Tena, M.Á., 2022. Nd: YAG laser vitreolysis and health-related quality of life in patients with symptomatic vitreous floaters. European Journal of Ophthalmology, 32(2), pp.1143-1148. https://doi.org/10.1177/11206721211008036

Summary: This study shows an improvement in the health-related quality of life and a significant decrease in anxiety for patients that have undergone Nd: YAG Ultra-Q Reflex laser vitreolysis for floaters vaporization. The effect found is higher in myopic patients.

Lin, T., Li, T., Zhang, X., Hui, Y., Moutari, S., Pazo, E.E., Dai, G. and Shen, L., 2022. The efficacy and safety of YAG laser vitreolysis for symptomatic vitreous floaters of complete PVD or non-PVD. Ophthalmology and Therapy, pp.1-14. https://doi.org/10.1007/s40123-021-00422-6

Summary: Suggests comparable efficacies of YAG laser vitreolysis for floater treatment in older patients. Treatment efficacy was comparable between groups with complete posterior vitreous detachment (PVD) and no PVD.

Ludwig, G.D., Gemelli, H., Nunes, G.M., Serracarbassa, P.D. and Zanotele, M., 2021. Efficacy and safety of Nd: YAG laser vitreolysis for symptomatic vitreous floaters: a randomized controlled trial. European Journal of Ophthalmology, 31(3), pp.909-914. https://doi.org/10.1177/1120672120968762

Summary: Suggests efficacy of Nd:YAG laser for treatment of symptomatic floaters when patient is a good candidate for this treatment. However, study had a small sample size.

Nguyen, J.H., Nguyen-Cuu, J., Yu, F., Yee, K.M., Mamou, J., Silverman, R.H., Ketterling, J. and Sebag, J., 2019. Assessment of Vitreous Structure and Visual Function after Neodymium: Yttrium–Aluminum–Garnet Laser Vitreolysis. Ophthalmology, 126(11), pp.1517-1526. https://doi.org/10.1016/j.ophtha.2019.06.021

Summary: Does YAG laser treatment benefit patients with floaters? This study explores how patients who have had YAG laser treatment of vitreous opacities compared to untreated patients complaining of floaters. Analyses found no differences in the YAG-treated patients compared to untreated patients. However, in a small subgroup of patients there was decreased vitreous density and better contrast sensitivity function, suggesting that there may be some patients who benefit from YAG laser treatment. Prospective, randomized trials are needed to determine this and to identify what type of patients might benefit.

Sun, X., Tian, J., Wang, J., Zhang, J., Wang, Y. and Yuan, G., 2019. Nd: YAG laser vitreolysis for symptomatic vitreous floaters: application of infrared fundus photography in assessing the treatment efficacy. Journal of Ophthalmology, 2019. https://doi.org/10.1155/2019/8956952

Summary: This study suggests that Nd:YAG laser can offer effective and safe treatment for individuals deemed to be suitable candidates based on the size and location of the opacities. However, the methods employed in this study are not standardized and validated, and the journal that published this paper has a relatively low status in the eye world.

Sebag, J. and Sadun, A.A., 2019. Re: Thompson: Much Ado about Nothing (or Something)—What Is the Role of Vitrectomy and Yttrium–Aluminum–Garnet Laser for Vitreous Floaters? (Ophthalmol Retina. 2018; 2: 879-880). Ophthalmology Retina, 3(7), p.e6. https://doi.org/10.1016/j.oret.2019.01.025

Summary: This editorial is a response to the article “Much ado about nothing (or something) – What is the role of vitrectomy and yttrium-aluminium garnet laser for vitreous floaters?" The authors note that this title “aggravates the disconnect that currently exists between the experience of patients and the perception of doctors with respect to vitreous floaters.”

Shah, C.P. and Heier, J.S., 2017. YAG laser vitreolysis vs sham YAG vitreolysis for symptomatic vitreous floaters: a randomized clinical trial. JAMA Ophthalmology, 135(9), pp.918-923. https://doi.org/10.1001/jamaophthalmol.2017.2388

Summary: This study suggests that Nd:YAG laser can offer effective and safe treatment for individuals deemed to be suitable candidates based on the size and location of the opacities. However, there are methodological problems with the study [[https://doi.org/10.1001/jamaophthalmol.2018.0212\](https://doi.org/10.1001/jamaophthalmol.2018.0212){.uri}] and the results showed improvement in only half of treated subjects. Thus, better studies using objective outcome measure are needed.

Michael Albrecht, Gerd U. Auffarth, Maximilian Friedrich, Lucy J. Kessler and Ramin Khoramnia, Vision degrading myodesopsia from vitreous floaters in the young: An important aspect of myopia, Survey of Ophthalmology, (2024) https://doi.org/10.1016/j.survophthal.2024.10.001

Summary:  This review article focuses on vision degrading myodesopsia (VDM) from the perspective of myopia (shortsightedness) and therefore a potentially younger patient group. The authors acknowledge that the condition is frequently downplayed in the ophthalmic community, mentioning a recent shift in the field towards recognising the condition as a disease, including defining terms like 'symptomatic vitreous opacities' and 'vision degrading myodesopsia', which come with objectively measurable changes in the eye.  The review is then broken down into 4 key sections:

Pathophysiology

The authors illustrate two pathways to VDM, which they note typically show different age distributions. A number of factors, including myopia, contribute to VDM development in the younger patient group where VDM may not be a result of posterior vitreous detachment. They hypothesise the symptoms may persist in this group as aggregation of collagen fibres may occur in the eye without the room for movement usually afforded by PVD progression, and the opacities do not move out of the line of sight. They also note that PVD can occur over many years, and one study reports that most individuals over the age of 30 have started the process to some degree.

Additionally, myopia can lead to complete PVD roughly 10 years earlier than normal and begin as early as 20, with higher rates of vitreous liquefaction, and lower concentrations of proteins, collagen, and hyaluronan. However, myopia can be an independent contributing factor to VDM, separate from PVD. Of note, it is mentioned that the exact biochemical pathogenesis of floater development through liquefaction remains unknown.

The possible influence of genetic conditions that affect connective tissue, like Stickler, Marfan, and Ehlers-Danlos syndromes are discussed as well as other genetic factors and their relation to myopia.

Symptom assessment

This section covers symptom assessment from contrast sensitivity function measurement (where loss can be more disturbing than visual acuity), to developments in visual questionnaires (which do not align well with the traditional disease oriented approach of ophthalmology), as well as mental health symptoms. Of most note is the objective differences in contrast sensitivity function, which is affected by floater symptoms, and where myopic patients typically perform worse. They also note that incomplete PVD is often considered subclinical. PVD status is usually reported as binary (PVD vs no PVD) in studies, which may obscure the effects of early PVD progression in VDM.

The authors suggest dilated fundoscopy, SD-OCT and sonography should be used in young patients to identify floaters routinely in a clinical setting.

Symptom localisation

This section discusses evidence that proximity of floaters to the retina is important, as well as pupil size, and the impacts of head movements on perception and measurement of floaters as it relates to localisation of opacities.

There is considerable discussion of structures in the back of the vitreous, and how this might contribute to disease. Specifically, the premacular bursa may become connected to liquefied cisterns over time, potentially contributing to collagen aggregation close to the retina over time. This pocket is also larger in myopic patients. The authors highlight the posterior vitreous structures require additional study in both healthy individuals and those suffering from VDM.

Therapy options

The authors caution that the 'watchful waiting' approach often advocated may not apply as well to patients with myopic vitreopathy compared to other groups. Additionally, it is noted that no studies have been carried out or proposed on mechanisms of neuroadaption to floaters. 

There is then discussion on the relative performance of vitrectomy and YAG-laser vitreolysis treatment options. They note that almost all of the 22 studies reported that evaluated vitrectomy for floater symptoms have over 90% satisfaction rates, compared to much more mixed results in the 12 studies evaluating YAG-laser vitreolysis.

Common complications and their rates observed in previous studies are discussed for each option, principally covering cataract development, retinal tears, and endopthalmitis. There is evidence that limited vitrectomy reduces rates of cataract development, but may lead to higher risk of endopthalmitis, although more studies are required for the latter. They also consider the role of smaller gauge instrumentation in lower rates of retinal tears and detachments in recent studies of vitrectomy. Complications of YAG-laser vitreolysis were observed to be less common.

Recent experimental treatments are discussed, with a range of approaches as well as study qualities. Highlighted is the particular promise of gold-nanoparticle-based laser treatment.

In their conclusions, the authors call for a continued increase in objective measurements, with some specific knowledge gaps, the role of genetics, and longer term follow-up in vitrectomy and laser vitreolysis studies. Additionally, the authors call for epidemiological studies of the prevalence of floaters and VDM in the general population.

Woudstra-de Jong, J.E., Manning-Charalampidou, S.S., Vingerling, H., Busschbach, J.J. and Pesudovs, K., 2023. Patient-reported outcomes in patients with vitreous floaters: a systematic literature review. Survey of Ophthalmology, 68(5), pp.875-888. https://doi.org/10.1016/j.survophthal.2023.06.003

Summary: Review article that notes the need for development of floater-specific patient-reported outcome measurements (RPOMs). Floater-related studies do not commonly use PROMs developed specifically for floaters. Most measurements are limited and relate to visual symptoms and activity limitations. Quality-of-life impacts are note well documented by these PROMs.

Mishra, D., Gade, S., Glover, K., Sheshala, R. and Singh, T.R.R., 2023. Vitreous humor: composition, characteristics and implication on intravitreal drug delivery. Current Eye Research, 48(2), pp.208-218. https://doi.org/10.1080/02713683.2022.2119254

Summary: The composition and characteristics of the vitreous humour, and how these change during natural aging processes, directly influence intravitreal drug delivery. This review therefore highlights the importance of understanding the properties of the vitreous and identifies the need to achieve greater understanding of how changing properties of the vitreous affect the therapeutic efficacy of drugs administered for the treatment of posterior eye diseases.

Seider, M.I., Conell, C. and Melles, R.B., 2022. Complications of acute posterior vitreous detachment. Ophthalmology, 129(1), pp.67-72. https://doi.org/10.1016/j.ophtha.2021.07.020

Summary: A retrospective cohort study of over 8,305 patients suggests that retinal tears and rhegmatogenous retinal detachments occur at lower rate than previously suggested as a result of posterior vitreous detachment (PVD).

Kakulavarapu, S., Kiryakoza, L. and Sridhar, J., 2022. Complications of treatment for symptomatic vitreous floaters: a review. International Ophthalmology Clinics, 62(3), pp.131-155. https://doi.org/10.1097/IIO.0000000000000433

Summary: Provides a review of the vitreous, causes, known causes of vitreous opacities, treatment options, treatment efficacies, and treatment complications.

Sebag J: Vitreous & Vitreo-Retinal Interface. In: Ryan’s Retina 7th ed (A. Schachat, ed.); Elsevier, 2022.

https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323722131000317

Summary: Overview on the anatomy of the vitreous and vitreo-retinal interface.

Kalavar, M., Hubschman, S., Hudson, J., Kuriyan, A.E. and Sridhar, J., 2021, February. Evaluation of available online information regarding treatment for vitreous floaters. In Seminars in Ophthalmology (Vol. 36, No. 1-2, pp. 58-63). Taylor & Francis. https://doi.org/10.1080/08820538.2021.1887898

Summary: Assessment of the quality, content, and readability of online information relating to vitreous floaters. Generally, the quality of information varies.

Sebag, J., 2020. Vitreous and vision degrading myodesopsia. Progress in Retinal and Eye Research, 79, p.100847. https://doi:10.1016/j.preteyeres.2020.100847

Summary: Vitreous biology and the causes of Vision Degrading Myodesopsia (VDM) are reviewed. Vitrectomy is highlighted as a surgical means to improve vision and quality of life for those impacted by VDM. Current laser-based treatments (YAG), may be effective for some individuals (based on the location of the opacity within the vitreous and its size). Future, non-invasive procedures merit exploration including improved laser treatments, pharmacotherapies, and optical corrections. Better understanding of VDM and its underlying pathologies should result in defining preventative measures.

Ankamah, E., Sebag, J., Ng, E. and Nolan, J.M., 2020. Vitreous antioxidants, degeneration, and vitreo-retinopathy: Exploring the links. Antioxidants, 9(1), p.7. https://doi:10.3390/antiox9010007

Summary: This article reviews antioxidant molecules within the vitreous and the role they may play in vitreous health and age-related vitreous degeneration.

Sebag, J., 2018. Methodological and efficacy issues in a randomized clinical trial investigating vitreous floater treatment. JAMA Ophthalmology, 136(4), pp.448-448. https://doi.org/10.1001/jamaophthalmol.2018.0212

Summary: Peer-reviewed letter highlighting that YAG lasers do not ablate vitreous opacities but operate via photodisruption. This was in response to the article “YAG laser vitreolysis vs sham YAG vitreolysis for symptomatic vitreous floaters: a randomized clinical trial”.

Sebag J: Vitreous anatomy and pathology. In: Ophthalmology (Yanoff, Duker, eds) 5th ed, Mosby, 2018.

Summary: Overview on the anatomy and pathology of the human vitreous.

Milston, R., Madigan, M.C. and Sebag, J., 2016. Vitreous floaters: etiology, diagnostics, and management. Survey of Ophthalmology, 61(2), pp.211-227. https://doi.org/10.1016/j.survophthal.2015.11.008

Summary: This review of 728 published cases highlights the negative impact on quality of life resulting from floaters and discusses treatment options. The development of sutureless vitrectomy with small gauge instruments, along with performing only a limited central vitrectomy without induction of a posterior vitreous detachment, may reduce the risks of surgery. The effectiveness of Nd:YAG laser treatment remains unconfirmed.

Huang LC, Yee KMP, Wa CA, Nguyen JN, Sadun AA, Sebag J: Vitreous floaters and vision: Current concepts and management paradigms. In: Vitreous – in Health & Disease (J. Sebag, ed.); Springer, New York, 2014, pp 771-788

https://doi.org/10.1007/978-1-4939-1086-1_45

Summary: Causes and visual impacts of floaters are discussed along with treatment options and their associated effectiveness and safety. While Nd:YAG laser based treatments remain unproven as an effective treatment option, 25-gauge vitrectomy has been shown to be safe and effective. Conclusion: it is reasonable to offer limited vitrectomy to individuals who have not been able to cope, and whose vision degradation (contrast sensitivity) resulting from the vitreous opacities causing the visual phenomenon of floaters can be quantified.

Sebag J: Vitreous – in Health and Disease. Springer, New York, 2014. https://doi.org/10.1007/978-1-4939-1086-1

Summary: Sebag’s Vitreous – in Health and Disease has 56 chapters (90 authors) dedicated to topics concerning the biochemistry, anatomy, development, physiology, aging, pathology, vitreo-retinal surgery, and pharmacologic vitreolysis of the vitreous body.

Sebag J: Vitreous Anatomy, Aging, and Anomalous Posterior Vitreous Detachment. In: Encyclopedia of the Eye (Dartt, Besharse, Dana, eds.) Elsevier, Oxford, Vol. 4, pp. 307-315, 2010

Summary: This is an encyclopedia entry on the human vitreous and posterior vitreous detachment.

Sebag J: Vitreous anatomy and pathology. In: Ophthalmology (Yanoff and Duker, eds.) Mosby Elsevier; Part VI, Section 9, Ch 6.46, pp 766 – 773, 2009.

https://www.vmrinstitute.com/wp-content/uploads/2013/09/Vit-Chap-in-Yanoff-Duker-old1.pdf

Summary: The structure, functions, and key features of the vitreous are discussed. This is a detailed yet concise chapter on the topic.

Sebag J, Yee KMP: Vitreous – from biochemistry to clinical relevance. In: Duane’s Foundations of Clinical Ophthalmology (Tasman & Jaeger, eds). Lippincott Williams & Wilkins, Philadelphia, 2007, Vol 1, Ch 16.

https://www.vmrinstitute.com/wp-content/uploads/2013/09/Vitreous-from-Biochemistry-to-Clinical-Relevance-2007.pdf

Summary: This chapter discusses molecular biochemistry, anatomy, development, age-related changes and degeneration, and pathologies of the human vitreous as understood at the time.

Brasseur G, et al: Pathologie du Vitré. Masson S.A.S., Paris, 2003.

Summary: This text derives from the Annual report of the French Ophthalmology Society which each year is dedicated to a chosen theme. The 2003 symposium resulted in this book that explores various aspects of vitreous pathology.

Sebag J: Classifying Posterior Vitreous Detachment – a new way to look at the invisible (Guest editorial). British Journal of Ophthalmology, 81:521-522, 1997. https://doi.org/10.1136/bjo.81.7.521

Summary: Comment on the posterior vitreous detachment classification method proposed by Kakehashi et al.. 

Sebag J: The Vitreous – Structure, Function, and Pathobiology. Springer-Verlag, New York, 1989. https://doi.org/10.1007/978-1-4613-8908-8

Summary: This text is a definitive, in-depth book devoted to the human vitreous written for medical professionals. It covers topics relating to vitreous embryonic development, biochemistry, anatomy, function, aging, and pathology, including the development of opacities and Vision Degrading Myodesopsia (VDM).

Sebag J: The vitreous. In: Adler’s Physiology of the Eye. (WM Hart, Jr, ed). Mosby, St. Louis, 1992, pp 268-347.

Summary: Adler’s Physiology of the Eye has an entire chapter devoted to the vitreous and associated diseases, including Vision Degrading Myodesopsia (VDM). It was written for an audience of medical professionals.