In a recent discussion regarding floaters (which I unfortunately deleted), I
believe you stated that floaters would have to be VERY bad before a
vitrectomy might be justified.

and tearing. Yet I have something close to 20/20 on an eye chart and no eye
disease according to recent dilated eye exams. What are your thoughts as to
what criteria justify vitrectomy?

I would also be interested in any additional opinions from other readers.

Charles, if I were in your situation, I'd be setting up a pre-surgery
consultation with my retinal surgeon rather than seeking opinions on
the internet. I had a vitrectomy about a year ago to remove a macular
pucker. The worst consequence of the surgery was the development of a
cataract in the surgical eye. (I've read that it's the result of the
lens' exposure to oxygen.) Unless you are at high risk for retinal
detachment, I believe that the a vitrectomy is quite safe if done by a
competent retinal surgeon. And with the new 25-gauge "sutureless"
equipment, recovery is very rapid. One surgeon wrote that the day
after the vitrectomy, it's frequently difficult to tell which of the
patient's eyes had the surgery.

Best of luck!

Dr. Stacy,

In a recent discussion regarding floaters (which I unfortunately deleted), I
believe you stated that floaters would have to be VERY bad before a
vitrectomy might be justified.

I have what I consider to be very bad floaters for the past 7 years, and
have been wrestling with that question over that time.

What criteria does one use to determine whether to seek a vitrectomy? In my
case, I have large globs of "mud" that obscure a large portion of my vision.
Reading is very difficult, for example, not only because so much of a line
of print is obscured, but because the contrast between the print and
background is poor. It is also not an exaggeration to say that the globs
torment me almost all of the time and seem to cause persistent eye strain
and tearing. Yet I have something close to 20/20 on an eye chart and no eye
disease according to recent dilated eye exams. What are your thoughts as to
what criteria justify vitrectomy?

Thank you for your comments.

I would also be interested in any additional opinions from other readers.

On Thu, 28 Dec 2006 15:12:11 -0800, "Charles Braverman"
braversir@aol.com> wrote:

I would also be interested in any additional opinions from other readers.

First of all, realize a vitrectomy is not "minor surgery".

Next, realize that anytime the eye gets "cracked open" there is real
risk of a microbial infection inside the eye (i.e., endophthalmitis).

I have never referred a patient to a retinal surgeon for an evaluation
for vitrectomy to get rid of floaters. However, my criteria for a
"20/20 patient" would be the patient would to have to be absolutely
miserable and thoroughly understand the risks/benefits of the
procedure. From your description (i.e., "torment") above, you may be
better off being prescribed an antidepressant than a vitrectomy.

And although some others have said recovery from a vitrectomy is
minimal, there are other times after a vitrectomy that your eye feels
like someone played pinball with it.

On Thu, 28 Dec 2006 15:12:11 -0800, "Charles Braverman"
braversir@aol.com> wrote:



Dr. Stacy,

In a recent discussion regarding floaters (which I unfortunately deleted), I
believe you stated that floaters would have to be VERY bad before a
vitrectomy might be justified.

I have what I consider to be very bad floaters for the past 7 years, and
have been wrestling with that question over that time.

What criteria does one use to determine whether to seek a vitrectomy? In my
case, I have large globs of "mud" that obscure a large portion of my vision.
Reading is very difficult, for example, not only because so much of a line
of print is obscured, but because the contrast between the print and
background is poor. It is also not an exaggeration to say that the globs
torment me almost all of the time and seem to cause persistent eye strain
and tearing. Yet I have something close to 20/20 on an eye chart and no eye
disease according to recent dilated eye exams. What are your thoughts as to
what criteria justify vitrectomy?

Thank you for your comments.

I would also be interested in any additional opinions from other readers.



First of all, realize a vitrectomy is not "minor surgery".

Next, realize that anytime the eye gets "cracked open" there is real
risk of a microbial infection inside the eye (i.e., endophthalmitis).

I have never referred a patient to a retinal surgeon for an evaluation
for vitrectomy to get rid of floaters. However, my criteria for a
"20/20 patient" would be the patient would to have to be absolutely
miserable and thoroughly understand the risks/benefits of the
procedure. From your description (i.e., "torment") above, you may be
better off being prescribed an antidepressant than a vitrectomy.

And although some others have said recovery from a vitrectomy is
minimal, there are other times after a vitrectomy that your eye feels
like someone played pinball with it.

And I think that "cracked" is a poor choice of words to use with
someone who is not familiar with the procedure, where 3 very small
holes are cut in the eye for the instrumentation.

I think vitrectomies for major vitreous opacities is becoming more
common, as it is quite successful.

But I really disagree with you in this case, Anon E. Muss, and your
comment about antidepressant medication is a little offensive.

Even more so when the objective findings (i.e., 20/20 vision with no
eye pathology) do not concur with his subjective complaints (i.e.,
torment).

20/20 is a subjective finding, not an objective one. And floaters
notoriously cause 20/20 vision to drop to 20/100 or worse as the
floater passes over the macula.
w.stacy, o.d.

Anon E. Muss wrote:

Even more so when the objective findings (i.e., 20/20 vision with no
eye pathology) do not concur with his subjective complaints (i.e.,
torment).

20/20 is a subjective finding, not an objective one.

On Sat, 30 Dec 2006 01:32:50 GMT, William Stacy <wstacy@obase.net
wrote:


20/20 is a subjective finding, not an objective one.


Quick answer: In the standard SOAP format for medical records, visual
acuity is recorded in the "O" section for (O)bjective.

Longer answer: When a patient's visual acuity is properly tested
using a wallchart with a patient who is being honest and giving proper
effort, I consider that to be an objective record of his visual acuity
unless proven otherwise.

No, it's NOT *purely* an objective test of visual function like a
visual evoked potential (VEP), optokinetic response (OKN), functional
magnetic resonance imaging (MRI) or a pattern electroretinogram
(pERG). Yes, people can lie, not give good effort, can be hysterical,
malinger or have otherwise non-physiologic loss of visual acuity.

In the same way, I consider a confrontation visual field that clearly
demonstrates a total homonymous hemianopia to be essentially
objective. And whether it is performed by confrontations, a tangent
screen, kinetically via Goldmann perimeter, a Matrix FDT or automated
via an Octopus 101, it's still gonna be there. The exact extent will
vary from test to test and is influenced by a person's subjectivity,
but an person educated in interpreting visual fields will clearly be
able to see it's there each and every time.

I consider extraocular motilities to be objective even though people
can fake those too.

Maybe this will help:

I consider anything which is a "sign" to be "objective" even if it
requires some sort of patient response or interpretation: Loss or
presence of normal snellen visual acuity, clear cut visual field
defects (e.g., homonymous hemianopia), restriction on extraocular
motilities, abnormal color vision plate test result, cover/uncover
test results, acquired torsional nystagmus, absence of stereoacuity,
positive photostress test, exophthalmometry, clear cut "red cap
desaturation test"/afferent pupillary defect.

I consider anything which is a "symptom" or complaint to be
"subjective": Vision is clear/blurry, can't see off to one side,
can't move my eyes to the right, hard to tell difference between navy
blue and purple socks, eyes cross, vision shakes, can't thread a
needle, can't see for a long time after car headlights blast me at
night, eyes bug out, colors/lights seem dim out of my one eye.

P.S. Got a pachymeter about a month ago.