Eyeworld

34 | EYEWORLD | FALL 2024 ATARACT C STRIKE! About the physicians Steve Charles, MD Charles Retina Institute Germantown, Tennessee Christina Y. Weng, MD, MBA Professor of Ophthalmology Fellowship Program Director, Vitreoretinal Diseases & Surgery Baylor College of Medicine Houston, Texas Dagny Zhu, MD Medical Director and Partner NVISION Eye Centers Rowland Heights, California by Liz Hillman Editorial Co-Director What's the impact? Dr. Weng said that floaters can be "extremely bothersome" to patients, but she added, "I think we are often too dismissive of the symptoms they cause." "Many patients have come to me after their cataract surgery unhappy with their surgical outcome even if they were 20/15 uncorrected," she said. "There was one study that found that patients younger than 55 years of age were will- ing to accept a 7% risk of blindness to remove floaters. 2 That statistic never ceases to shock me, but it emphasizes what a negative impact floaters can have on one's quality of life. "Considering how floaters can lead to post- operative dissatisfaction is increasingly import- ant in the era of premium IOL technology where patients have higher expectations than ever before," Dr. Weng continued. Dr. Zhu said that floaters should be on a surgeon's workup for the 20/20-unhappy multi- focal IOL patient. "Previously when a multifocal patient was unhappy postop … the most com- mon reasons were refractive error, dry eye, or you blame the lens itself, and you recommend an IOL exchange. So many of those are now be- ing diagnosed as floaters," Dr. Zhu said. "We've been neglecting the vitreous, which makes up more than 90% of the eye." Floaters getting in the way of postop patient happiness? Large posterior Weiss ring seen at YAG laser with mid-vitreous lens Source: Dagny Zhu, MD A ccording to one survey, 76% of a population (age 29.5±10.7 years) experience visual symptoms attribut- ed to floaters. 1 These wispy veils/curtains, cob- web-like threads, or thick diffuse clouds (three ways that Dagny Zhu, MD, describes different categories of vitreous opacities) can impact pa- tient perception and happiness with their vision after cataract surgery. While there are treatment options for floaters, there is some division as to methods of treatment, especially as YAG laser vitreolysis is becoming more common. Regardless, all of the physicians who spoke with EyeWorld on the topic—Dr. Zhu as a cataract surgeon, and Christina Y. Weng, MD, MBA, and Steve Charles, MD, as retina specialists—said they advise pa- tients complaining of floaters to wait at least 6 months before pursuing treatment. "I say [to patients]: 'These floaters will get less obvious with time.' Then I say, 'I didn't say they would go away. … I mean it when I say they'll get less obvious with time, but if you look at a blue sky or a white sheet of paper, you'll still see them. If you look at a blank computer screen, you'll still see them,'" Dr. Charles said, adding that he tells patients that he also has floaters, but he still performs complex medical procedures and flies jets. "I try to put the per- spective that way." Vitreous veil with a small hole created at the beginning of a YAG laser session Source: Dagny Zhu, MD

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