The Clinical Impact of Floaters and Success of Laser Vitreolysis

It is well known that the vitreous forms 80% of the ocular body and consists of water (98%) and a network of collagen fibrils and hyaluronic acid (2%). Thus, the vitreous is typically characterised as a transparent gel firmly attached to the retina. Vitreal transparency is key as it allows transmission of light through unobstructed media to the retina for visual stimulation. With age, the vitreous begins to liquefy due to molecular rearrangement between hyaluronic acid and collagen macromolecules. This involves cross-linking and aggregation of collagen causing light scattering and consequently “floaters” and entopticlike symptoms. Simultaneously, there is a weakening of the vitreous and retinal interface causing separation of the posterior vitreous cortex, a phenomenon known as posterior vitreous detachment (PVD). During this process, the acute onset of multiple floaters and those of longstanding appearance causes functional visual problems for patients and bothersome symptoms1. IMPACT OF FLOATERS Many physicians will typically rule out events of retinal detachment or vitreous haemorrhage before discharging a patient with symptomatic floaters. However, the implication of floaters is misunderstood and under appreciated.