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This Is The Cause Of Floaters After Lasik

This Is The Cause Of Floaters After Lasik

You may see floaters after lasik. They may appear as persistent hair-like strands in your vision or may take on a larger ring shaped appearance.

While the risk of floaters increase with age and nearsighted prescription, lasik can also increase the risk of developing floaters. These floaters initially can be really annoying and bothersome, but gradually the brain starts to pay less attention and ignore them over time.

But before we get too deep into floaters, we first need to break down the two types of “floaters” and why they happen

  • Tear Film Debris
  • Vitreous Floaters

In addition, we'll also cover any serious vision-threatening issues that can come from floaters and what can be done about floaters.

Quick Note On Tear Film Debris

On the surface of your cornea exists a thin layer of liquid called the tear film. This tear film bathes the cornea in nutrients and keeps it from drying out.

Like any body of water, the tear film can have things floating in it. Some of this floating debris comes from the eyelashes (and even eye makeup). Some of these floating things are actually corneal cellular debris.

Within the cornea are tiny nerves that sense when the eye dries out. These nerves then send signals to the tear gland to produce more tears. After lasik, the eye has a reduced ability to replenish the tear film. The lasik flap and the treatment disrupt these nerves. Until these nerves regrow, less tears are produced on the eye. The eye is more prone to drying out.

And overall, when the eye is drying out and the tear film is inadequate, there is an increase in debris in the tear film. This debris can cause small floaters in your vision.

After lasik, you can have an increase in these tear film debris floaters. But this tear film debris is easily treated.

These floaters can rapidly move out of the way with blinking. Using artificial tears can also help by replacing the tear film with a clean debris-free surface.

True Floaters

The most important floaters come from a different part of the eye: the vitreous.

The vitreous is the gel-like substance that makes up the vast majority of the eye.

Vitreous in the eye

Vitreous in the eye; image by Original: Holly Fischer Vector: Pixelsquid, CC BY 3.0, via Wikimedia Commons

The vitreous initially provides a structural framework for the eye. But eventually becomes unnecessary and starts to break down into more of a liquid through normal aging processes. This causes parts of the vitreous to clump up into some visible solid strands that create some floaters in your vision.

Ultimately, this vitreous begins to pull away and detach from the retina in the back of the eye. This is called a posterior vitreous detachment.

Some parts of the vitreous attach more firmly to the eye than other parts of the vitreous. One firm attachment point of the vitreous is to the optic nerve in the back of the eye. When this dense part of the vitreous detaches, a very large floater can be seen in the vision. This floater is often described as often having a cobweb-like shape. This is the cause of most bothersome floaters.

Risk Of Lasik And Floaters

Posterior vitreous detachments will eventually happen to most people in life.

  • The older you get, the more likely it is to occur (as the vitreous breaks down with age).
  • And also, the more nearsighted you are, the more likely it is to happen (due to a difference in the shape of the eye)

But many eye surgeries (including lasik) can increase the risk of a posterior vitreous detachment.

The first step of lasik involves the creation of a lasik flap. A femtosecond laser is used to create an intricate 3D shaped lasik flap. But to make sure that the eye doesn't move around when the laser is creating this flap, a suction ring is used to hold the eye in place.

This suction ring increases the pressure inside the eye. This additional pressure can cause a slight pull on the vitreous and increase the risk that this vitreous detaches.

Approximately 15% of patients after lasik can develop a posterior vitreous detachment and notice floaters.

This depends on how nearsighted you are. Similar to the normal risks for a posterior vitreous detachment, the more nearsighted you are before lasik, the greater your risk of getting floaters afterwards. Highly nearsighted people can have a risk of 24% compared to a risk of 4% for people less nearsighted. This is increased from the normal usual age and nearsighted risk that one would have.

Problem With Posterior Vitreous Detachment & Floaters

The most common problem is that floaters are annoying!

Wherever you look, you see the floaters. They are distracting and bothersome.

But a posterior vitreous detachment can have a more serious problem.

Retinal Tears & Detachments

In addition to the vitreous being firmly attached at the optic nerve, the vitreous can also be firmly attached to some points of the retina.

The optic nerve is strong and is unaffected when the vitreous pulls away.

The retina, however, is not.

When the vitreous pulls away from those firm retina attachments, it can cause a small tear in the retina. Because the retina only knows how to send light information, a retinal tear causes lots of flashing lights - like camera light-bulbs flashing all of a sudden. This can be followed by a bunch of new floaters.

The good news is that retinal tears can be treated to prevent further issue. A laser is used to place a barricade around the retina tear to prevent it from getting worse.

If the tear is left untreated, fluid can get underneath the retina at the site of the tear and cause the retina to detach. A detachment of the retina can cause a shade or curtain of vision loss. This is an emergency. Untreated, a retinal detachment can cause permanent loss of vision. It is important to seek evaluation with any of those symptoms.

Lasik & Retinal Detachment

The good news is, despite lasik having an increased risk of posterior vitreous detachment, lasik does NOT have an increased risk of retinal detachment. And in some patients, the risk of retinal detachment may be lower after lasik (perhaps due in part to the through screening exam done prior).

So fortunately, this real main issue with floaters after lasik is simply that they are annoying and bothersome.

Treating Floaters

For just about everyone, treating floaters involves doing absolutely nothing. That's right! Just by doing nothing the floater most likely will “disappear”.

Technically, the floater doesn't actually disappear. Just our perception of the floater changes over time.

Our brain has the remarkable ability to adjust. This process is called neuroadaptation. When we first encounter new stimuli, we pay attention to it. But if this stimuli persists and becomes unimportant, we stop paying attention to it.

When you start wearing a wristwatch or a ring, you are keenly aware of it. But pretty quickly, as you go about your day, you stop paying attention. It is only when you think about the wristwatch or the ring that you are able to feel it and realize that it is still there.

The same thing happens with our vision and our floaters. Initially, when floaters first develop, it is hard not to see them. But gradually over time, you start to ignore the floaters more and more and you begin to forget the floaters are even there. The brain focuses on everything else in your vision rather than the floaters. The floaters have effectively “disappeared” from your vision.

The downside? This process can take months to years to completely occur. It takes patience.

Procedures for floaters

Neuroadaptation technically isn't a treatment for the floaters, it is something that just happens. But there are a few ACTUAL treatments for floaters.

  • A laser can be used to disrupt and break up floaters. This is called YAG laser vitreolysis.
  • The floater and the vitreous can be removed entirely through a procedure called a vitrectomy.

These procedures don't come without risks (especially the vitrectomy) and are thus reserved for very severe and symptomatic floaters - a very small proportion

Summary

Lasik does increase the risk of the vitreous detaching away from the retina in the back of the eye and creating floaters in your vision. However, fortunately, this doesn't increase the risk of any serious issues such as a retinal detachment. Instead, the floaters can just be plain annoying. Gradually, by doing nothing, the brain starts to ignore the floater and it fades over time.

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