Editing Floater (section)

== Treatment ==
While surgeries do exist to correct for severe cases of floaters, there are no medications (including eye drops) that can correct for this vitreous deterioration. Floaters are often caused by the normal aging process and will usually become less bothersome as a person learns to ignore them. Looking up/down and left/right will cause the floaters to leave the direct field of vision as the vitreous humour swirls around due to the sudden movement.<ref>{{cite web |date=19 May 2010 |title=Flashes and Floaters |url=https://www.nlm.nih.gov/medlineplus/tutorials/flashesandfloaters/ot089103.pdf |url-status=dead |archive-url=https://web.archive.org/web/20130728004305/http://www.nlm.nih.gov/medlineplus/tutorials/flashesandfloaters/ot089103.pdf |archive-date=July 28, 2013 |access-date=9 December 2013 |work=[[National Library of Medicine]]}}</ref> If floaters significantly increase in numbers and/or severely affect vision, then one of the treatments below may be necessary.

{{As of|2017}}, insufficient evidence is available to compare the safety and efficacy of surgical vitrectomy with laser vitreolysis for the treatment of floaters. A 2017 [[Cochrane Library|Cochrane Review]] did not find any relevant studies that compared the two treatments.<ref name="Kokavec">{{cite journal |vauthors=Kokavec J, Wu Z, Sherwin JC, Ang AJ, Ang GS|title= Nd:YAG laser vitreolysis versus pars plana vitrectomy for vitreous floaters |journal=Cochrane Database Syst Rev|volume=2017 |pages= CD011676 |date=2017 |issue= 6 |pmid= 28570745 |doi= 10.1002/14651858.CD011676.pub2|pmc=6481890 }}</ref>

Aggressive marketing campaigns have promoted the use of laser vitreolysis for the treatment of floaters.<ref>{{cite web|url=http://www.ellex.com/physicians/treatment-spotlight/vitreolysis/ |title=Vitreolysis: Overview |website=Ellex.com |access-date=2016-04-11 |url-status=dead |archive-url=https://web.archive.org/web/20160501033345/http://www.ellex.com/physicians/treatment-spotlight/vitreolysis/ |archive-date=2016-05-01 }}</ref><ref>{{cite web |url=http://www.ellex.com/patients/floaters/about-vitreolysis/ |title=Floaters |website=Ellex.com |access-date=2016-04-11 |url-status=live |archive-url=https://web.archive.org/web/20160502221837/http://www.ellex.com/patients/floaters/about-vitreolysis/ |archive-date=2016-05-02 }}</ref> No strong evidence currently exists for the treatment of floaters with laser vitreolysis. The strongest available evidence comparing these two treatment modalities are retrospective case series.<ref>{{cite journal |pmid=11913884 | doi=10.1038/sj.eye.6700026 | volume=16 | issue=1 | title=Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters | date=January 2002 |vauthors=Delaney YM, Oyinloye A, Benjamin L | journal=Eye (Lond) | pages=21–6| s2cid=25021874 | doi-access=free }}</ref>

=== Surgery ===
{{Main article|Vitrectomy}}
[[Vitrectomy]] may be successful in treating more severe cases.<ref>{{cite journal |vauthors=Roth M, Trittibach P, Koerner F, Sarra G | date = Sep 2005 | title = [Pars plana vitrectomy for idiopathic vitreous floaters.] | journal = Klin Monatsbl Augenheilkd | volume = 222 | issue = 9| pages = 728–32 | pmid = 16175483 | doi=10.1055/s-2005-858497| s2cid = 260205524 }}</ref><ref name="Vitro">{{cite web  | title = Pars plana vitrectomy (PPV) & floater only vitrectomy  | url = http://www.eye-floaters.com/treatingfloaters-vitrectomy.php  | archive-url = https://web.archive.org/web/20070105025556/http://www.eye-floaters.com/treatingfloaters-vitrectomy.php  | url-status = dead  | archive-date = 2007-01-05  | access-date = 2008-02-01  }}</ref> The technique usually involves making three openings through the part of the [[sclera]] known as the [[pars plana]]. Of these small gauge instruments, one is an infusion port to resupply a saline solution and maintain the pressure of the eye, the second is a fiber optic light source, and the third is a vitrector. The vitrector has a reciprocating cutting tip attached to a suction device. This design reduces traction on the retina via the vitreous material. A variant sutureless, self-sealing technique is sometimes used.

Like most invasive surgical procedures, however, vitrectomy carries a risk of complications,<ref>{{cite web |url=http://nei.nih.gov/health/floaters/floaters.asp |title=Facts About Floaters |work=nih.gov |url-status=dead |archive-url=https://web.archive.org/web/20131207084700/http://www.nei.nih.gov/health/floaters/floaters.asp |archive-date=2013-12-07 }}</ref> including: retinal detachment, anterior vitreous detachment and macular edema – which can threaten vision or worsen existing floaters (in the case of retinal detachment).

=== Laser vitreolysis ===
Laser vitreolysis is a possible treatment option for the removal of vitreous strands and opacities (floaters). In this procedure an ophthalmic laser (usually a [[yttrium aluminium garnet]] (YAG) laser) applies a series of [[nanosecond]] pulses of low-energy laser light to evaporate the vitreous opacities and to sever the vitreous strands. When performed with a YAG laser designed specifically for vitreolysis, reported side effects and complications associated with vitreolysis are rare. However, YAG lasers have traditionally been designed for use in the anterior portion of the eye, i.e. [[posterior capsulotomy]] and [[Iridectomy|iridotomy]] treatments. As a result, they often provide a limited view of the vitreous, which can make it difficult to identify the targeted floaters and membranes. They also carry a high risk of damage to surrounding ocular tissue. Accordingly, vitreolysis is not widely practised, being performed by very few specialists. One of them, John Karickhoff, has performed the procedure more than 1,400 times and claims a 90 percent success rate.<ref>{{cite web |url=https://www.cbsnews.com/news/surgery-to-rid-eye-floaters-scrutinized/ |title=Surgery To Rid Eye "Floaters" Scrutinized|date=30 January 2007 |publisher=CBSNews HealthWatch|access-date=December 5, 2011}}</ref> However, the [[MedicineNet]] web site states that "there is no evidence that this [laser treatment] is effective. The use of a laser also poses significant risks to the vision in what is otherwise a healthy eye."<ref>{{cite web |url=http://www.medicinenet.com/eye_floaters/page5.htm#rid |title=Eye Floaters|publisher=[[MedicineNet]] |access-date=December 5, 2011}}</ref>

=== Medication ===
Enzymatic vitreolysis has been trialed to treat [[vitreomacular adhesion]] (VMA) and anomalous [[posterior vitreous detachment]]. Although the mechanism of action may have an effect on clinically significant floaters, {{As of|2015|03|lc=y}} there are no clinical trials being undertaken to determine whether this may be a therapeutic alternative to either conservative management or vitrectomy.<ref>{{cite web|url=http://www.oneclearvision.org/eye-floater-research/pharmacologic-vitreolysis/|title=Pharmacologic vitreolysis|work=One Clear Vision|access-date=2015-03-22|archive-date=2015-03-28|archive-url=https://web.archive.org/web/20150328233909/http://www.oneclearvision.org/eye-floater-research/pharmacologic-vitreolysis/|url-status=dead}}</ref>

=== Atropine ===
Dropping low doses of atropine onto the eye dilates the pupil, thus reducing shadow formation on the retina by floaters.<ref>{{Cite web |last1=Kaymak |first1=H. |last2=Frickle |first2=A. |last3=Hagan |first3=P. |last4=Auffarth |first4=G. |last5=Breyer |first5=D. |last6=Klabe |first6=K. |last7=Fulga |first7=R. |date=2017-10-10 |title=Training and Innovation |url=https://www.escrs.org/Lisbon2017/programme/free-papers-details.asp?id=28365&day=0 |url-status=live |archive-url=https://archive.today/20220321184525/https://www.escrs.org/Lisbon2017/programme/free-papers-details.asp?id=28365&day=0 |archive-date=2022-03-21 |access-date=2022-03-21 |website=ESCRS {{!}} EUROPEAN SOCIETY OF CATARACTS AND REFRACTIVE SURGEONS}}</ref><ref>{{Cite journal|last1=Kaymak|first1=Hakan|last2=Fricke|first2=Andreas|last3=Mauritz|first3=Yvonne|last4=Löwinger|first4=Anne|last5=Klabe|first5=Karsten|last6=Breyer|first6=Detlev|last7=Lagenbucher|first7=Achim|last8=Seitz|first8=Berthold|last9=Schaeffel|first9=Frank|date=November 2018|title=Short-term effects of low-concentration atropine eye drops on pupil size and accommodation in young adult subjects|journal=Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv für Klinische und Experimentelle Ophthalmologie|volume=256|issue=11|pages=2211–2217|doi=10.1007/s00417-018-4112-8|issn=1435-702X|pmc=6208716|pmid=30145612}}</ref>