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![Vitreous Floaters Symptom Questionnaire. This is the vitreous floaters questionnaire used in this study, which was translated from Korean to English. The drawing in question 6 was adopted from van Overdam et al. [4].](publication/321727767/figure/fig1/AS:1086494563414048@1636051898330/Vitreous-Floaters-Symptom-Questionnaire-This-is-the-vitreous-floaters-questionnaire-used.jpg)
Vitreous Floaters Symptom Questionnaire. This is the vitreous floaters questionnaire used in this study, which was translated from Korean to English. The drawing in question 6 was adopted from van Overdam et al. [4].
Source publication
Purpose
To evaluate the degree of psychological distress in symptomatic vitreous floater patients and to evaluate whether these psychological factors are associated with the severity of discomfort associated with vitreous floaters.
Methods
We recruited 61 patients with symptomatic vitreous floaters and 34 controls. The degree of posterior vitreous...
Citations
... In addition, more than two thirds of the cases reported SVO to be associated with, or responsible for, a form of anxiety and/or depression, for which professional counseling and/or medication in the form of antidepressants and/or anxiety remedies had been needed recently. This is also in agreement with past research findings, which have reported that patients with vitreous floaters not only have a decreased quality of life but are also psychologically affected [22]. SVO in our study cohort were longstanding, at least 12 months, with half of the subjects complaining for more than 3 years. ...
Objectives: To assess the mismatch between the clinical observation of vitreous alterations and self-reported symptoms in young patients complaining of symptomatic vitreous opacities (SVO). Methods: The ophthalmic medical records of young patients presenting primarily with SVO were retrospectively evaluated. Symptoms severity was assessed using a questionnaire. The status of the vitreous body was examined with indirect ophthalmoscopy at the slit-lamp and classified according to an ad hoc severity scale. Results: Sixty eyes of thirty otherwise healthy patients (median age: 32.5 (IQR: 29.0–37.0) years old) complaining of SVO (median duration: 38 months; interquartile range: 18–84 months) were enrolled. SVO was rated as severe by 50% of participants, affecting all the activities explored in the questionnaire. Twenty-three patients (76.6%) reported SVO-related depression and/or anxiety, for which eleven patients (36.6%) were or had been using medication. Fifty-eight eyes (96.6%) showed no evidence of (or minimal) vitreous opacity, while two eyes (3.3%) were found to have significant vitreous opacity. No significant inter-gender differences (p > 0.05) and no significant differences (p > 0.05) were found between the severity of vitreous opacity and patients’ reported symptoms nor with their psychological status and medication use. Conclusions: Severe discomfort related to the perception of vitreous floaters exists in young patients whose vitreous gel examination is unremarkable or shows only minor alterations. We believe this discrepancy can be explained by optical anisotropy; significant forward-scattering of light, which results in floater symptoms; and reduced back reflection, which limits the clinical observation.
... Adapted questionnaires started to include these aspects as well. 49,80,81,97 Not to forget, morphological aspects of floaters should also be included in a floater assessment questionnaire, as they can give an impression about the visual impact of the patient. 196 Current research projects are dedicated to query the impact of floaters, for instance through a new questionnaire called the Vitreous Floaters Functional Questionnaire (VFFQ). ...
... Another study by Kim and coworkers categorized floater patients based on the severity of their symptoms (mild, moderate, severe). 80 The group with severe symptoms reported the highest levels of discomfort and displayed "substantial levels of psychological distress". 80 In terms of health-related quality of life, Wagle and coworkers used a standard utility value questionnaire to assess the impact of floaters. ...
... 80 The group with severe symptoms reported the highest levels of discomfort and displayed "substantial levels of psychological distress". 80 In terms of health-related quality of life, Wagle and coworkers used a standard utility value questionnaire to assess the impact of floaters. 212 They found that floater patients were willing to trade off a 7 % risk of blindness and an average of 1.1 years of their remaining 10 years of life to eliminate their floater symptoms. ...
... Although the vitreous floaters are usually harmless and part of the natural aging process, they are sometimes associated with retinal tears and/or retinal detachment, especially when they increase suddenly and/or are accompanied by light flashes [6]. Vitreous floater symptoms usually recede over time; however, a considerable percentage of patients encounter significant and persistent discomfort, affecting in a negative way their health-related quality of life (QoL) due to periodic blurry vision, increased haze and glare, and reduced contrast sensitivity [7,8], while they may be occasionally debilitating since they interfere with activities like driving, reading, and near work [2,5,9]. It is not uncommon for the ophthalmologists to encounter extremely distressed patients with floaters, who are afraid of having a serious ocular problem [9,10]. ...
... Vitreous floater symptoms usually recede over time; however, a considerable percentage of patients encounter significant and persistent discomfort, affecting in a negative way their health-related quality of life (QoL) due to periodic blurry vision, increased haze and glare, and reduced contrast sensitivity [7,8], while they may be occasionally debilitating since they interfere with activities like driving, reading, and near work [2,5,9]. It is not uncommon for the ophthalmologists to encounter extremely distressed patients with floaters, who are afraid of having a serious ocular problem [9,10]. Nevertheless, the benign and innocuous nature of the floaters has as a result the clinicians to pay usually little attention to patients' complaints and discomfort when they seek medical care [9]. ...
... It is not uncommon for the ophthalmologists to encounter extremely distressed patients with floaters, who are afraid of having a serious ocular problem [9,10]. Nevertheless, the benign and innocuous nature of the floaters has as a result the clinicians to pay usually little attention to patients' complaints and discomfort when they seek medical care [9]. ...
Purpose
To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications with the symptoms duration and possible improvement, the degree of posterior vitreous detachment, and the discomfort severity.
Methods
Ninety patients complaining for floaters and fifty-seven age- and gender-matched healthy-control subjects were recruited. Every participant underwent a complete ophthalmological examination, including funduscopy and optical coherence tomography scans, while clinical and demographic data were also gathered. The Patient Health Questionnaire-9 (PHQ-9), the Zung Depression Inventory-Self-Rating Depression Scale (Zung SDS), and the Hospital Anxiety and Depression Scale (HADS) were completed by everyone.
Results
Between the studied groups, no significant differences were detected regarding the clinical and demographic data (p > 0.05). The patients with floaters had significantly higher scores of PHQ-9, Zung SDS, HADS Anxiety, and HADS Depression (p < 0.001). After adjustment for several confounders, PHQ-9 (p = 0.041), Zung SDS (p = 0.003), and HADS Anxiety (p = 0.036) values remained significantly impaired. Among the patients, PHQ-9 and Zung SDS scores were significantly elevated in the patients with floaters duration less than 4 weeks (p < 0.05). Finally, anxiety and depression were significantly correlated with the symptoms duration and intensity, with the floater-associated discomfort, and with the stage of posterior vitreous detachment.
Conclusion
Vitreous floaters have a negative impact on patients’ psychological status, by the terms of enhanced depressive and anxiety levels. To the best of our knowledge, our study is the first in the literature to elaborate the aforementioned association, by assessing three different questionnaires simultaneously.
... 7 Although floaters are a common entoptic phenomenon, also in young eyes, and typically harmless and unnoticed, they can, in some severe cases, be highly bothersome and have a significant impact on a person's quality of life. 8,9 Floaters acquired later in life may diminish or disappear within weeks or months. In these cases, psychological as well as physical parameters are suspected to play a role. ...
Purpose:
Symptomatic vitreous opacifications, so-called floaters, are difficult to objectively assess majorly limiting the possibility of in vitro studies. Forward light scattering was found previously to be increased in eyes with symptomatic floaters. Using an objective setup to measure forward light scattering, we studied the effects of enzymatically digesting the components of the vitreous body on straylight to develop an in vitro model of vitreous opacifications.
Methods:
Fifty-seven porcine vitreous bodies were digested using hyaluronidase, collagenase, trypsin, and bromelain, as well as using a combination of hyaluronidase + collagenase and hyaluronidase + bromelain. A modified C-Quant setup was used to objectively assess forward light scattering.
Results:
Depletion of hyaluronic acid majorly increased vitreous straylight (mean increase 34.4 deg2/sr; P = 0.01), whereas primarily digesting the vitreous gel with collagenase or trypsin did not significantly affect straylight. When collagenase or bromelain is applied in hyaluronic acid depleted vitreous gels, the increase in forward light scattering is reversed partially.
Conclusions:
The age-related loss of hyaluronic acid primarily drives the increase in vitreous gel straylight induced by conglomerates of collagen. This process can be reversed partially by digesting collagen. This in vitro model allows the objective quantification and statistical comparison of straylight burden caused by vitreous opacities and, thus, can serve as a first testing ground for pharmacological therapies, as demonstrated with bromelain.
... [11] A higher incidence of psychological stress was reported in patients with symptomatic vitreous floaters. [12] In Ayurvedic purview, these symptoms are included under Dwitiya patalagata dosha dushti which is mainly caused by Vata dosha. Vata dosha is the root cause behind degenerative changes in a person's body. ...
Vitreous floater is a commonly found eye condition in patients who complain of visualizing non-existing figures such as hair lines, black spots, and webs. Vitreous floaters are a sign of degeneration of vitreous gel, which if left untreated may cause severe irritation in the visual field of the patient. In modern science, floaters are treated with oral administration of antioxidants and pars plana vitrectomy surgeries. Conventional treatment options are not affordable to all patients and they may cause postoperative complications. These complications include moderate-to-severe pathophysiologies such as posterior vitreous detachment, traction retinal detachment, vitreous hemorrhage, macular edema, and full-thickness macular holes. A 56-year-old female patient who suffered from vitreous floaters was presented to Shalakya tantra outpatient department whose condition was managed by Ayurveda treatment approaches. The Triphala-yashti yoga was selected as a plan of treatment. The principle of treatment used in this study involves Ayurvedic medicines having an activity such as Chakshushya (~beneficial for eyes) to mitigate intravitreal oxidative stress, which has been linked to vitreous degeneration and associated symptoms. Changes in the symptoms were noted and the Short Floater Questionnaire score was reduced to 3.75/13 from 07/13 after three months of treatment. The utilization of a classical literature-based approach, combined with a methodology of identifying commonly mentioned botanicals within diverse mixtures, demonstrated favorable outcomes in the current study.
... Likewise, patients with vitreous opacities are willing to take risk, including 11% risk of death, a 7% risk of blindness, or give up one out of ten years of life to get rid of these problems [16]. Frequently, some patients are forced to leave their profession or take antidepressants permanently to alleviate the problem [17]. This was also confirmed in our series, with 8 out of 35 patients (23%) taking antidepressants or anxiolytics as a consequence of the problem of perception of floaters. ...
Aim
The aim of this study is to evaluate the efficacy and safety of a YAG laser vitreolysis procedure used to remove bothersome vitreous opacities/floaters.
Methods
The prospective clinical study included 42 eyes of 35 patients (age 32-81 years) with vitreous opacities generating visual disturbances. All patients were treated using the Ellex - Ultra Q Reflex YAG laser and underwent a complete eye examination before the laser vitreolysis and at 1, 3 and 6 months after the intervention. Changes in corrected distance visual acuity (CDVA), central retinal thickness (CRT), intraocular pressure (IOP) and patient’s subjective perception of disturbances were analysed.
Results
The average number of laser shots was 118 (6 - 310 shots), with a total average energy of 3.8 mJ per laser shot (2.2 - 9 mJ). The laser intervention was performed only once in a total of 31 eyes (73.8%), whereas it was necessary to perform the intervention twice in 10 cases (23.8%). No significant differences in CDVA were detected during the whole follow-up (p>0.40). No significant changes were found either in CRT (p>0.32). Concerning IOP (p<0.001), it was reduced significantly immediately after the intervention, returning to the pre-intervention level afterwards. The analysis of the responses to the questionnaire revealed that there was a mean improvement in subjective visual symptoms according to patients of 71%. No complications were detected in the sample during the follow-up.
Conclusion
Laser vitreolysis is a minimally invasive treatment, allowing a complete or partial elimination of vitreous opacities and leading to alleviation of patient’s disturbances.
... [18,19] [20]. Therefore, they require attention and intervention not only due to their severity, but also because of the level of patient frustration [21,22]. In our ophthalmic practice, we may encounter patients complaining on vitreous floaters lowering patient's visual comfort. ...
Vitreous floaters are one of the most common complain of ophthalmological patients. The aetiology of floaters includes pathological process (vitreous haemorrhages, injuries, diabetics or uveitis) and also natural age-related changes in vitreous body. Diagnosis and treatment depends on the severity of the symptoms. Process of posterior vitreous detachment requires particularly careful monitoring, because of potential complications such as retinal tears or retinal detachment. Supplementation with anti-glycation and antioxidant substances allows to reduce complains of patients with vitreous floaters.
... None of these PROMs have been developed specifically for patients with vitreous floaters or other ophthalmic conditions. We found one study using a generic multi-domain PROM: the Dartmouth Cooperative Functional Health Assessment (COOP) charts, 23 and 5 generic single-domain PROMs used for patients with floaters: the State-Trait Anxiety Inventory (STAI) 74 assessing anxiety 18,29 ; the Perceived Stress Scale (PSS) 7 assessing stress 29 ; the Center of Epidemiological Studies -Depression (CES-D) 59 scale and Patient Health Questionnaire (PHQ-9) 30 assessing depression 29,91 ; and Visual Analog Pain Scales (VAPS) to measure ocular pain during anesthesia injections, during surgery, or after surgery. 13,22,24,28,43,79,81,89,92 All studies used sum scoring. ...
... None of these PROMs have been developed specifically for patients with vitreous floaters or other ophthalmic conditions. We found one study using a generic multi-domain PROM: the Dartmouth Cooperative Functional Health Assessment (COOP) charts, 23 and 5 generic single-domain PROMs used for patients with floaters: the State-Trait Anxiety Inventory (STAI) 74 assessing anxiety 18,29 ; the Perceived Stress Scale (PSS) 7 assessing stress 29 ; the Center of Epidemiological Studies -Depression (CES-D) 59 scale and Patient Health Questionnaire (PHQ-9) 30 assessing depression 29,91 ; and Visual Analog Pain Scales (VAPS) to measure ocular pain during anesthesia injections, during surgery, or after surgery. 13,22,24,28,43,79,81,89,92 All studies used sum scoring. ...
... None of these PROMs have been developed specifically for patients with vitreous floaters or other ophthalmic conditions. We found one study using a generic multi-domain PROM: the Dartmouth Cooperative Functional Health Assessment (COOP) charts, 23 and 5 generic single-domain PROMs used for patients with floaters: the State-Trait Anxiety Inventory (STAI) 74 assessing anxiety 18,29 ; the Perceived Stress Scale (PSS) 7 assessing stress 29 ; the Center of Epidemiological Studies -Depression (CES-D) 59 scale and Patient Health Questionnaire (PHQ-9) 30 assessing depression 29,91 ; and Visual Analog Pain Scales (VAPS) to measure ocular pain during anesthesia injections, during surgery, or after surgery. 13,22,24,28,43,79,81,89,92 All studies used sum scoring. ...
Seeking treatment for bothersome vitreous floaters is patient driven. To measure the impact of floaters and treatment on an individual's quality of life, patient-reported outcome measurements (PROMs) are essential. We review all studies using a PROM for patients with floaters. We evaluated content coverage against quality-of-life domains previously identified in other ophthalmic disorders, and against a qualitative study investigating quality-of-life issues in patients with floaters. We assessed measurement properties of PROMs using an extensive range of psychometric quality criteria. We identified 59 studies using 28 different PROMs. Many PROMs were not specifically developed for patients with floaters. Floater-specific PROMs were mostly based on content validation from an ophthalmologist or researcher perspective; two included a patient perspective. Using the outcomes of the qualitative study, we found that the floater-specific PROMs were narrow in their content coverage, with most items relating to visual symptoms and activity limitations. Testing the psychometric quality of PROMs was rare, and when employed mostly limited to responsiveness and known group validity. The remarkable high number of floater-specific PROMs reveals a need for such measurements in ophthalmology. Unfortunately, reporting on psychometric quality is limited and content development is most often done without patient involvement.
... 3 Although often dismissed as harmless, light scattering by vitreous opacities profoundly degrades contrast sensitivity (CS), 6,7 impairing vision and quality of life 8 and inducing psychological stress. 9 Clinically significant cases can be identified using objective, quantitative assessment of vitreous structure (using ultrasonography), and visual function (by measuring CS) to establish the diagnosis of vision degrading myodesopsia (VDM). 4 Several approaches are used to treat VDM, 10 including vitamin supplements, 11 neodymium-doped yttrium aluminum garnet laser treatment, [12][13][14] and vitrectomy. ...
Purpose:
Limited vitrectomy improves vision degrading myodesopsia (VDM), but the incidence of recurrent floaters post-operatively is not known. We studied patients with recurrent central floaters using ultrasonography and contrast sensitivity (CS) testing to characterize this subgroup and identify the clinical profile of patients at risk of recurrent floaters.
Methods:
286 eyes (203 patients, 60.6±12.9 years old) undergoing limited vitrectomy for VDM were studied retrospectively. Sutureless 25G vitrectomy was performed without intentional surgical PVD induction. CS (Freiburg Acuity Contrast Test: Weber Index, %W) and vitreous echodensity (quantitative ultrasonography) were assessed prospectively.
Results:
No eyes (0/179) with pre-operative PVD experienced new floaters. Recurrent central floaters occurred in 14/99 (14.1%) without complete pre-operative PVD (mean follow-up = 39 months vs. 31 months in the 85 without recurrent floaters). Ultrasonography identified new-onset PVD in all 14 (100%) recurrent cases. Young (<52 years; 71.4%), myopic (≥-3D; 85.7%), phakic (100%) males (92.9%) predominated. Re-operation was elected by 11 patients, who had partial PVD pre-operatively in 5/11 (45.5%). At study entry, CS was degraded (3.55±1.79%W) but improved post-operatively by 45.6% (1.93±0.86 %W, p = 0.033), while vitreous echodensity reduced by 86.6% (p = 0.016). New-onset PVD post-operatively degraded CS anew, by 49.4% (3.28±0.96%W; p=0.009) in patients electing re-operation. Repeat vitrectomy normalized CS to 2.00±0.74%W (p=0.018).
Conclusion:
Recurrent floaters following limited vitrectomy for VDM are caused by new-onset PVD, with younger age, male gender, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.
... Z 603 dotazovaných 76 % respondentů vnímalo sklivcové zákaly, z toho 33 % je označilo jako významně zhoršující vidění. Kim a kolektiv [13] reportuje míru psychické alterace ovlivňující vnímání zákalů, přičemž lidé s depresí a úzkostí mají tendence výskyt sklivcových zákalů vnímat jako velmi obtěžující. Zmínky o využití Nd:YAG laseru k laserové vitreolýze najdeme publikované od roku 1993. ...
The aim of this paper is to present an outline of forms of ocular manifestations of visceral larva migrans in children, as illustrated by the extensive photographic documentation. Ocular larval toxocariasis (OLT) has various clinical manifestations even in childhood age, in which age representation has an influence. The most common is presence of peripheral granuloma of the eye, frequently with a tractional vitreal streak leading from the retinal periphery to the optic nerve papilla. This is followed by granuloma of the posterior pole of the eye, usually reaching from the macular landscape to the central retinal periphery, always with vitritis. In children OLT may be manifested also in affliction of the optic nerve (cystic granuloma of the head of the optic nerve or neuropathy with vitreal reaction), fulminant endophthalmitis and in rare cases also diffuse chorioretinitis. The diagnosis rests upon a clinical ophthalmological finding, as well as laboratory examination of the levels of antibodies with potential eosinophilia. Histological examination may demonstrate spherical polypoid ossification in the choroid at the posterior pole of the eye as a consequence of fibrotisation and calcification, proceeding from the surrounding area of the absorbed larva. General combined treatment with antihelminthics and corticosteroids is arduous and does not always produce the desired effect in the sense of a satisfactory improvement of visual acuity. In differential diagnostics, manifestations of OLT in small children are still associated with retinoblastoma and a clinical picture of other intraocular diseases.
