Are You Seeing Spots?

Outpatient, painless procedure eliminates annoying eye floaters.

The floaters in my left eye are gone. My vision is perfectly clear in that eye.

The floaters in my left eye are gone. My vision is perfectly clear in that eye.

 

New York native Anthony Santonocito resided in the Empire State for the first 72 years of his life. He was just a youth when he got his initial experience with what would become his life’s ambition.

“I’ve been doing construction since I was a kid, and I worked in the business for most of my life,” elaborates Anthony, 74. “I primarily did heavy construction in New York City. I worked on most of the larger buildings in Manhattan, including the original World Trade Center.”

Two years ago, a newly retired Anthony opted to leave the freezing New York winters and relocate to Florida. He discovered a new home in The Villages®, which offers a multitude of amenities and recreational activities.

“I wanted a change,” Anthony reveals. “I was looking to get out of the cold, and the weather is so much nicer in Florida. I’m enjoying my retirement. I don’t golf or fish, but I like living in The Villages with all of the restaurants and entertainment available.” 

Going back many years, Anthony has struggled with various eye problems, including one very aggravating issue: eye floaters. These are small specs of material suspended within the vitreous, the gel-like fluid that fills the space inside the eye. Floaters may look like dark spots, strings or even cobwebs moving in and out of the individual’s vision.

“I’ve had floaters for a long time; I can’t even remember when they started,” Anthony divulges. “I had them in both eyes, but my left eye was really saturated with them. Seeing with floaters is like looking through a windshield while it’s raining and you don’t have windshield wipers. When they float by, it’s like looking through a window full of water.

“The floaters interfered with my everyday activities, including driving and watching TV. They were always in the way, constantly there in the middle of my eyeballs. They just floated back and forth in front of my eyes like water drops. It was very irritating.

“I saw some very small flashes in my eyes as well, but my problem was mainly the floaters that annoyed me all day long.”

Over the years, Anthony consulted multiple eye specialists in New York, seeking treatment. Years ago, one specialist told him there was a surgical procedure to eliminate eye floaters, but it was dangerous and not widely used. The doctor didn’t recommend the surgery for Anthony, but the retired construction worker felt hopeful for the future.

In 2019, Anthony told his New York ophthalmologist that he was relocating to Florida. The eye doctor recommended he visit Florida Retina Institute, which has three offices near The Villages (Lady Lake, Mount Dora and Clermont). At Florida Retina Institute, Anthony met with S.K. Steven Houston III, MD, a board-certified, fellowship-trained retina specialist.

“Floaters are a very common complaint of patients that come to us for evaluation,” Dr. Houston reports. “Anthony was experiencing acute floaters and was also seeing some flashes of light. His floaters were hovering around in the center of his vision. Our initial treatment was observation and periodic reassessment to evaluate his symptoms.”

When Anthony didn’t improve and remained highly symptomatic after six months, Dr. Houston recommended a surgery called vitrectomy to remove the floaters. 

“I talked to many eye doctors going back 10, 20, 30 years,” Anthony relates. “They all told me the procedure to remove floaters was experimental.

But Dr. Houston explained that things have changed, and the procedure can now be performed safely. He told me that I’m a perfect candidate, so I agreed to move forward with it.”

Define and Diagnose

When people are young, the vitreous is well-formed and clear. But with age, it begins to degenerate and liquify. Eventually, it starts to separate from the retina, the light-sensitive nerve tissue that forms the back wall of the eye.

“When the vitreous pulls away from the retina it condenses, and little concentrations of vitreous form,” Dr. Houston explains. “Instead of being transparent, these concentrations become translucent or opaque and float around in the inside of the eye. Floaters are essentially the shadows of those opacities that people see.”

Some people experience flashes of light in the far peripheral area of their vision in addition to floaters. There are several potential causes for flashes, but they mainly occur as a consequence of the separation of the vitreous from the retina. 

“As the vitreous tugs on the retina, it exerts traction on the cells of the retina,” Dr. Houston educates. “When this occurs, the retinal cells become stimulated, which results in flashes of light.”

Retina specialists suspect floaters based on the patient’s symptoms. To confirm the diagnosis, they first perform a dilated eye exam. During dilation, doctors can look for signs of the vitreous separating and even see the opacities floating in the vitreous.

“We utilize imaging such as optical coherence tomography, or OCT, which can display the retina-vitreous interface so we can see if there’s any separation,” Dr. Houston discloses. “We also use ultra-widefield imaging, which gives us clear pictures of the back of the eye so we can look for those telltale changes associated with floaters.”

Miniature Laparoscopy

In many cases, the opacities in the vitreous that are the source of floaters fade within  four to six months. In other cases, people’s brains get used to seeing the floaters so they are no longer an annoyance.

“In 90 percent of cases, patients don’t require treatment,” Dr. Houston stresses. “The process of the vitreous separating from the retina is a common age-related development that happens to everyone. 

“However, there are potential complications when the gel separates. These complications include the development of a retinal hole, retinal tear or even a retinal detachment. That is why it’s important for people who have a sudden onset of floaters and/or flashes to have their eyes evaluated by a retinal specialist.”

Dr. Houston may recommend vitrectomy for patients who have very symptomatic eye floaters that don’t fade within six months. 

“Vitrectomy is essentially a miniature laparoscopic surgery on the eye,” Dr. Houston describes. “We create three small holes in the white part of the eye and use tiny instruments to remove all of the vitreous, which eliminates all of the opacities that the patient sees as floaters. The eye replaces the vitreous with its own fluid, which is much clearer.”

Vitrectomy is an outpatient surgery that takes about 20 minutes to perform. Patients are lightly sedated and the eye is numbed. The procedure is not painful and there’s a very low risk for complications such as bleeding and infection, Dr. Houston says. 

“They put you under but not altogether; you’re kind of awake during the procedure,” Anthony recalls. “I remember waking up in a bed with a patch on my left eye. Dr. Houston told me everything went well and explained what I needed to do afterward, such as put drops in my eye. The next day, he looked at my eye to make sure everything was fine, and it was all good.”

“A World of Difference”

Dr. Houston performed the vitrectomy on Anthony’s left eye in August. The retired construction worker is quite pleased with the outcome. 

“The floaters in my left eye are gone,” Anthony enthuses. “My vision is perfectly clear in that eye; no more windshield full of rain. My right eye still has floaters, but there are about half as many as I had in my left eye. And with one good eye, I can pretty much see through the floaters in my right eye. 

“I’ve had no problems since the surgery; it’s made a world of difference in my vision. When I go back to Florida Retina Institute, Dr. Houston and I will discuss whether or not to do the procedure on my right eye. I’ll see what Dr. Houston suggests. I trust him.”

Anthony is also delighted with the care he received from the retina specialist and his staff.

“What I like most about Dr. Houston is that he sat with me and calmly explained everything,” Anthony raves. “I wouldn’t have jumped into the procedure without knowing what the doctor was going to do. Dr. Houston made me feel comfortable. I’m very happy I dealt with him. He did a great job.

“The staff at Florida Retina Institute is very good as well. I’ve been going there for two years, and everything’s been fine. When I have an appointment, they take me at my appointment time and I’m pretty much in and out even with all the tests they perform.

“I definitely recommend this procedure to people who have floaters that are really bothering them. If your floaters are getting worse, you should visit Dr. Houston at Florida Retina Institute.”

© FHCN article by Patti DiPanfilo. Photos by Jordan Pysz. js
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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • S.K. Steven Houston III, MD

      S.K. Steven Houston III, MD, is board certified by the American Board of Ophthalmology. He earned a Bachelor of Science degree in Materials Science and Engineering from the University of Florida and a Doctor of Medicine degree from University o... Read More