Can Eye Floaters Be Removed? Surgical & Non-Surgical Options

So, if you’ve clicked on this article, it’s likely you’ve already got an idea what eye floaters are…BUT understanding how they can arise and the science underpinning their existence helps to explain how and why the available treatment options aim to work - so let’s dive into it!

In subjective terms, eye floaters are those shadowy squiggles you might see floating in your vision that move with eye and head movements and are particularly apparent against bright backgrounds.

Now in scientific terms, these shapes you’re seeing are visible changes to the vitreous humour (aka “vitreous”) – the gel-like substance in your eye that comprises about 80% of the eye’s volume and helps maintain its round shape. This vitreous gel is primarily composed of water, the protein collagen, a large sugar molecule known as hyaluronan (which you may know as hyaluronic acid – something also found in many skincare products), and a multitude of antioxidant molecules and enzymes.

Molecular changes to this vitreous gel and its components can ultimately alter vitreal structure and contribute to ‘vitreous liquefaction’, a process characterised by disrupted homogeneity (uniformity) in the vitreous gel and the dissociation of 

hyaluronic acid from collagen.

It’s these structural changes to the vitreous gel which can then give rise to floaters. Examples of these changes include:
 

• Aggregation (clumping) of collagen proteins
• Formation of liquid pockets within the vitreous gel known as ‘lacunae’

Each of these processes (and possible causes of floaters) may have slightly different effects on the vitreal structure – offering also a possible explanation for the variety in floater appearance that has been documented (which you may also experience).

Alterations to vitreous-gel structure can occur due to inflammation, protein glycation (addition of sugar molecules), and eye conditions like diabetic retinopathy or macular degeneration, but most commonly arise from ageing – something sadly none of us can escape! While the exact molecular mechanism underlying age-related vitreal-degeneration is unclear, it’s thought to be caused by oxidative stress within the eye.

Oxidative stress in the eye (see our article on Oxidative Stress and Floaters here) is due to an age-related decline in the antioxidant capacity of the eye itself, as well as repeated exposure to free radicals and reactive oxygen species (ROS) over time. This disrupted balance within the eye can lead to unwanted reactions between reactive species and the components of vitreous - for example, ROS can degrade hyaluronic acid in the vitreous and lead to it’s depolymerisation (unlinking).

Increased glycation associated with a high-sugar diet and poor glycaemic control (control of blood sugar) may similarly contribute toward the incidence of floaters and other eye conditions. For example, glycation of collagen is associated with unwanted protein crosslinking, leading to its dissociation from hyaluronic acid and subsequent vitreous gel destabilisation.

While the conditions above contribute to gradual vitreal degeneration, which causes gradual floater onset, sometimes floaters can arise more suddenly. These sudden floaters are often accompanied with reduced vision and occur on a much shorter time frame. Retinal tears and preretinal haemorrhage, or vitreous haemorrhage are among the underlying causes of these acute floaters, and in such cases, prompt treatment should be sought immediately before moving onto the concern of floater management or removal – as discussed below.

So – we’ve established how those pesky floaters may arise, now we want to consider if there’s anything we can actually do about them. Well – you’ve got a couple of options, some more invasive, some less so, and each of which have factors you may want to consider to work out which is most suited to you and your floaters.

Opting for surgical intervention is a rather large decision and is considerably more invasive than the alternative management routes as discussed later in this article. Despite this, high success rates are commonly reported (though it should be noted that reported ‘success’ is often measured subjectively through patient questionnaires, so is a relatively hard metric to precisely quantify).

Alternate surgical and pharmaceutical interventions may also emerge in the coming years, however currently there exists two main approaches to surgical treatment of floaters – vitrectomy and vitreolysis, with the former much more commonly performed.

What does it involve? The physical removal of vitreous gel and its constituents, floaters included. Current techniques use very fine gauge needles to extract approximately 5-15ml of vitreous gel dependent on the extent of vitrectomy performed. This procedure mostly requires only a single session. Interestingly, future techniques could potentially use robots to perform this surgery! Robotics are already in use for a wide range of surgeries within ophthalmology today, such as the IRISS system to remove cataracts. 

What is the success rate? In a key review on floaters and their management in 2016 by Milston et al, across the various studies considered, 85-100% satisfaction rates were found to be reported across the studies. (Once again, the subjective basis of this metric brings a possibility of the placebo effect influencing results, though a study in 2014 measured contrast sensitivity (the ability to perceive sharp and clear outlines of small objects) as a more objective metric for success and also found significant improvements following vitrectomy. Overall, rates of success and satisfaction certainly appear to be positive.

Are there any side effects? Overall vitrectomy has a low risk profile. Complications (as reported in the Milston 2016 review) include:

• Retinal tears  - a tear in the thin layer at the back of your eye (0-16.4% reported incidence)
• Retinal detachments - detachment of that thin layer at the back of your eye11 (0-10.9% reported incidence)
• Chronic glaucoma - progressive vision loss as a result of increased eye pressure
• Endophthalmitis - a much less common, yet very serious complication involving infection of the internal eye tissues and liquid (0.018-0.04% reported incidence)

The most common side effect however is the development of cataracts, with Milston’s review reporting cataract occurrence in approximately 53-76% of cases within 2 years in patients over 50. Various other studies similarly document high rates of development which appear to be further influenced by a number of variables - such as the reason for vitrectomy, existing health conditions (e.g diabetes), the exact surgical protocol performed, and the length of time for patient follow up.

The cause for post-vitrectomy cataracts seems multifactorial, though it’s proposed that the removal of antioxidant-rich vitreous humour and increased oxygen exposure to the vitreous cavity and lens as a result of vitrectomy leads to oxidative damage and cataract formation.

It should also be noted these side effects may be more common with more extensive vitrectomies.

What does it involve? Rather than physical removal of vitreous gel as is seen in vitrectomies, vitreolysis utilises laser therapy to break up large, collagenous floaters into smaller, less symptomatic ones by focussing laser beams on the most prominent floater strands. Due to potential laser damage to the retina, only certain collagenous floaters far from the retina may be viable for treatment. Multiple sessions (up to 6+ in some cases) may be required for this procedure.

What is the success rate? Success rates seem to be much more variable for this surgery, with 0-100% satisfaction reported across various studies from the same key review by Milston.

Are there any side effects? Complications appear to be minimal. As vitreolysis is performed closed-eye (unlike vitrectomy), risk of endophthalmitis is obviated, and cataract development risk may also be reduced. Some reported side effects include 1 case of uveitis (inflammation in the eye) and increased eye pressure (which if serious can cause damage to the optic nerve and vision loss, however there are minimal reports of side effects overall. Nonetheless it should be noted that laser use near the retina in other settings has various documented risks, such as glaucoma, retinal holes, and vitreous/retinal haemorrhage – necessitating the requirement of a specialist surgeon very familiar with the technique.

To summarise, while both options have positive reports of success, as with any surgery, they do not guarantee a desired outcome, nor are they without inherent risks and limitations. Hence, surgical intervention should be considered with all risks and benefits fully and should be sought only if floaters are significantly impacting quality of life. Thorough consultation with an eye surgeon should also be performed prior.

So, now we’ve covered the somewhat scary-sounding surgical treatment options – what about non-surgical options? Generally, this is what most individuals suffering with floaters will opt for - proactive management.

Management of floaters non-surgically comes down to considering the underlying causes of floaters and tackling those factors, rather than direct ‘removal’. As mentioned previously when we considered the causes of changes to vitreous structure (resulting in floaters) – inflammation, oxidative stress and glycation may all be driving factors. Various changes to lifestyle and nutrition habits can have positive effects on each of these areas of concern, many of which go hand in hand:

Inflammation and Glycation: Physical activity, diet, and sleep, have all been shown to be intimately connected with systems in our body responsible for the regulation of whole-body inflammation and glycaemic control. Regular exercise, a good sleep routine and following a balanced diet of mostly whole, unprocessed foods, low in refined sugars seems to offer multitudes of benefits, including the reduction of systemic inflammation and improved glycaemic control.

Oxidative stress: We can try to reduce exogenous sources of oxidative stress, whilst also increasing our body’s own defence against free radicals and reactive species – antioxidants! Sources of oxidative stress and ways to reduce them include:

• UV and blue light exposure --> Reduce exposure to these light sources e.g by wearing sunglasses and blue light glasses, and using ‘night mode’ on your electronic devices!
•  A diet high in ultra-processed foods --> Prioritise whole foods
• Smoking / alcohol --> Reduce or cut out alcohol / tobacco consumption
• Sedentary lifestyle --> Include regular physical activity in your routine
• Chronic stress --> A good sleep routine and meditation can help reduce stress

For more information on Oxidative Stress and Floaters, see our article here!

With the above methods it’s important to recognise that these lifestyle changes are thought to help to reduce further floater formation but won’t physically ‘remove’, nor break up existing floaters as we saw with surgery…

…However, in a double-blind, placebo-controlled study (the gold standard in research) by Ankamah et al in 2021, researchers used targeted micronutrient supplementation with the aim to optimise internal antioxidant stores and reduce glycation products. L-lysine, Vitamin C, Vitis vinifera (Grape Seed) extract, Zinc and Citrus aurantium (Bitter Orange Extract) were used. This study was carried out over a period of six months in 61 floater patients of various ages, and found significant improvements in both subjective and objective parameters - e.g 67% success rates for reported visual discomfort, and 77% success rates for a quantitative area reduction in vitreous opacities (i.e floaters)!

A second study; the Age-Related Eye Disease Study (AREDS) and AREDS2 sponsored by the National Eye Institute also found that oral antioxidant supplements including: Vitamin C and E, Lutein, Zinc and Zeaxanthin may decrease the likelihood of progression of certain age-related eye conditions.

While debate of supplement efficacy exists worldwide, these findings give us promise for improving existing floaters as well as protecting against further floater formation by consuming certain micronutrients! To do this you can:

• Boost your micronutrient intake - while this doesn’t allow specific targeting of the micronutrients used in the study above, eating a variety of fruits and vegetables is a great way to obtain antioxidants beneficial for the whole body as well as the eyes! Some of these antioxidants can only come from our diet and can’t be synthesised by our bodies, and variety is key so try to ‘eat the rainbow’...and no we don’t mean Skittles!
• Consider a supplement – supplements like Clearer™ available here have been specifically designed and formulated with the current research and aobve studies in mind, with the following ingredients: Lutein, Zeaxanthin, Grape Seed Extracts, Bitter Orange Extracts, L-lysine, Zinc and Vitamin C - all of which scientifically proven to be beneficial to eye health. Targeted supplements can also be a good option if you don’t have access to a variety of fruit and vegetables or simply don’t enjoy them!

While there is no guarantee of definitive floater alleviation with these various lifestyle habits and dietary interventions, implementing these changes offers benefits to health that go way beyond just prevention and management of floaters – so you’ve nothing to lose!

Ultimately, if your floaters are highly symptomatic, impacting quality of life, or are accompanied with other bothersome symptoms, it’s best to speak to an eye surgeon to assess if you’re a good candidate for surgery and to then consider the options available to you. Otherwise – try to lead a healthy, balanced lifestyle and get your antioxidants in!

We hope this answered your questions and left you with an idea of what to do regarding your floaters next! For more articles on floaters see the rest of our blog here.