Disabling Visual Disturbance Caused by Clinically Invisible Vitreous Opacities

Background

Myodesopsia may be caused by floaters and is a common cause of concern for patients. The prevalence of symptomatic floaters in the general population increases from 24% in adults aged 50 to 59 years to 87% among those aged 80 to 89 years [1]. Floaters are a frequent reason for consulting an ophthalmologist or optometrist, with up to 14 patients a month seeking advice for this reason in a practice [2]. Floaters are usually due to benign age-related degenerative changes of the vitreous body and the occurrence of posterior vitreous detachment, but may also be caused by retinal tears, eventually indicating the presence of a retinal detachment. Patients with floaters report various shapes and sizes, usually moving with eye movements. In most cases, the visual discomfort associated with myodesopsia is limited, but some patients suffer from a significant degradation of visual comfort. On clinical examination, the detection of visually disturbing floaters and their impact on the patientʼs visual perception is sometimes challenging. On the other hand, it is often particularly unsatisfactory for patients with myodesopsia if the clinical examination does not deliver a clear reason for their symptoms, and some patients may develop psychological issues due to the inability to demonstrate why they have these symptoms [3]. In the following, we describe a patient in whom only high-definition OCT revealed a central vitreous floater invisible at indirect ophthalmoscopy.

• References

• 1 Hollands H, Johnson D, Brox AC. et al. Acute-onset floaters and flashes: is this patient at risk for retinal detachment?. JAMA 2009; 302: 2243-2249
• 2 Alwitry A, Chen H, Wigfall S. Optometristsʼ examination and referral practices for patients presenting with flashes and floaters. Ophthalmic Physiol Opt 2002; 22: 183-188
• 3 Cipolletta S, Beccarello A, Galan A. A psychological perspective of eye floaters. Qual Health Res 2012; 22: 1547-1558