Treatment of Vitreous Haze

About the disease

Vitreous haze, also known as "floaters", is deposit or condensation in vitreous membranes, which causes vision problems. Vitreous haze is an eye turbidity which could appear in one or both eyes gradually or suddenly. Floating cloud which is the main manifestation of vitreous haze happens because of vitreous dysfunction. When a person looks at something, concentrated beam of light from outside world is directed on retina. This beam of light ensures clear vision and regulates the extent of clarity we can perceive. But until the light beam reaches retina, it passes through another transparent membrane, called vitreous. Vitreous is a jelly-like substance, which occupies nearly 2/3 of the back of the eye. During first years of child`s life vitreous is completely transparent. As he grows up, vitreous forms deposits, also called fluid pockets. During vitreous haze each of such deposits casts a shadow on the retina, which is perceived by a person as floating haze. These opacities are "floating" because with every movement of the eye in its orbit, these deposits also shift.

That`s why a person sees floating cloud-like spots, curved strips and shapes in the form of letter C or D. Disease can be manifested in slight blurring, while in others it can be quite severe. Floating lines can be both thick and thin and sometimes they are branched. In most cases patients describe clouds as brown or black. The density of floating particles may be different in each case. In some situations, turbidity is present at all times, in others “floaters” appear only when a person is looking at sky. Floating vitreous opacities always disappear when a person closes his eyes. Floating cloud can cause irritation, but in principle, they are not dangerous to the eye. However, if a person is diagnosed with vitreous haze, he needs to have regular eye exams to detect it at early stage.

Any condition which damages transparency of vitreous membrane can cause floaters in the vitreous. With age, vitreous can occur quite naturally without any apparent reason.  It happens because with age collagen fibers, which are contained in vitreous body, become denser and thicker, which leads to the appearance of floaters. Any person older than 50 can have vitreous haze. Normally, vitreous is attached to the edges of the optic disc. During vitreous haze connection weakens and "floating" starts in the cavity of an eye. Weakening of this connection can be caused by many diseases. For example, the most common cause is eye hemorrhage which can appear during inflammation. Vitreous hemorrhage may be result of trauma to the eye. It can also be caused by diabetic retinopathy, retinal tear. Vitreous haze can appear as complication of an eye surgery. Inflammation in vitreous body can also be caused by uveitis, which is one of the most common eye infections. It can appear after cataract surgery or surgery with laser. Rare causes of haze in vitreous body are primary and secondary tumors, such as leukemia and lymphoma.

Symptoms

Vitreous opacities can create the most bizarre forms and become denser with the progression of disease. They are particularly visible when a person is looking at white computer screen. Manifestations of vitreous haze are clouds in front of eyes, dots, decreased visibility in the morning, headache.

Diagnosis

Floating opacities in vitreous body are quite common and they are usually diagnosed by ophthalmologist during general check-up. He uses special drops that dilate pupils to examine the state of vitreous membrane and see if it was disconnected from other layers of an eye. He also projects the light beam into an eye and asks a patient if he starts to see “floaters”. If a patient does see them, it is a clear indicator of vitreous haze.

Treatment

Eventually floating vitreous opacities decrease in size and become darker. In some cases, this is due to the natural resorption process of deposits inside the eye. Also over time brain adopts to these opacities and ignores them, that's why a person does not register clouds anymore.

• Drugs are unable to completely destroy the haze. In severe cases, patient may need to undergo vitreous haze vitrectomy, a surgery on removal of vitreous body along with all opacities and its replacement with saline solution. Vitrectomy is commonly performed for other various retinal pathologies. However, when planning such surgery, a person needs to take into account the fact that this surgery can cause cataract in future.
• In the last decade in order to reduce size and intensity of opacity doctors started to use laser techniques. After laser treatment, clouding wears off after some time. Currently, however, there is no clear indication if opacities disappeared on their own or if laser treatment contributed to the recovery. Pharmacotherapy with absorbable drugs can be a good alternative for laser treatment, but their effectiveness is also still studied.
• Also, in order to eliminate the density and size of haze, a patient is advised to practice special eye gymnastics which would eliminate intensity of disease.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko