Consider vitreous opacities as significant as any other opacity in ocular media
Vitreous opacities have many names including vitreous floaters and mouches volantes.
Their impact on vision has been called myodesopsia, which is to me a positive dysphotopsia caused by blockage and scattering of light as it passes through the eye to the retina.
We are all familiar with the negative impact that opacities in the ocular media at any level can have on visual function. Every day we deal with corneal, natural lens and posterior capsule opacities and decide with the patient which are severe enough to require surgical intervention. In my opinion, vitreous opacities are no different. I suggest we stop putting the word floaters in our charts and use the appropriate diagnosis: vitreous opacity. The ICD-10-CM coding system, effective Oct. 1, 2024, uses H43.3 for the diagnosis of vitreous opacities.
Every eye care professional knows that some ocular media opacities warrant surgical intervention and some do not. An opacity in the vitreous is no different from an opacity in the cornea, natural lens or posterior capsule. If the opacity is visually significant and causing a meaningful negative impact on quality of vision and quality of life, which involves interfering with a patient’s ability to read, drive, work or enjoy their preferred recreational activities, treatment is a consideration.
If we look carefully at any patient’s cornea, natural lens or intact posterior capsule, there are always some opacities. Most are not visually significant and do not require surgical intervention. The same is true with vitreous opacities. In one U.S. survey of 603 patients, 76% said they had vitreous opacities that were visible to them, and 33% said they caused some visual disability. Most of these patients after discussing the cause of their symptoms will be reassured and desire no further treatment. However, for those with significant visual dysfunction from vitreous opacities, offering treatment with surgical intervention is in my opinion a discussion no different from the one we use for corneal opacity, cataract or posterior capsule opacity.
It is time to stop putting vitreous floaters in our charts as a diagnosis and replace it with the appropriate diagnosis: vitreous opacities. Then we can deal with the patient’s problem in a similar fashion to any other opacity in the ocular media.
- Reference:
- Webb BF, et al. Int J Ophthalmol. 2013;doi:10.3980/j.issn.2222-3959.2013.03.27.
- For more information:
- Richard L. Lindstrom, MD, can be reached at rllindstrom@mneye.com.
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