Recently, I’ve been asked about floaters (called “myodesopsia” in medical terms). These are small spots or filaments that seem to float in your field of vision. In reality, they’re not objects in front of your eyes, but small opacities inside the vitreous (which is the transparent gel inside your eye).
Several questions came up. What are these floaters, can we stop their progression, can we make them disappear with natural methods?
So I investigated this topic for you. There’s nothing in traditional herbalism, so we cannot rely on remedies from the past. This is therefore an episode based on a review of the science and modern approaches to the problem.
Before we start, I’d like to remind you that I am neither a doctor, pharmacist, nor health professional. The information shared in this episode is for educational purposes only and is not intended to replace medical supervision.
What Are Floaters and Why Do They Appear?
Alright. So first, we need to describe the phenomenon. You know if you have those floaters. Because one day you looked at the sky, maybe, or another surface of uniform color, and you saw these small spots or little squiggles. I have several myself. Depending on where they’re located, I can see how it can be quite bothersome to vision.
Of course, I won’t repeat it, but the first thing to do is to see an ophthalmologist to make sure everything is fine inside your eye and that nothing more serious is happening. So we’re going to eliminate pathological causes from the discussion.
Someone recently told me “these are small damaged veins in the eye”. Well, not at all. It actually comes from the vitreous.
The vitreous (also called the vitreous body or vitreous humor) is a gel composed of 98% water and 2% macromolecules, mainly collagen and hyaluronic acid. These two molecules probably sound familiar to you because we talk about them a lot regarding skin integrity and tissue aging. Well, we also find them in the vitreous.
And this gel, especially regarding the “fibrous” part if I may say so (that is, the macromolecule part), is very well organized. It’s this organization that makes it transparent. The macromolecules are very well distributed and organized in the gel. Unfortunately, this structure can degrade.
Why, what are the degradation factors? Age and myopia are often mentioned as risk factors. But you can also add factors like oxidative stress that exceeds our capacities and our antioxidant reserves. And all the pro-inflammatory factors of industrialized life—I’m not going to list them all for you. Pollutants of all kinds make our tissues age much quicker.
So, in this context, the collagen and hyaluronic acid no longer stay well bonded together and intertwined, interlocked if I may say so, and they’re going to separate. We can see this clearly in some photos published in studies—rather than having the two well intermixed, we start to see clusters of hyaluronic acid on one side, separated from collagen, and packs of collagen on the other side.
This separation will lead to 2 processes:
- First, the gel becomes more liquid. Seems logical, we’re separating the structural part from the water part, so the water part becomes even more liquid.
- And collagen fibers are going to bunch together and thicken.
It’s these collagen fibrils, grouped together when they shouldn’t be, that create opacities that scatter light. Hence, the appearance of floaters, which sometimes look like small tunnels or small vessels.
You follow me so far?
Posterior Vitreous Detachment
When these processes worsen, the vitreous can progressively separate from the retina. This is what’s called posterior vitreous detachment, the most common phenomenon that causes the most bothersome floaters.
A More Serious Problem Than We Thought
For a long time, we thought these opacities were merely a cosmetic nuisance without importance. But in practice, they can really reduce our contrast sensitivity, our ability to distinguish details, and ultimately affect vision quality and, therefore, indirectly, quality of life. When they’re really bothersome, we now speak of “vision-degrading myodesopsia” (or VDM).
Solutions Offered Today
Regarding the solutions offered today, several options:
- Observation (that is, doing nothing and waiting for the brain to adapt to these disturbances). This is what most people do.
- Certain surgical interventions such as vitrectomy (that is, surgery to remove the vitreous), or laser vitreolysis (which consists of fragmenting the opacities with a laser).
- And certain plants and supplements that we’re going to discuss.
Well, I should tell you that ophthalmology is not my specialty, so I discovered quite a few things researching this topic. Especially regarding surgical interventions. I believe they are only offered in more serious cases, in which the opacities considerably interfere with vision or become an almost intolerable problem from a psychological standpoint.
So, let’s talk a bit about these interventions…
Vitrectomy (Removal of the Vitreous Gel)
Vitrectomy: This is an intervention in which there is partial or total removal of the vitreous gel. It sounds a bit frightening, I know. The vitreous body will be partially or totally emptied by making a small incision in the eye. Once the gel is removed, the eye is not left empty, of course. The surgeon replaces the gel with a sterile saline solution or a special gas that resorbs over time. The body will then naturally recreate a new gel to fill the eye.
An analysis grouping 18 studies on over 2,000 eyes shows that this surgical intervention achieves excellent results: 90% of patients are satisfied. Vision and contrast sensitivity improve. On the other hand, cataracts develop in more than 30% of patients, and retinal detachment occurs in approximately 1.5% of patients, which is a bit concerning (Dysager 2022). References on my site.
Nd:YAG Laser
We also have the Nd:YAG laser (which is a type of neodymium-doped yttrium aluminum garnet laser). It sounds straight out of a science fiction movie.
We have two rigorous trials against placebo showing that the laser works in terms of results: a 2017 study (Shah 2017), and a 2020 study (Ludwig 2020) with fairly significant improvement rates and a reduction in gel opacities. Another 2019 study, however (Nguyen 2019), reports no change in vision quality or overall quality of life. So mixed results. Too bad because it’s much less invasive than a vitrectomy.
In any case, if the situation is very disabling for you, this is definitely a discussion to have with an ophthalmologist who can tell you much more in terms of real-world experience with these procedures. Again, I am no expert here.
Natural Substances
Regarding natural substances, we have a handful of studies that could point us in some interesting directions. You’ll see that there will be a speculative part, but that’s all we have right now, so we work with what we have, and I think there’s information worth keeping.
Proteolytic Enzymes
The first substances studied are proteolytic enzymes from certain fruits like papaya, pineapple, and fig. We’re talking here about 3 enzymes called bromelain, papain, and ficin. You may have already heard of the first two, since we find them in various natural formulations.
They are used today to better digest proteins, to promote the breakdown of fibrin and fibrinogen, so for different disorders related to cardiovascular health. They also have anti-inflammatory properties. Here, the idea is to see if they can break up these collagen clusters in the vitreous. Since collagen is a protein.
We have a 2022 study conducted by Japanese and Taiwanese teams, on 224 patients complaining of myodesopsia. Double-blind study against placebo, the placebo being a vitamin C capsule, and the intervention being a capsule containing 190 mg of bromelain, 95 mg of papain, and 95 mg of ficin. All of this for 3 months.
The groups were divided into those who had the condition appear spontaneously, and those who had their condition appear after vitreous hemorrhage. Also note, a division into subgroups taking either 1 capsule, 2 capsules, or 3 capsules per day.
Results: In the group with spontaneous problem onset, the floater disappearance rate was 55%, 62.5%, and 70% after taking 1, 2, and 3 capsules, respectively, so improvements were dose-dependent. For the group in which floaters appeared following vitreous hemorrhage, the floater disappearance rate was lower, 18%, 25%, and 56% respectively. So the results seem very significant, and especially in the spontaneous onset group, which is the case for many people today.
Furthermore, the vision of people improved from 0.63 to 0.19 LogMAR. This is a scale used to measure visual acuity. And here, as far as I can tell (and correct me if your assessment is different from mine), a decrease of 0.44 LogMAR seems very significant to me.
There is a second 2024 study, in vitro though, in which the vitreous was mixed with the same proteolytic enzymes extracted from fruits, plus hyaluronidase and collagenase in some samples. Then the researchers looked at the impact on vitreous opacity. The study confirms that collagen digestion by certain enzymes can improve the nature of the vitreous in cases of collagen aggregation. That said, it’s an in vitro study, so take it with a large grain of salt, but one that seems to validate in a test tube what we observed in the human study.
In conclusion, it seems to me that this approach of oral supplementation with fibrinolytic enzymes (bromelain, papain, and ficin) has the potential to reduce vitreous opacities. The patients in this study showed a high level of satisfaction, and we also saw an improvement in visual acuity. Knowing that there is a dose-dependent effect.
A small note about commercial products containing these enzymes. We’re talking about lab-made products here, so make sure the lab is trustworthy with quality labels. You’re not going to find exactly this formulation with these dosages on the market. Some products contain 2 of the 3 enzymes mentioned. That’s market reality. Will we get exactly the same results with those commercial products? I cannot tell you, but we remain overall with the proteolytic properties we’re interested in.
Polyphenols
The second study I could find, done on humans, is a 2021 study conducted by an Irish and German team. The problem: conflict of interest. The study is sponsored by those who patented the product, so we have to be skeptical about the results, since the team had every interest in producing positive results. That said, we’ll try not to throw the baby out with the bathwater, as they say, and see if we can find clues. This type of study cannot provide certainties, but just possible leads.
The formulation contains a micronutritional part: 125 mg of L-lysine, 40 mg of vitamin C, and 5 mg zinc. It also contains a part extracted from plants: 26 mg of grape seed extract standardized in proanthocyanidols, and 100 mg of a citrus extract standardized in hesperidin. Supplementation was done for 6 months.
Why this choice?
- Proanthocyanidols and hesperidin inhibit protein glycation, so they inhibit the process that damages collagen. They are antioxidants and anti-inflammatory, and they could therefore protect against vitreous degradation.
- L-lysine, vitamin C, and zinc because a healthy vitreous contains a certain concentration of these micronutrients and it’s thought they contribute to the protection or regeneration of the structural part. Is oral supplementation enough to make up for deficiencies in this area? Very good question.
In short, it’s a patented blend. The company announces 5 clinical studies that have already been conducted, 2 observational studies, 2 case-control studies, and a randomized double-blind trial, which is the one we’re talking about.
The results are clearly positive on several points. Improvement in visual comfort, decreased vitreous body opacity. I’ll spare you the study’s limitations: the use of an unrecognized questionnaire, the absence of vitreous biopsy to confirm certain results, etc.
My Conclusions
What to do with this? Buy a supplement and take it for 6 months like in the study (ideally the one that will be marketed from the patent, while we’re at it)? Use sources of proanthocyanidols and hesperidin that we can prepare ourselves? Like a tea of red vine leaves (I did an episode on that) or a tea of blackcurrant leaves, that we combine with sweet orange or bitter orange peel?
Should we take even more of a step back and focus on substances that block protein glycation and collagen damage? Should we consider collagen cofactors like silica and vitamin C? And plants like Centella asiatica that seem to help regenerate collagen? Maybe. I actually got feedback recently—a person who takes collagen for joint disorders noticed that her floaters had disappeared.
So we’re going to think about all this, and when we don’t have centuries of tradition and not enough practice data, we’re forced to go into a somewhat more speculative and empirical mode. So at some point, we stop heading in all directions, we set up a first protocol, test it for several months, and see if it improves our quality of life. Meaning do we end up with less visual discomfort and better visual acuity?
As for me, I would probably pick the following starting point:
- A herbal tea formulation that contains sources of proanthocyanidols, hesperidin, other flavonoids. Perhaps red vine leaves, blackcurrant leaves, ginkgo leaves, plus orange peel. Because I really enjoy working with herbal teas, and this is quite anchored in the French herbal tradition.
- And I would add a well-dosed supplement with proteolytic enzymes (at least a combination of bromelain and papain).
I run it for several months, and try to see if there’s improvement in the situation. It’s a very imperfect method, but it’s also very practical. And for these somewhat novel situations, it’s pretty much the only method at our disposal. And it’s always better than doing nothing. And sometimes it gives us beautiful results.
That’s it for floaters. Thank you for being here, for being interested in all these topics. See you very soon for a new episode of TheFrenchHerbal!
Precautions
Bromelain and papain present several contraindications and precautions for use related to hemorrhagic risk, cross-allergies, and drug interactions.
- Discontinue 2–3 weeks before surgery or dental work
Contraindicated if:
- Taking anticoagulants
- Taking NSAIDs (ibuprofen, naproxen, aspirin)
- Thrombocytopenia or clotting disorders
- Pregnancy and childbirth
- Peptic ulcer or other gastric mucosal inflammation
- Hepatic and renal insufficiency
Patients allergic to pineapple, latex, celery, or wheat flour have an increased risk of reaction to bromelain. Overall, bromelain is a potent sensitizer capable of inducing respiratory, gastrointestinal, and cutaneous allergic reactions in certain sensitive individuals.
References
J.-W., Hung, J.-L., Takeuchi, M., Shieh, P., & Horng, C. (2022). A New Pharmacological Vitreolysis through the Supplement of Mixed Fruit Enzymes for Patients with Ocular Floaters or Vitreous Hemorrhage-Induced Floaters. Journal of Clinical Medicine, 11.
Hammer, M., Muuss, M., Schickhardt, S. K., Scheuerle, A., Khoramnia, R., Łabuz, G., Uhl, P., & Auffarth, G. (2024). Forward Light Scattering of the Vitreous Gel After Enzymatic Aging: An In Vitro Model to Study Vitreous Opacification. Investigative Ophthalmology & Visual Science, 65.
Ankamah, E., Green-Gomez, M., Roche, W., Ng, E., Welge-Lüssen, U., Kaercher, T., & Nolan, J. (2021). Dietary Intervention With a Targeted Micronutrient Formulation Reduces the Visual Discomfort Associated With Vitreous Degeneration. Translational Vision Science & Technology, 10.
Dysager, D. D., Koren, S. F., Grauslund, J., Wied, J., & Subhi, Y. (2022). Efficacy and Safety of Pars Plana Vitrectomy for Primary Symptomatic Floaters: A Systematic Review with Meta-Analyses. Ophthalmology and Therapy, 11, 2225 – 2242.
Shah, C., & Heier, J. (2017). YAG Laser Vitreolysis vs Sham YAG Vitreolysis for Symptomatic Vitreous Floaters: A Randomized Clinical Trial. JAMA Ophthalmology, 135, 918–923. https://doi.org/10.1001/jamaophthalmol.2017.2388
Ludwig, G., Gemelli, H., Nunes, G. M., Serracarbassa, P., & Zanotele, M. (2020). Efficacy and safety of Nd:YAG laser vitreolysis for symptomatic vitreous floaters: A randomized controlled trial. European Journal of Ophthalmology, 31, 909 – 914. https://doi.org/10.1177/1120672120968762
Nguyen, J. H., Nguyen-Cuu, J., Yu, F., Yee, K. M. P., Mamou, J., Silverman, R., Ketterling, J., & Sebag, J. (2019). Real-World Assessment of Vitreous Structure and Visual Function After Nd:YAG Laser Vitreolysis. Ophthalmology, 126, 1517 – 1526. https://doi.org/10.1016/j.ophtha.2019.06.021
