Asteroid hyalosis is a rare condition where patients have calcifications throughout the vitreous jelly. It occurs in about 1-2% of the population and there is a wide range of the density of these opacities, with some patients having relatively few and others have a tremendous number. Even between eyes of the same patient, there can be asymmetry.
The asteroid opacities allow us to easily visualize the movement of the vitreous as we perform cataract surgery. In this video you will notice just how much shifting the vitreous does even when a minimally-invasive and highly-efficient cataract surgery is done.
Amazingly, the patients do not notice these opacities and they do not complain of floaters. But certainly, these opacities will scatter incoming light and will result in a decrease in the visual quality. The patient shown in this video has asked for a trifocal lens since his wife had the same implant and loves her wide range of vision without glasses. Would you implant a multifocal IOL in this patient? After all, if need be, you could do a pars plana vitrectomy later to remove the asteroid hyalosis.
Click below to learn my thought process regarding Asteroid Hyalosis:
OK Uday, suppose this patient is DESPERATE for spectacle independence, has always hated glasses, is a young, active, professional, and has a completely normal eye except for the cataract and asteroid hyalosis, low HOA’s, low angle kappa, etc. Suppose she is more than willing to do whatever it takes to have as much freedom from glasses as possible.
Do you refer for combined PPV/PE/IOL, refer for PPV and then do the PE/IOL yourself after she’s stable, or do the PE/IOL and then refer for PPV later, if unhappy? If the retina surgery is going to involve the use of intraocular gas, does that change anything? :0)
Great question. I would do the IOL surgery first. Wait and see how the patient does. If not fully happy then refer for PPV. Then wait it out. If needed, do LVC for any mild refractive shift.