Asteroid Hyalosis - Severe with Decreased Vision

A 60 year old female complained of blurred vision left eye over the past several years. She originally went to a general ophthalmologist who attributed her blurred vision to cataract and performed cataract extraction with intraocular lens implant. She had no improvement in vision. She was sent for retinal consultation to find out why the left eye was blurry. The vision of the left eye was 20/40. A - Color fundus photograph of the right eye. B - Color fundus photograph of the left eye; asteroid blocks the view. C - OCT shows a normal macula; the asteroid bodies are reflective (yellow arrows). D - Fluorescein angiography is normal. E - After a vitrectomy, the view to the left fundus is clearer; the vision is 20/20. Comment: Classical teaching is that asteroid hyalosis does not affect vision of the patient, although it can obscure the view of the ophthalmoscopist. There are exceptions to this rule-of- thumb. With heavy asteroid hyalosis, especially after a posterior vitreous detachment causes the vitreous and asteroid to collapse in dense sheets behind the lens, removal by vitrectomy can solve the patient's problem.