AbstractTopic : Depression and anxiety are common in chronic eye diseases, and the psychological implications of symptomatic vitreous opacities (SVO) remain underexplored. This systematic review synthesized current evidence on the psychological burden of SVOs and the extent to which interventions confer psychological benefit. Clinical Relevance : Although SVOs typically occur with normal visual acuity, many patients with vision-degrading myodesopsia (VDM) report significant distress, impaired well-being, and measurable degradation of contrast sensitivity. Understanding the magnitude of this burden and the potential psychological benefits of available treatments is important for clinical decision-making and patient counseling. Methods : In June 2025, Medline, Embase, and the Cochrane Library were searched. Eligible studies assessed outcomes related to mental health, depression, anxiety, personality, quality of life, coping, and/or patient experiences or perceptions of vitreous opacities or their treatment. The protocol was prospectively registered in PROSPERO (CRD420251243887). The primary outcome was psychological burden relative to healthy controls; secondary outcomes included psychological changes following Nd:YAG vitreolysis or pars plana vitrectomy. Given substantial heterogeneity in study design and psychological instruments, findings were synthesized descriptively. Results : Thirteen studies met inclusion criteria, encompassing 635 patients aged 18–88 years across Europe, Asia, and the Americas. Across study designs, individuals with SVO reported significantly higher levels of depression, anxiety, and perceived stress than healthy controls, despite preserved visual acuity. Standardized instruments (NEI-VFQ, PHQ-9, CES-D, HADS, Zung SDS, GAD-7, STAI, PSS-10) consistently showed elevated psychological symptom scores and lower mental health-related quality-of-life scores. Personality assessments (BFI) revealed greater neuroticism and lower extraversion in patients with SVO. Interventional studies with Nd:YAG laser vitreolysis and pars plana vitrectomy demonstrated improvements in vision-related QoL and psychological well-being. Conclusion : SVOs commonly present with a psychological overlay that affects emotional well-being. Our findings raise the possibility of a visual somatization component in psychologically vulnerable individuals, whereby vitreous changes may contribute to heightened anxiety or distress. Recognizing that traditional clinical metrics such as visual acuity may underestimate functional impairment supports the need for psychological screening, patient-centered counseling, and integration of validated floater-specific outcome measures alongside psychological endpoints.
Leung et al. (Wed,) studied this question.