Many patients develop bothersome floaters particularly as they age. Doctors and eye specialists often underestimate how much floaters can impact vision and our patients’ lives but they can be a bothersome frustrating condition to live with.
Floaters can be described as a black blob obscuring part of the field of vision or strands that float in view or even as bugs that fly in front of whatever one is looking at. In the past, other than a surgical procedure to remove the gel know as vitreous, that fills the eye, there were no options available.
The major surgical procedure or vitrectomy is still a procedure that can be offered but can be associated with an increased incidence of inadvertent retinal tears or detachment. In patients who have not yet had cataract surgery a vitrectomy will definitely result in visually significant cataract formation requiring surgical intervention within one year.
That is why, in the past, most of the time we told patients to live with their vitreous floaters.
Now we have an effective, new alternative: yag laser vitreolysis. This is a simple laser procedure completed in one to three sessions that I am happy to offer to my patients. What has changed, is that that we now have new technology which enable us to safely detect, target and vaporize floaters.
I use the Ultra Q Reflex laser by Ellex to accomplish this treatment. Recently, a study was present detailing the results on 1200 patients of which 300 had four years of follow up. This study showed an adverse event profile of only 0.8%, no cases of retinal tears or detachments as a result of the treatment and only one small retinal peripheral hemorrhage in the first twenty cases.
Yag vitreolysis is particularly effective in patients who have had prior cataract surgery and have developed a posterior vitreous detachment or PVD. In these patients, a ring of glial tissue, known as a Weiss ring, pulls away from the optic nerve and causes a particularly large and bothersome floater. This type of floater has a particularly good prognosis when treated with yag laser vitreolysis.
Generally, I recommend that a patient wait at least six months after PVD to see if they neuroadapt to their floaters. If not, then yag vitreolysis is an excellent option.
David H. Aizuss, M.D.