What is a Floater?
In the back of our eyes, there is a material called vitreous that is 99% water but has 1% collagen and hyaluronic acid that can clump together forming bothersome floaters. Most people will have these to some extent and they tend to accumulate as we age. They can result after an injury, retinal inflammation or other problems in the back of our eye. A lot of the time there is no clear explanation as to why they occur. They also tend to occur in everyone at some point generally in our 50s or 60s when a process called posterior vitreous separation happens. Sometimes these remain near the center of our vision and can interfere with driving, reading or other activities. Prior to the innovation of laser floater treatment (LFT), there was not much that we could do. We told our patients to either get used to it, or they needed an invasive and risky surgery called a vitrectomy.
After a posterior vitreous separation, there is a part of the vitreous that was previously attached to the round optic nerve head that floats above the nerve. The position of this fibrous ring of tissue, called a Weiss ring, often blocks the central part of vision. This can create an annoying or even disabling blockage of vision that can impair reading, driving, or any other visually demanding task. It tends to move as our eyes move, which can be especially bothersome while reading, as the eyes move quickly as we scan text.
The use of vitreolysis dates back to the 1980s when Professor Aron Rosa, Paris, France, and Professor Franz Fankhauser, Berne, Switzerland, who were pioneers in the use of YAG lasers, published on their success with vitreolysis. Since then, clinical studies have shown vitreolysis to be an effective treatment approach, which offers a high degree of patient satisfaction. Despite these advantages, vitreolysis is generally not taught, nor endorsed, by ophthalmology residency programs. This is due, in part, to the belief that floaters are benign and do not require treatment. Indeed, many ophthalmologists consider floater treatment to be unnecessary. Furthermore, the technical constraints of conventional YAG laser technology, which offer a limited view of the vitreous, can make it difficult to visualize the vitreous strands and opacities and to perform the procedure. These conventional YAG lasers also require the use of high levels of energy, which poses a significant risk of damage to surrounding ocular tissue, as well as of side effects such as cataract and intraocular pressure (IOP) spike. As a result, vitreolysis has not been widely practiced and is performed only by a small number of specialists.
The Laser Floater Treatment Process:
First we must do a complete eye exam to make sure that your eyes are otherwise healthy. The floaters must not be too close to the back or the front of your eye. The laser tends to be the most effective on single dense floaters rather than diffuse extensive floaters but can potentially decrease them either way. Generally speaking, LFT will be more helpful for older patients who have already had a posterior vitreous separation where the floater is away from the retina.
For the procedure itself, we place lots of dilating drops, drops to reduce the pressure in your eye, and numbing drops. We then put some gel in a special lens that sits on the surface of your eye. The laser makes a clicking sound and we will typically do from 200 to 1500 spots that vaporize the floaters. You feel nothing and will tend to see particles that fall down in your vision, which are actually the bubbles floating upward in your eye. These bubbles will dissipate over several hours after the procedure. It is normal that your vision will be dimmer and somewhat blurry due to the drops, bright light and lens on your eye. This will return to normal a few hours after the procedure. It will typically take one to four sessions to minimize the floaters in your eye. Each session lasts from 5 to 15 minutes, and we perform them two weeks or more apart. LFT will not likely clear the floaters from your eye completely but can reduce or eliminate the floaters that bother you the most.
The risks of laser floater treatment are very low. There are basically three rare risks: hitting the back of your eye-or the retina, hitting the front of your eye-or lens, or elevated eye pressure, which can be managed with eye drops. We ask that you stay for at least 30 minutes after your procedure to make sure that the pressure in your eye is normal. Another risk is just that you may not always be completely satisfied with the improvement in the floaters. There will likely always be some clumping of the vitreous material that can be seen as you look at a uniform lighted background such as the blue or overcast sky. For complete optical clarity, the only current solution is a vitrectomy. A vitrectomy is an appropriate treatment for some people, and is very good at completely removing all the material that causes floaters. However, it almost always leads to cataract formation in the months or years following the surgery. If you’ve already had cataract surgery, or have a cataract that will need to be removed soon, then a vitrectomy may be a good choice. Be sure you understand all of your options before proceeding.
For more information, please go to this excellent website created by Ellex, the company that makes this innovative new version of the YAG laser: www.floater-vitreolysis.com.
– Dr. Matthew Sharpe, MD