LASER FLOATER TREATMENT

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. Floaters are located between the lens and the retina. When we are born, the vitreous humor (the gelatinous substance filling the eye) is perfectly transparent. As we age, this vitreous humor degenerates, losing its form and liquefying. Without the stable vitreous humor, the collagen fibers collapse and bind together to form clumps. It is these fibers that cast shadows on the retina and appear as spots, strings, or cobwebs that are commonly referred to as “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.

We can now use a YAG laser, a laser used in eye surgeries for decades, in a specially designed way to vaporize the vitreous strands and opacities that cause floaters. When approving this procedure, the U.S. FDA classified this as a “non-significant risk procedure.” Studies compiled by ophthalmologists after the FDA’s analysis reflect the same conclusion. Ophthalmologists’ high success rates, combined with the low complication rates, make this procedure a great option for patients suffering from floaters.

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. As a result, vitreolysis has not been widely practiced and is performed only by a small number of specialists.

First, we must do a complete eye exam to make sure that your eyes are otherwise healthy. Then, the cause of the floater and its location are determined to see whether you would benefit from laser vitreolysis and whether you are a good candidate. 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, LFR 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. Each session lasts from 5 to 15 minutes. We will check the pressure in your eye 30 minutes after the conclusion of the procedure and then you are free to go home. It will typically take one to four sessions to minimize the floaters in your eye. We perform them two weeks or more apart. LFR will not likely clear the floaters from your eye completely but can reduce or eliminate the floaters that bother you the most.

There is one follow-up exam approximately one month later to ensure that the floaters have disappeared. It sometimes takes more than one session to clear the floaters to an acceptable level. No drops are required after the procedure.

The risk of laser floater removal is 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. We will go over all possible risks and benefits thoroughly at your evaluation.