A floater is a term used to describe specks, threads, cobwebs and cloud-like images that occasionally drift across your visual field. Most floaters are made of clumps of a protein called collagen. Collagen is one of the ingredients in the gel-like fluid known as vitreous that fills the eyeball.
As we age, the vitreous gel in our eye gradually liquefies and takes up less space. This causes the sac containing the vitreous gel to gradually separate from the rear eyewall and some of the collagen clumps or breaks into pieces, casting a shadow on the retina.
The shadow cast by these vitreous opacities is what you perceive as a floater.
Floaters are the most frequent patient complaint heard at most ophthalmologists' offices. According to the American Academy of Ophthalmology, by age 60 one quarter of the population will experience symptomatic floaters. This increases to two-thirds of the population by age 80.
For some, floaters are just an annoyance, but for others, floaters can cause significant interference with their vision, ability to function, and quality of life. In fact, a 2013 study found that nearly one-third of patients report that floaters interfere with their daily activities so much that they are driven to visit their eye doctor to seek symptomatic improvement. 2
Using laser treatment to break up large symptomatic vitreous floaters into small, less visually disabling fragments dates back to the 1980s. What was once considered an experimental alternative to surgical treatment has become mainstream with the advent of highly sophisticated laser technology in recent decades.
In today's YAG laser vitreolysis, your surgeon can precisely visualize floaters in relation to your retina and natural lens (or crystalline lens if you have had cataract surgery). This enables precise targeting of the laser beam to break up or vaporize floaters impairing your visual function.
You will complete a questionnaire to give us an idea of how the floaters affect your vision and daily function. We will then perform a slit-lamp examination to directly visualize the structures in your eye. We may perform a special ultrasound study in order to assess the density of your vitreous fluid, which is a contributing factor to the formation of floaters.
We may also obtain an OCT (ocular computerized tomography) to identify floaters using an infrared video scan. Additionally, we may use specialized equipment to take photographs of your retina to assess its condition and look for possible weak spots.
YAG vitreolysis is performed in our surgery suite and, typically, you are able to go home following the procedure.
You will follow-up at our office the day after your procedure for another eye exam and pressure check. We will have you return in a week for yet another examination and pressure check.
At that point, we will ask if you are still experiencing floaters and, if so, by what percentage have they decreased from before your YAG procedure. Based on your response to your initial treatment, we will make further recommendations as to whether you might benefit from additional treatment.
As with any procedure, there are risks, however small the likelihood may be. The decision to undergo any procedure is not one that should be taken lightly. At AGEI, we carefully screen our patients to ensure they meet very specific criteria that would make them a suitable candidate for YAG vitreolysis.
We will perform a comprehensive screening examination to determine if your floaters cause sufficient impairment of your visual function to warrant undergoing a YAG procedure. We will explain to you what your particular situation entails and what can reasonably be achieved with a YAG vitreolysis procedure.
In order to better understand the risk of YAG vitreolysis, a study was performed in 2016-2017 to compile post-op adverse events data from seven major U.S. vitreoretinal specialty centers performing hundreds of procedures. A total of 16 complications following laser vitreolysis were reported in 15 patients during the study period.3
These included:
American Academy of Ophthalmology (AAO). "Annoyed by floating specks in your vision? You may soon be able to zap them away." ScienceDaily. ScienceDaily, 13 November 2017.
Reported Complications Following Laser Vitreolysis
Hahn P1, Schneider EW2, Tabandeh H3, Wong RW4, Emerson GG5; American Society of Retina Specialists Research and Safety in Therapeutics (ASRS ReST) Committee.
JAMA Ophthalmol. 2017 Sep 1;135(9):973-976. doi: 10.1001/jamaophthalmol.2017.2477
As a member of an elite group of only 3000 retina-vitreous specialists in the United States, Stanford trained Dr. Pilyugina brings to AGEI a unique skill set in the treatment and surgery of retinal disease. Her academic credentials include numerous research papers, conference presentations, medical publications, and clinical trials.