Procedures: YAG Laser Vitreolysis (for eye floaters)

Treatment for eye floaters

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.

IS YAG VITREOLYSIS IS RIGHT FOR ME?

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.

A good candidate for YAG Vitreolysis will:

• Describe troublesome floater symptoms that have persisted for at least 4 months
• Complain of floaters affecting their ability to perform specific tasks such as reading, watching TV or driving
• Report that these functional visual problems have taken a serious toll on their quality of life
• Not have serious eye conditions such as cataracts, retinal tears or detachments, or clouding of the cornea or lens that would impair visualization of the vitreous

WHAT HAPPENS IN THE YAG VITREOLYSIS PROCEDURE?

YAG vitreolysis is performed in our surgery suite and, typically, you are able to go home following the procedure.

• Numbing eye drops and, if necessary, local anesthesia is used to keep you comfortable during the procedure.
• A special device is placed on your eye to keep it open and your doctor works using magnification lenses to visualize and target the floaters in your eye.
• The YAG laser then precisely targets each floater that can be safely dissolved. If a floater is in a spot that's too close to an important structure (like your retina or lens) or if the floater is particularly large or irregularly shaped, you might require more than one treatment session to effectively treat it.
• Immediately following your procedure, your eye doctor will carefully examine the internal structures of your eye and measure your eye pressure, which can become temporarily elevated as a result of the treatment.

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.

RISKS OF YAG VITREOLYSIS

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 AEI, 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:

• Increased intraocular pressure resulting in glaucoma
• Inducement of cataract following surgery
• Retinal tear
• Retinal detachment
• Retinal hemorrhage
• Increased quantity of floaters

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