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Archive October 2016 XVII, No. 10

Should You Add Laser Floater Removal?

Advancements in YAG laser technology have made vitreolysis safer and more effective.

Inder Singh, MD


visual disturbance caused by floaters LASER FOCUSED Vitreolysis is a non-invasive procedure that can eliminate the visual disturbance caused by floaters.

"Ican read again." "I can drive again." These are the types of symptomatic improvements we see in patients undergoing procedures like cataract and refractive surgery, but lately we're seeing these same improvements in patients undergoing laser floater removal (vitreolysis). Patients like ophthalmologist Jack Bussa, MD. He noticed that floaters — tiny clumps of cells inside the vitreous — impaired his vision after he had multifocal lenses implanted. The high-volume surgeon from Janesville, Wis., was frustrated with his vision when he showed up in my clinic to give YAG laser vitreolysis a try. After 2 sessions, the floaters had mostly disappeared and he noticed significantly improved visualization when performing cataract surgery under the microscope.

A significant number of cataract surgery patients experience post-op floaters, and many of them, like Dr. Bussa, suffer life-altering vision impairment. A lot of those patients were willing to undergo the risks of vitrectomy or silently suffered with the chronic condition. But that's changing, now that surgeons have access to improved YAG laser technology that can vaporize floaters in a matter of minutes. Here are the key clinical factors you and your surgeons need to consider when adding a new laser platform.

  • Improved illumination. Vitreolysis isn't a new concept, but the illumination systems on previous generations of YAG lasers were not optimized to visualize and treat floaters in the middle or posterior vitreous. That limitation increased the difficulty of identifying most floaters that are symptomatic and provided limited spatial context of where floaters sit in relation to the retina and posterior capsule — the perspective surgeons need to provide safe, effective treatment. YAG laser technology has improved dramatically in recent years. In particular, the ability to view floaters using 2 different illumination positions: coaxial illumination, or "on axis," as well as "off axis," with the slit lamp in the oblique position. In the coaxial position, the laser platform aligns with the surgeon's vision, the target illumination and the treatment beam along the same optical path and the same optical plane. This lets the surgeon focus on-axis with more depth and spatial reference when treating posterior floaters.
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