Physician Interviews

LFR: An Objective Evaluation of Improvement in Quality of Vision
Paul I. Singh, MD
The Eye Centers of Racine and Kenosha, USA

Having performed more than 1500 LFR procedures, Dr. Paul Singh consistently reports a positive response from his patients in regards to the improved quality of vision afforded by the procedure. With the advent of screening technologies such as the iTrace wavefront aberrometer, he can now objectively assess his patients’ improvement in quality of vision following treatment with LFR.

“We’ve known for over four years how much of a difference LFR has made to patients’ quality of vision, based upon subjective questioning. But what we wanted was an objective evaluation. Using the iTrace we can now truly understand the positive impact of LFR on internal quality of vision.”

Don’t Let Floaters Cloud Your Vision
Con Moshegov, MD
Sydney Laser Eye Surgery, Australia

Also known as floater laser treatment, laser vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. It is performed in your ophthalmologist’s office and typically takes 20-60 minutes per treatment session.

Don’t Let Floaters Cloud Your Vision
Paul I. Singh, MD
The Eye Centers of Racine and Kenosha, USA

If you suffer from vitreous strands and opacities (commonly referred to as “eye floaters”), then you are already familiar with the frustrating visual disturbance caused by these cobweb and cloud-like shadows. Vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. Watch the video interview with Dr. Paul Singh, MD, to learn more.

Laser Floater Removal
Paul I. Singh, MD
The Eye Centers of Racine and Kenosha, USA

In this video interview, Paul Inder Singh addresses the clinical impact of floaters and the success of laser floater removal in his practice.

“I have been privy first-hand to the changes in how our profession perceives laser vitreolysis. On one hand, the poor historical data and the fact that many consider laser vitreolysis beyond their comfort zone (because it does not follow traditional conventions and is not taught in medical schools and residency programs), has led to initial pushback. On the other hand, patients and ophthalmologists are becoming increasingly aware of this procedure and the new technology, which is triggering growing acceptance of the potential benefits of laser vitreolysis. Although it is still considered novel and “outside-of-the-box” to apply a different use to something as familiar as a YAG laser, doctors are now beginning to grasp the potential benefits of using different energy profiles and visualization systems to make treatment of floaters possible.”

Vitreolysis. Redefining Convention
Paul I. Singh, MD
The Eye Centers of Racine and Kenosha, USA

Clinical studies have shown vitreolysis to be an effective treatment approach for vitreous strands and opacities. It also offers a high degree of patient satisfaction. In this video interview, Paul Singh, MD, of The Eye Centers of Racine and Kenosha, Wisconsin, discusses the fundamentals of vitreolysis in the management of floaters.

Vitreolysis in the Spotlight
Paul I. Singh, MD
The Eye Centers of Racine and Kenosha, USA

In this video interview, Dr. Paul Singh of The Eye Centres of Racine and Kenosha, Wisconsin, shares his pearls for success with vitreolysis. Drawing on his experience with the Ultra Q Reflex™ multi-modality laser, he addresses a number of topics ranging from patient selection to treatment protocol, including recommended laser lenses and energy settings.

YAG Laser Vitreolysis: Results of 500 Eyes
Feike Gerbrandy, MD
OMC Amstelland, Netherlands

Effective in 70-95% of all cases – and with a low complication rate and high degree of patient satisfaction – Dr. Feike Gerbrandy, The Netherlands, shares his insight for successful treatment of floaters with YAG Laser Vitreolysis.

Laser Vitreolysis for the Refractive Surgeon
Karl G. Stonecipher, MD
TLC Greensboro, USA

In this video interview, refractive specialist Karl G. Stonecipher, MD (Clinical Associate Professor of Ophthalmology at the University of North Carolina, and Medical Director of TLC Laser Eye Centers in Greensboro, North Carolina) addresses his decision to incorporate laser floater removal into clinical practice.

“For many if not most of my refractive surgery colleagues, the idea of treating floaters with a YAG laser was taboo. They felt it was crossing a line, that these were healthy eyes that did not require surgical intervention, and that the risks outweighed any potential benefits. I understood and even shared some of their skepticism, but I really felt that we owed it to our patients to offer them something more than just a sympathetic ear when they explained the negative impact of floaters on their quality of life.”

Modern Laser Vitreolysis
Karl Brasse, MD MRCOphth (Germany)

Compared with its early clinical use in the 1980s, modern laser vitreolysis provides more efficient and safer energy profiles, offering reliable and repeatable outcomes that provide a low rate of complications combined with a high degree of patient satisfaction. In this interview, Dr. Karl Brasse addresses his experience to date using the Ultra Q Reflex laser in the treatment of symptomatic floater patients.

“Karickhoff, one of the original pioneers of laser vitreolysis, in my opinion, may have advocated the procedure before its time; the technological capabilities were not as superior as they are today. I strongly believe that the success I have encountered with laser vitreolysis is due to the system that I use.”

YAG Laser Vitreolysis for Floater Treatment
James H. Johnson, MD (USA)

Having performed more than 2000 vitreolysis procedures over the past five years, Dr. James H. Johnson, Medical Director of Vitreous Floater Solutions, Irvine, is considered an expert in the treatment of floaters. In this interview, Dr. Johnson provides his tips on treatment protocol for floater treatment.

Webinars

AAO 2016
Modern Laser Floater Removal
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

Watch a recording of Dr. Paul Singh’s Laser Floater Removal (LFR) presentation from the American Academy of Ophthalmology (AAO) 2016, in which he addresses his treatment pearls and clinical tips for LFR in the treatment of symptomatic floater patients. Dr. Singh also highlights titratable axis illumination and coaxial visualization, and how these new technologies have improved the safety profile and efficacy of LFR.

AAO 2016
Floaters. To Treat or not to Treat?
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

Dr. Paul I. Singh was one of the first adopters or modern Laser FLoater Removal (LFR) and has performed more than 1500 procedures to date. In this webinar, he discusses how advanced screening technologies such as the iTrace™ Wavefront Aberrometer and Corneal Topographer (Tracey Technologies LLC), allows him to objectively measure the improvement in quality of vision in his patients following LFR. Specifically, the iTrace™ provides a breakdown of the contribution between corneal and internal aberrations, including the lens, the posterior cornea, macula and the vitreous.

AAO 2016
Floaters. To Treat or not to Treat?
Karl G. Stonecipher, MD
TLC Greensboro, USA

A refractive surgeon, Dr. Karl Stonecipher addresses the role of Laser Floater Removal (LFR) in his daily clinical practice. He also discusses how the innovation of technologies such as titratable axis illumination allows you to toggle between on- and off axis modes in order to better visualize floaters – and to assess their position relative to the lens and/or retina.

A Paradigm Shift in the Management of Symptomatic Floaters
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

Having performed more than 250 YAG Laser Vitreolysis procedures, Dr. Paul Singh reports a success rate of more than 90%, combined with a high safety profile. Watch the webinar to learn more.

EURETINA/ESCRS 2014
YAG laser Viterolysis:
A Safe and Effective Alternative to Vitrectomy?
Marc Veckeneer, MD
Rotterdam Eye Hospital, Rotterdam, Netherlands

EURETINA/ESCRS 2014
YAG Laser Vitreolysis:
Membranotomy in Patients With Multifocal IOLs
Cees van der Windt, MD
Ziekenhuis Rivierenland, Tiel, Netherlands

webinar-vitrectomy

AAO 2013
Vitreolysis Vs. Vitrectomy
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

Vitrectomy is a highly effective treatment for the removal of vitreous strands and opactiies but also carries significant risks, including cataract. Vitreolysis is a simple, outpatient-based alternative, which vaporizes the vitreous strands and opacities and may delay or obviate the need for surgery.

webinar-vitreolysis

AAO 2013
Vitreolysis: the Challenges and the Rewards
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

Vitreolysis is an outpatient-based procedure, which involves the use of a specially designed YAG laser to vaporize the vitreous strands and opacities. Highly effective, it has a low complication rate and offers a high degree of patient satisfaction. It can also delay or obviate the need for surgery.

AAO 2012
YAG Laser Treatment of Vitreous Floaters: My Five Year Experience
James H. Johnson, MD

James H. Johnson, Medical Director of Vitreous Floater Solutions, Irvine, is considered an expert in the treatment of floaters. At the 2012 annual meeting of the American Academy of Ophthalmology, Dr. Johnson addressed AAO delegates regarding the latest advancements in Nd:YAG laser-based floater treatment.

Laser Floater Removal Clinical Footage

Clinical Footage 1
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

Because the YAG laser energy has to pass through more optical media than during capsulotomy treatment, more energy will typically be required to perform vitreolysis. Regardless, always start with a low level of energy and titrate up until there is adequate vaporization and optical breakdown of the vitreous collagen.

Clinical Footage 2
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

Commence treatment with a single pulse per shot. Set energy at the minimum level required to create the optical breakdown in the vitreous cavity (typically 2-2.5 mJ).

Clinical Footage 3
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

More energy will be required if the floater is located deep in the posterior vitreous. For example, the same floater may be vaporized at 3 mJ in the anterior vitreous, at 4 mJ in the mid-vitreous and 5 mJ in the posterior vitreous.

Laser Floater Removal: On-Axis and Off-Axis
Paul I. Singh, MD
Eye Centers of Racine and Kenosha, USA

The Ultra Q Reflex incorporates a proprietary slit lamp illumination tower design, which converges the operator’s vision, the target illumination, and the treatment beam along the same optical path and onto the same optical plane. The illumination tower can be used coaxially to enhance the view of the target opacity and more effectively vaporize it.

“I think it is vitally important for the surgeon to appreciate spatial context. It is crucial to understand how far behind the lens you can treat. I utilize the on-axis feature first to visualize a floater against the red-glow background (to help visualize floaters in the middle and posterior vitreous), and then I go off-axis to determine how far behind the lens it is. If the floater is hard to see in off-axis mode then I know that it is safe to treat since off-axis setting only allows for visualization 1-2 mm behind the lens.”

Laser Floater Removal Through a Multi-Focal Lens
Paul I. Singh, MD
The Eye Centers of Racine and Kenosha, USA

In this video, US physician Paul Singh uses the Ultra Q Reflex laser to perform laser floater removal through a multi-focal lens. The videos shows how coaxial illumination provides more spacial context i.e. lens to the retina; when the retina is not in focus he knows that he is in the middle of the vitreous and treatment can proceed accordingly. Average power setting was 6.0 mJ.

Coaxial Illuminiation Using the Ultra Q Reflex
Paul I. Singh, MD
The Eye Centers of Racine and Kenosha, USA

In this video, Dr. Paul Singh demonstrates the benefits of coaxial illumination with Ultra Q Reflex that enables him to focus on a weiss ring floater clearly and to deliver the energy needed to break down the weiss ring floater safely.

Laser Vitreolysis of Weiss Ring Floater
Feike Gerbrandy, MD
OMC Amstelland, Netherlands

A weiss ring floater is larger in size in comparison to other floaters and occurs when the vitreous tissue surrounding the optic nerve becomes separated from the back of the eye. Typically, a weiss ring floater appears like a big ring-shaped floater which is seen clearly against a light background. Whilst floaters are often considered benign – a minor and short-lived inconvenience – for some patients, including those with low tolerance of visual obscurations, the presence of floaters can become a disabling condition. In these cases, Nd:YAG laser-based floater treatment offers a viable treatment solution.

Reflex Technology – Nd:YAG Laser Vitreolysis
(Clinical Video 1 of 2)
Feike Gerbrandy, MD
OMC Amstelland, Netherlands

For Nd:YAG laser-based floater treatment, the Ultra Q Reflex™ from Ellex provides optimal illumination of the vitreous. A proprietary slit lamp illumination tower design converges the operator’s vision, the target illumination and the treatment beam onto the same optical path, and focuses them onto the same optical plane. This is of particular importance when aiming at vitreous strands or floaters, as it greatly minimizes the potential for focusing errors, and the risk of damage to the natural lens or the retina.The Reflex illumination mirror, which briefly moves out of the laser pathway during firing, ensures that the laser beam is never obstructed. The illumination tower can thus be used coaxially, in addition to the typical off-axis position.

Reflex Technology – Nd:YAG Laser Vitreolysis
(Clinical Video 2 of 2)
Feike Gerbrandy, MD
OMC Amstelland, Netherlands

Patient Stories

Patient Story: Laser Floater Removal
Eugene Hembrook
Paddock Lake, Wisconsin

A competitive trap shooter, Eugene was hindered by the presence of floaters on a daily basis. Prior to undergoing Laser Floater Removal, his average trap scores ranged from 8 to 15 our of 25. Following the procedure, he is back to his best, averaging 24 or 25 out of 25.

“The results were immediate. I walked out of Dr. Paul’s office following the procedure and I could tell that things were a lot better, sharper and clearer. The day after the procedure I started shooting 24s and 25s out of 25, so I’ve been extremely happy about that.”

Patient Story: Laser Floater Removal
Chicago, Illinois

Working with computers daily, the patient was bothered by his floaters: they made him tired and he found it difficult to concentrate on his work and simply everyday tasks.

“It is actually phenomenal because the floaters have gone away. And so I no longer have the tiredness, I no longer have the distraction and I’m able to focus on my work.”