Nd:YAG Laser Vitreolysis (vitreolysis) is a highly effective, outpatient-based procedure, which involves the use of a nano-pulsed YAG laser to vaporize 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.
Using a laser lens placed on the patient’s eye, the YAG laser is focused onto the front surface of the floater. The laser emits a short 3 nanosecond (0.000000003 seconds) burst of energy. It is important to note that the laser energy does not simply break the floater into smaller pieces. Instead, the high power density of this laser energy converts the collagen and hyaluronin molecules to a gas, which is then resorbed into the eye.
The use of vitreolysis dates back to the eighties 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 medical schools. 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. Furthermore, the technical constraints of conventional YAG laser technology, which offer a limited view of the vitreous, can make it difficult to visualize the vitreous strands and opacities and to perform the procedure. These conventional YAG lasers also require the use of high levels of energy, which poses a significant risk of damage to surrounding ocular tissue, as well as of side effects such as cataract and intraocular pressure (IOP) spike. As a result, vitreolysis has not been widely practiced and is performed only by a small number of specialists.
In general, ophthalmic YAG lasers are designed for use in the anterior segment to perform capsulotomy following IOL implantation, and to perform iridotomy prior to implanting an anterior chamber lens, or in cases of angle closure glaucoma. The Ultra Q Reflex™ has been optimized for use in both the posterior and anterior segment. Featuring a proprietary slit lamp illumination tower design that converges the operator’s vision, the target illumination and the treatment beam onto the same optical path, and focuses them to the same optical plane, Ultra Q Reflex™ minimizes the potential for focusing errors and the risk of damage to the natural lens or the retina. This makes it ideal for targeting vitreous strands and opacities.
Non-Invasive Treatment for Floaters
Unlike vitrectomy, which carries a high risk of bleeding and infection, vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. John Karickhoff, MD, USA has performed the procedure more than 1,400 times and reports a success rate of 90%. In a recent Dutch study by Cees van der Windt, MD, and colleagues, 100 eyes with PVD-related floaters persisting for more than nine months were treated with vitreolysis (n=65) or pars plana vitrectomy (n=35). After all eyes were treated, both the YAG and vitrectomy groups reported an improvement in vision at 80% and 90% respectively. Furthermore, over a follow-up period of eight years, no complications were observed among patients treated with vitreolysis.
What Type of Patient is Best Suited to Vitreolysis?
Vitreolysis is well suited to the Weiss-ring type of floater caused by a PVD. Because these floaters are fibrous, they absorb the laser energy well and can be vaporized more efficiently. In addition, they are usually located safely away from the crystalline lens and the retina.
What Level of Energy is used for Vitreolysis?
Compared to capsulotomy treatment, more energy is typically required to perform vitreolysis. This is because the YAG laser energy has to pass through more optical media. Irrespective of this, it is recommended to commence treatment with a low level of energy and to titrate upwards until there is adequate vaporization and optical breakdown of the vitreous collagen.
Webinar: A Paradigm Shift in the Management of Symptomatic Floaters
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.
For clinical and practical information on vitreolysis, as well as practice and patient marketing tools, visit www.floater-vitreolysis.com – the primary online resource for the management and treatment of floaters.