Floaters by: Adam AufderHeide, MD, PhD

Floaters, or small specks that float across your vision, are a common complaint in middle aged and elderly people. These specks occur in the vitreous humor, the clear, jelly-like substance in the main chamber of your eye located between your lens and your retina. When you’re young, the vitreous is clear. As you age, the vitreous degenerates. Collagen fibers collapse and bind together to form clumps. These clumps are what cast shadows on the retina and are the floaters you see. As the vitreous continues to collapse, it can lead to a posterior vitreous detachment or PVD. A PVD is often associated with new floaters and flashes of light around the periphery of your vision. This can sometimes cause tears in the retina so you should have a dilated eye exam with a retina specialist if you are experiencing these symptoms. Once your eye doctor has ruled out a retina tear, the annoying floaters can by addressed.

Historically, the only remedy for floaters was a vitrectomy, or removal of the vitreous in the operating room. Side effects of this procedure were having to undergo anesthesia, worsening of cataracts, risk of bleeding and infection, and rarely loss of vison. For these reasons, most patients were advised to just “live with” the floaters. However, floaters can be quite bothersome to some patients.

A new procedure allows a laser to treat these floaters in the office. The Ellex Ultra Q Reflex YAG laser was used in the first randomized controlled clinical trial of YAG-vitreolysis for vitreous floaters. The study, published in JAMA Ophthalmology, a major peer reviewed journal, demonstrated that treatment reduced both the subjective symptoms and objective findings of vitreous opacities. 53% of patients in the laser treatment group reported significantly or completely improved symptoms vs 0% of individuals in the untreated group (P < .001). No clinically relevant adverse events were identified.

YAG-Vitreolysis involves the application of nanosecond pulses of laser light to vaporize the vitreous opacities and to sever the vitreous strands. The floater’s collagen and hyaluronin molecules are converted into a gas. The end result is that the floater is removed or reduced to a size that no longer impedes vision. YAG-Vitreolysis is performed in the office so you do not have to go to the hospital. Only a mild, topical anesthetic is required. A contact lens will be placed on your eye to better focus the laser directly onto the floaters. During the treatment, you will likely observe bright lights and small dark shadows as the floaters are being vaporized into small gas bubbles. These gas bubbles quickly dissolve. Each treatment session typically takes 15-30 minutes. More than one treatment may be necessary to obtain satisfactory results. Following treatment, you may observe small black floaters at the bottom of your vision from the gas bubbles produced during the Vitreolysis. These dissolve quickly. Rare side effects include cataract and an increase in the intraocular pressure.

If floaters are bothering you and impacting the quality of your vision, limiting your ability to function, schedule an appointment for an evaluation to see if YAG-Vitreolysis could help you.

Adam AufderHeide, MD, PhD