BACKGROUND: Complaints of vitreous floaters are not new to veteran ophthalmologists, and many can attest to the reported burden symptomatic floaters have on visual clarity and quality of life. Classic treatment paradigms recommend indefinite observation or, in the case of severely bothersome floaters, pars plana vitrectomy (PPV). Despite the proven efficacy, PPV requires intraocular access and has a side effect profile that warrants severe visual impairment to justify the risks of surgery. Floater laser treatment has the potential to fill the treatment gap as a less invasive alternative using photodisruption to vaporize floaters. Studies have attempted to quantify the efficacy of Nd:YAG laser treatment with moderate success, but the safety profile of the laser floater treatment (LFT) is still limited in duration of follow-up.
OBJECTIVE: To analyze the efficacy and safety of Nd:YAG laser vitreolysis performed in-clinic as measured by number of sessions, patients who went on to pursue secondary vitrectomy, and a self-reported survey comparing visual satisfaction before and after LFT.
METHODS: In a retrospective study, 32 eyes with a history of symptomatic floaters of varied etiology were treated with the Ellex Nd:YAG laser set to single-shot mode with a maximal pulse energy of 7mJ. The number of treatments each patient underwent until receiving full visual benefit served as an objective measure of the efficacy of the laser. Secondary vitrectomy patients who failed laser vitreolysis were sampled as evidence of inadequate response to treatment. A self-administered survey explored patient satisfaction in terms of overall quality of vision, frequency/severity of floaters, and impact floaters have on activities of daily life (ADLs) before and after the laser, graded on a 4-point scale.
RESULTS: Laser Floater Treatment performed in-clinic at Boston Vision/Boston Laser (BVBL) yielded moderate success in resolving symptomatic floaters, as indicated by improved mean patient scores following treatment for quality of vision (+1.13), frequency/severity of floaters (+1.00), and impact floaters have on ADLs (+1.33) when compared to pretreatment scales. The mean number of discrete treatment sessions to gleam full benefit of laser vitreolysis was 2.5 sessions per patient. Approximately 6% (2/32) patients failed vitreolysis and went on to pursue PPV.
CONCLUSIONS: Our results showed an improvement of mean patient scores in overall quality of vision, severity of floaters, and floaters’ impact by at least 1 scale point, supporting the efficacy of laser vitreolysis. Patients underwent a mean of 2.5 treatment sessions, and offering multiple sessions likely bolstered the overall efficacy of the procedure. The sample population of 32 yielded only two patients (6%) who went on to pursue secondary vitrectomy, suggesting LFT could potentially serve as another treatment option filling the gap between observation and PPV.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43434 |
| Date | 19 November 2021 |
| Creators | Inouye, Marissa Chiemi |
| Contributors | Gong, Haiyan |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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