Laser vitreolysis (YAG laser)

Laser vitreolysis uses a Neodymium:Yttrium-Aluminum Garnet (Nd:YAG) laser to vaporize floaters within the eye. The YAG laser is commonly used in other eye procedures including posterior capsule opacification and peripheral iridotomy. The laser process used is called “optical breakdown” and is same process used by all cataract surgeons to make a clear hole in postoperative cataract membranes. 

After dilating the pupil, a numbing eye drop is given and a special contact lens for treating eye floaters is placed on the eye. Then the laser, which is focused to a 6 micron spot, is carefully aimed and the floater is either vaporized with the laser or the floater's attachments are vaporized so that the floater is repositioned to a different part of the eye. This disruption also helps the eye to absorb any remaining particles. After vaporizing the big floater or floaters, the doctor may have to leave tiny particles that are just too small to aim at.

The disruption is carried out with a beam of invisible light through the pupil. There is no incision or discomfort. Depending on the type and number of floaters, the procedure may take as little as 5 minutes or up to half an hour. Post-operatively there are no restrictions on activities. The patient is seen the next day. Occasionally it is not possible to disrupt the floaters in one sitting. In that case an additional sitting may be required.

Laser vitreolysis is generally considered to be safer than a classic, surgical vitrectomy since it is less invasive. Despite a variety of studies describing this procedure as a treatment for vitreous floaters, it is not widely practiced. This is perhaps due in part to its limitations. In any event there are, generally speaking, three types of floaters that can be treated with lasers:

1. One or two small to moderate sized floaters can be treated with approximately 85% success rate.
2. Numerous clumps or clumps that are large and free floating in the vitreous, whilst difficult to treat, can still be treated.
3. If a large degenerative cloud is suspended within line of sight with one or two strands, the doctor in this instance can cut the strands which in effect relocates the floater clump to another part of the vitreous clump. Success rates are higher as the results are more dramatic for these floater types (usually approximately 90% or higher)

The success of laser treatment very much depends on the type of floaters and their position. Dr. Scott Geller writes that some patients, predominantly those under the age of 35, cannot be treated (for floaters) as the floaters may be too close to the retina in an area referred to as the 'pre-macula bursa' (the consequence of which is that the floater is more dominant in the patients view, its size exaggerated as a result of the distance to the retina). To qualify this Dr. Geller recommends ensuring that your ophthalmologist uses a Goldmann examination lens.

The surgeons offering this type of treatment may have various types of YAG laser. Dr. Steven Bailey, for example, uses both Zeiss and Litetechnia YAG lasers whereas Dr. Mehel, Geller, Prof. Tassignon & Prof. Frankhauser (the son of the inventor of YAG) all use the Microrupter II laser from Lasag.

Any measure of success is very subjective in definition and therefore hard to quantify. It depends on the detail of examination (as referred to by Geller wherein he recommends analysis by the Goldmann lens to identify untreatable floaters) and one’s own definition of success. Some forums report that the results can be variable and in particular some users reporting  no change or indeed a worsening of floaters. As such we recommend you consult with your surgeon beforehand to ensure the right expectation is being set.

More Information:

1. Facts About Floaters. Bethesda: National Eye Institute, 2009.
2. Arons, Irv Using Lasers to Treat Vitreous Floaters: Laser Vitreolysis. Irv Arons' Journal . Massachusetts: blogger.com, 2010.
3. Arons, Irv Using Lasers to Treat Vitreous Floaters: Laser Vitreolysis in the UK and Europe. Irv Arons' Journal . Massachusetts: blogger.com, 2010.
4. Delaney, Y. M., A. Oyinloye, and L. Benjamin. "Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters." Eye (Lond). 16.1 (2002): 21-6.
5. Aron-Rosa, D., and D. A. Greenspan. "Neodymium:YAG laser vitreolysis." Int Ophthalmol Clin. 25.3 (1985): 125-34.
6. Fankhauser, F., S. Kwasniewska, and E. van der Zypen. "Vitreolysis with the Q-switched laser." Arch. Ophthalmol.. 103.8 (1985): 1166-71.
7. Fankhauser, Frank, and Sylwia Kwasniewska. "Laser Vitreolysis. A review." Ophthalmologica. 216.2 (2002): 73-84.
8. Little, H. L., and R. L. Jack. "Q-switched neodymium: YAG laser surgery of the vitreous." Graefes Arch. Clin. Exp. Ophthalmol.. 224.3 (1986): 240-6.
9. Tassignon, M. J., et al. "Indications for Q-switched and mode-locked Nd: YAG lasers in vitreoretinal pathology." Eur J Ophthalmol. 1.3 (1991): 123-30.
10. Tsai, W. F., Y. C. Chen, and C. Y. Su. "Treatment of vitreous floaters with neodymium YAG laser." Br J Ophthalmol. 77.8 (1993): 485-8.
11. http://vitreousfloatersolutions.com/index.html
12. http://www.vitreousfloaters.com/