Pearls About Plasma: YAG Laser Treatment for Floater Removal is Effective

Laser energy with a yttrium-aluminum garnet (YAG) laser transforms the collagen and hyaluronic acid molecules in floaters to gas that is reabsorbed by the eye — giving the people who are impacted by the hindrance of floaters an option other than trying “to live with it,” or undergoing vitrectomy in the operating room. In a presentation by Nate Lighthizer, OD, at the Southeastern Educational Congress of Optometry (SECO) 2021 meeting, clinicians will be offered a light-zapping tour of the impact of floaters, imaging systems, and knowledge about launching or improving YAG laser technique in the clinic.

Dr Lighthizer’s course illustrates the rings, clouds or dots, lines, and cobwebs, and detailing how these opacities can persistently affect daily life. Contrast sensitivity is much more important than visual acuity in assessing the effect and treatment of floaters, Dr Lighthizer affirms, adding that in previous studies, some patients feel this problem may be as debilitating as age-related macular degeneration. Among the different types of opacities, some are very treatable, while others are difficult to remove with laser floater treatment (LFT). 

The goal of LFT, or laser vitreolysis, is to achieve functional vision improvement with minimal risk. Prior studies have shown that treated patients had significantly fewer opacities after LFT compared with control participants. In fact, 53% experienced significant or complete improvement from Weiss ring floaters compared with controls in 1 study that Dr Lighthizer references. Another study noted some intraocular pressure (IOP) spikes in pseudophakic post-YAG capsulotomy patients, but no adverse macular events were noted. 

The course reviews contraindications for YAG and reviews pre-procedure evaluation protocols. When launching LFT in a clinical practice, Dr Lighthizer recommends starting with pseudophakic patients and Weiss ring floaters, and to ensure any other necessary procedures are completed before the YAG session.

A contact lens with flange is best to examine the vitreous, and the clinician should also assess the peripheral retina for pre-existing pathology, Dr Lighthizer adds. During LFT, he says it is vital to maintain a safety zone of 2 mm to 3 mm from the lens and 3 mm to 4 mm from the retina, checking that retinal vessels are not also in focus. Reasons for using “on axis” or “off axis” are discussed, as well as energy parameters needed in terms of millijoules (mJ) and offsets for anterior, mid-vitreous, and posterior opacities. 

The presentation includes suggested patient reassurance during YAG, such as “You may hear the sound of a shutter opening with each laser pulse, which is normal.” Dr Lighthizer also advises on postoperative care strategies, including follow-up, and reminding a patient that small specks in their lower field are micro-gas bubbles will dissolve fairly quickly. 

Disclosure: Presenters have declared affiliations with the biotech or pharmaceutical or medical device companies. Please see the original reference for a full list of authors’ disclosures.

Reference 

Lighthizer N, Cantrell Z. YAG laser vitreolysis: an update. Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 150.