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An upgrade in YAG laser technology may be a breakthrough in the management of vitreous floaters, offering a safe, effective and minimally invasive alternative that lies between “learn to live with it” and vitrectomy.

YAG laser vitreolysis has been around for some time, and a handful of surgeons worldwide embraced it long ago, have seen its potential and worked at further developments. The technique, however, has been surrounded by controversy due to justified safety concerns and lack of data. Difficulty in exactly targeting floaters, the risk of damaging the retina and lens, the potential consequences of the shockwave effect, and dispersion of energy inside the eye kept most eye specialists from considering it a feasible option.

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“What has changed now, markedly improving the efficacy and safety of the procedure, is the advancement in the technology. Now we have YAG lasers, the Ultra Q Reflex and Tango Reflex by Ellex, that are specifically designed to precisely detect, target and vaporize floaters,” Inder Paul Singh, MD, said.

“The technique is booming now, and an increasing number of ophthalmologists are adopting it in Europe and the U.S. We have also founded the International Society of Vitreous Laser Surgery, open to ophthalmologists worldwide and aimed at promoting knowledge of this treatment, sharing experiences and protocols, and raising awareness,” Marie-José Tassignon, MD, PhD, said.

Doctors and eye specialists often underestimate how much floaters can affect the vision and life of patients, but they can be a bothersome, frustrating condition to live with.

“We tended to minimize the impact of floaters because there was nothing we could offer that was safe and effective apart from the extreme solution of vitrectomy. Therefore, in most cases we dismissed these patients with a few tips on how to cope and learn to live with them. It was only when I started doing vitreolysis 4.5 years ago that I realized how many people are suffering from this condition, and it was shocking to me how much of an impact floaters have on patients’ quality of life,” Singh said.

When the only option was vitrectomy, most of his patients would go untreated, but now vitreolysis has lowered the threshold for intervention, he said.