YAG Laser Vitreolysis –
Floater Busting
Ellex Nanopulse Laser Innovations Symposium
ECSRS 2012, Milan, Italy
Jaap J. Dito / Feike Gerbrandy
Opsis Amstelveen The Netherlands
www.floaterlaser.nl
Question 1
Who would have thought, 10 years ago,
that cataract could be treated with laser
therapy?
Question 1 continued
Who would have thought, 10 years ago, that
cataract could be treated with laser therapy?
Yes 97%
No 3%
Question 2
Today, how many people think that
floaters can be treated with YAG laser
therapy?
Opsis , Amstelveen, The Netherlands
Question 2
Today, how many people think that floaters
can be treated with YAG laser therapy?
No 97%
Yes 3%
Feike Gerbrandy, Amstelveen
Floaters: Treatment Options
1. Observation only: “nothing to worry about, just
ignore them”
2. Surgical removal of the vitreous (vitrectomy)
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highly invasive procedure that carries a significant
risk of complications, such as retinal detachment,
macular edema, anterior vitreous detachment and
residual floaters
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may also cause an impression of shadows across
the visual pathways
Feike Gerbrandy, Amstelveen
Floaters: Treatment Options
3. YAG Laser Vitreolysis
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Vaporize the clumps and cut a “peep hole” through the
membranes using a nanopulse YAG laser
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Painless, outpatient based procedure
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High success rate
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The method is not generally taught or endorsed by
medical schools – difficult to perform; long learning
curve
Feike Gerbrandy, Amstelveen
My Experience with YAG Laser
Vitreolysis
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+300 eyes treated
Low complication rate
Effective for 70-95% of floaters
Decreased symptoms; never complete resolution
High degree of patient satisfaction
Strong patient uptake: internet access = high patient awareness
• Patients travel from Belgium, Canada, Indonesia, Russia,
Ukraine, etc…)
Feike Gerbrandy, Amstelveen
Best Results with Weiss Ring
• 44 eyes (17 pseudophakic, 25
phakic)
• Follow up over 298 days (31721 days)
• Floater score = 8.01 to 2.3
• Succes 95.5%
Floater score is a subjective scale from 1-10.
• 1 no complants
• 10 severe complaints
Treatment Guidelines
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Complaints of floaters; refer or
treat only pseudophakic eyes in
the beginning
Indication for YAG laser
treatment
• complaints > 3 months
• subjective floaterscore of 5.5 or higher
• Safe distance from retina or lens
Feike Gerbrandy, Amstelveen
Treatment Guidelines continued
• Purpose of the treatment is to minimize the
symptoms, not to completely remove them
• More info on www.floaterlaser.nl
Complications/Side Effects
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305 eyes (415 laser treatments) 2.6%
3x retina hit (last with patient 92)
1x traumatic cataract (patient 25)
2x increased intraocular pressure
recent 1x retinal detachment (pseudophakic, s-15)
vitrectomy rate 3.9% (up until now…)
Patient Feedback:
Results questionaire 2011
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138 questionnaires sent (all to patients with > 6mths follow up)
Response rate: 67% (93/138)
Average symptom score = 7.88 to 3.85 ( visual analogue scale 110)
Satisfaction 3.82 (on a scale 1-5)
Average no. of treatments 1.27 per eye
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89% would choose this treatment again
89% would refer other people for this treatment
Bias 1: non-responders were not contacted
Bias 2: Not all treatments completed
Opsis, Amstelveen, The Netherlands
Nanosecond YAG Laser Technology
for the Treatment of Floaters
Ultra Q microsurgical YAG laser
(Ellex, www.ellex.com)
Laser Source: Q-switched Nd: YAG
Wavelength: 1064 nm
Energy: 0.3 to 10 mJ, single pulse,
continuously variable
Pulse Duration: 4 ns
Nanosecond YAG Laser Technology
for the Treatment of Floaters
Ultra Q microsurgical YAG laser (Ellex, www.ellex.com)
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Nd:YAG lasers emit high energy - potential risk of damage to
surrounding ocular tissue
The Ultra Q™ produces optical breakdown at lower energy
with fewer shots and less cumulative energy = minimal risk
Ultra Q™ achieves ultra-low energy optical breakdown (in
air) of approx. 1.8mJ, compared to other YAG lasers at 3 to
4mJ.
Nanosecond YAG Laser Technology
for the Treatment of Floaters
Ultra Q microsurgical YAG laser (Ellex, www.ellex.com)
• Traditionally, YAG lasers have not been designed for
use in the posterior chamber
• Ellex has a new delivery system under development to
help reduce the risks involved in performing YAG laser
vitreolysis and hopes to be able to make it available
more widely in the near future.
Question 2
Today, how many people think that
floaters can be treated with YAG laser
therapy?
Opsis , Amstelveen, The Netherlands
Question 2
Today, how many people think that floaters
can be treated with YAG laser therapy?
No 75%
Yes 25%
Feike Gerbrandy, Amstelveen
Question 2
Who thinks floaters cannot be treated effectively with
YAG laser vitreolysis?
Yes 75%
No 25%
Feike Gerbrandy, Amstelveen
Question 2
Who thinks floaters cannot be treated effectively with
YAG laser vitreolysis?
Yes 65%
No 35%
Feike Gerbrandy, Amstelveen
Question 2
Who thinks floaters cannot be treated effectively with
YAG laser vitreolysis?
Yes 50%
No 50%
Feike Gerbrandy, Amstelveen
Question 2
Who thinks floaters cannot be treated effectively with
YAG laser vitreolysis?
No 35%
Yes 65%
Feike Gerbrandy, Amstelveen
Question 2
Who thinks that, in 10 years, floaters will be treated
routinely and effectively with YAG laser therapy?
No 5%
Yes 95%
Feike Gerbrandy, Amstelveen
Question 2
Who thinks that, in 10 years, floaters will be treated
routinely and effectively with YAG laser therapy?
No 5%
Yes 95%
Goals
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Commence Vitreous Floaters Study Group AAO 2011
www.vitrousfloatersstudygroup.com
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Publication of results
Evidence for efficacy and safety
Presentation AAO 2012
(Geller, Karickhoff Gerbrandy)
Future Treatment: YAG laser therapy will become first choice
in treatment of floaters
Thank you for your attention
Jaap J. Dito / Feike Gerbrandy
Opsis Amstelveen The Netherlands
www.floaterlaser.nl
Feike Gerbrandy, Amstelveen