Laser Floater Removal, LFR
Laser Floater Removal (LFR), also known as Laser Vitreolysis, is a highly effective, outpatient-based procedure, which involves the use of a nano-pulsed YAG laser to vaporize vitreous strands and opacities (floaters). Highly effective, it has a low complication rate and offers a high degree of patient satisfaction. It can also delay or obviate the need for surgery.
The use of LFR dates back to the eighties when Professor Aron Rosa, France, and Professor Franz Fankhauser, Switzerland, who were pioneers in the use of YAG lasers, published on their success with the procedure.
Despite limited published findings, compelling evidence shows very low complication rates with Laser Floater Removal. For instance, in a study of 1500 patients, Karickhoff reported that the adverse event profile was 0.1%. The study also showed that treatment was effective in 75-95% of patients. Furthermore, Geller showed a similar success rate (85%), with no report of post-treatment complications such as retinal detachments, hemorrhages, holes or vitritis.
LFR has undergone a renaissance in recent times, with the innovation of technologies such as titratable axis illumination and coaxial visualization. Today, ophthalmologists can offer their symptomatic floater patients treatment with LFR with greater safety and efficacy than ever before.
Karickhoff JR. Laser Treatment of Eye Floaters, 2nd Edition. Washington Medical Publishing.2006. 4. Geller S: Nd YAG laser treatment effective for floaters. OSN. Dec 2001:37.
Introducing Modern LFR
Compared to its early clinical use in the 1980s, modern Laser Floater Removal provides more efficient and safer energy profiles — offering reliable and repeatable outcomes with a low rate of complications and a high degree of patient satisfaction.
Recent innovations for LFR include titratable axis illumination and coaxial visualization. The Reflex Technology™ laser platform from Ellex aligns the operator’s vision, the target illumination, and the treatment beam along the same optical path and the same optical plane. This allows physicians to focus on-axis with more depth and spatial reference when treating posterior floaters. Furthermore, it permits use of the illumination tower coaxially to enhance the view of the target opacity by using the fundus red-reflex as a contrast comparison.
In contrast, traditional YAG lasers deliver the illumination and laser from a low, non-coaxial position with larger convergent zones, making it extremely difficult to target and treat floaters. These conventional YAG lasers also require the use of high levels of energy, which poses a significant risk of damage to surrounding ocular tissue, as well as of side effects such as cataract and intraocular pressure (IOP) spike.
|“Modern laser floater removal is a different procedure. It is not the same procedure as in past years. Earlier attempts at treating floaters were not always positive, because the technology was not optimized for the procedure.”
Karl Brasse, MD, MRCOphth
Floaters. To Treat or Not to Treat?
Despite its many advantages, LFR is generally not taught, nor endorsed, by medical schools. This is due, in part, to the belief that floaters are benign and do not require treatment. Indeed, many ophthalmologists consider floater treatment to be unnecessary.
While floaters are often easy to overlook as a common symptom of vitreous deterioration, the adverse impact that they can have on a patient’s quality of life is sometimes significant enough to warrant treatment. Indeed, despite relatively good BVA, patients suffering from floaters may still experience a decreased health-related quality of life. In a study of 311 outpatients, Wagle et al reported that floaters had the same negative impact on quality of life as age-related macular degeneration.
(Wagle AM, Lim WY, Yap TP, et al. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011;152(1):60-65.)
In general, ophthalmic YAG lasers are designed for use in the anterior segment to perform capsulotomy following IOL implantation, and to perform iridotomy prior to implanting an anterior chamber lens, or in cases of angle closure glaucoma. Ellex’s proprietary Reflex Technology™ has been optimized for use in both the posterior and anterior segment. Featuring a patented slit lamp illumination tower design that converges the operator’s vision, the target illumination and the treatment beam onto the same optical path, and focuses them to the same optical plane, Reflex Technology™ minimizes the potential for focusing errors and the risk of damage to the natural lens or the retina.
What Type of Patient is Best Suited for Laser Floater Removal?
Laser Floater Removal is well suited to the Weiss-ring type of floater caused by a PVD. Because these floaters are fibrous, they absorb the laser energy well and can be vaporized more efficiently. In addition, they are usually located safely away from the crystalline lens and the retina.
What Level of Energy is used for Laser Floater Removal?
Compared to capsulotomy treatment, more energy is typically required to perform LFR. This is because the YAG laser energy has to pass through more optical media. Irrespective of this, it is recommended to commence treatment with a low level of energy and to titrate upwards until there is adequate vaporization and optical breakdown of the vitreous collagen.
Webinar: A Paradigm Shift in the Management of Symptomatic Floaters
Having performed nearly 1500 LFR procedures, Dr. Paul I. Singh reports a success rate of more than 90%, combined with a high safety profile. Watch the webinar to learn more.
For clinical and practical information on vitreolysis, as well as practice and patient marketing tools, visit www.floater-LFR.com – the primary online resource for the management and treatment of floaters.