Physician Interviews

Vitreolysis. Redefining Convention
Video Interview with Paul Singh, MD (USA)

Clinical studies have shown vitreolysis to be an effective treatment approach for vitreous strands and opacities. It also offers a high degree of patient satisfaction. In this video interview, Paul Singh, MD, of The Eye Centers of Racine and Kenosha, Wisconsin, discusses the fundamentals of vitreolysis in the management of floaters.

YAG Laser Vitreolysis for Floater Treatment
Video Interview with 
James H. Johnson, MD (USA)

Having performed more than 2000 vitreolysis procedures over the past five years, Dr. James H. Johnson, Medical Director of Vitreous Floater Solutions, Irvine, is considered an expert in the treatment of floaters. In this interview, Dr. Johnson provides his tips on treatment protocol for floater treatment.

YAG Laser Vitreolysis: Results of 500 Eyes
Video Interview with 
Feike Gerbrandy, MD (Netherlands)

Effective in 70-95% of all cases – and with a low complication rate and high degree of patient satisfaction – Dr. Feike Gerbrandy, The Netherlands, shares his insight for successful treatment of floaters with YAG Laser Vitreolysis.

Vitreolysis in the Spotlight
Video Interview with Paul Singh, MD (USA)

In this video interview, Dr. Paul Singh of The Eye Centres of Racine and Kenosha, Wisconsin, shares his pearls for success with vitreolysis. Drawing on his experience with the Ultra Q Reflex™ multi-modality laser, he addresses a number of topics ranging from patient selection to treatment protocol, including recommended laser lenses and energy settings.

Laser Vitreolysis for the Refractive Surgeon
Video Interview with Karl G. Stonecipher, MD (USA)

In this video interview, refractive specialist Karl G. Stonecipher, MD (Clinical Associate Professor of Ophthalmology at the University of North Carolina, and Medical Director of TLC Laser Eye Centers in Greensboro, North Carolina) addresses his decision to incorporate laser floater removal into clinical practice.
“For many if not most of my refractive surgery colleagues, the idea of treating floaters with a YAG laser was taboo. They felt it was crossing a line, that these were healthy eyes that did not require surgical intervention, and that the risks outweighed any potential benefits. I understood and even shared some of their skepticism, but I really felt that we owed it to our patients to offer them something more than just a sympathetic ear when they explained the negative impact of floaters on their quality of life.”

Modern Laser Vitreolysis
Video Interview with Karl Brasse, MD MRCOphth (Germany)

Compared with its early clinical use in the 1980s, modern laser vitreolysis provides more efficient and safer energy profiles, offering reliable and repeatable outcomes that provide a low rate of complications combined with a high degree of patient satisfaction. In this interview, Dr. Karl Brasse addresses his experience to date using the Ultra Q Reflex laser in the treatment of symptomatic floater patients.
“Karickhoff, one of the original pioneers of laser vitreolysis, in my opinion, may have advocated the procedure before its time; the technological capabilities were not as superior as they are today. I strongly believe that the success I have encountered with laser vitreolysis is due to the system that I use.”

Patient Video: About Laser Vitreolysis
Video interview with Dr. Con Moshegov, (Australia)

Also known as floater laser treatment, laser vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. It is performed in your ophthalmologist’s office and typically takes 20-60 minutes per treatment session.

Laser Floater Removal
Video Interview with Paul Singh, MD (USA)

In this video interview, Paul Inder Singh addresses the clinical impact of floaters and the success of laser floater removal in his practice.
“I have been privy first-hand to the changes in how our profession perceives laser vitreolysis. On one hand, the poor historical data and the fact that many consider laser vitreolysis beyond their comfort zone (because it does not follow traditional conventions and is not taught in medical schools and residency programs), has led to initial pushback. On the other hand, patients and ophthalmologists are becoming increasingly aware of this procedure and the new technology, which is triggering growing acceptance of the potential benefits of laser vitreolysis. Although it is still considered novel and “outside-of-the-box” to apply a different use to something as familiar as a YAG laser, doctors are now beginning to grasp the potential benefits of using different energy profiles and visualization systems to make treatment of floaters possible.”

Clinical Videos

Laser Vitreolysis: Clinical Footage 1

Because the YAG laser energy has to pass through more optical media than during capsulotomy treatment, more energy will typically be required to perform vitreolysis. Regardless, always start with a low level of energy and titrate up until there is adequate vaporization and optical breakdown of the vitreous collagen.

Source: Video courtesy of Paul Singh, MD (USA)

Laser Vitreolysis: Clinical Footage 2

Commence treatment with a single pulse per shot. Set energy at the minimum level required to create the optical breakdown in the vitreous cavity (typically 2-2.5 mJ).

Source: Video courtesy of Paul Singh, MD (USA)

Laser Vitreolysis: Clinical Footage 3

More energy will be required if the floater is located deep in the posterior vitreous. For example, the same floater may be vaporized at 3 mJ in the anterior vitreous, at 4 mJ in the mid-vitreous and 5 mJ in the posterior vitreous.

Source: Video courtesy of Paul Singh, MD (USA)

Laser Floater Removal: On-Axis and Off-Axis

The Ultra Q Reflex incorporates a proprietary slit lamp illumination tower design, which converges the operator’s vision, the target illumination, and the treatment beam along the same optical path and onto the same optical plane. The illumination tower can be used coaxially to enhance the view of the target opacity and more effectively vaporize it.

“I think it is vitally important for the surgeon to appreciate spatial context. It is crucial to understand how far behind the lens you can treat. I utilize the on-axis feature first to visualize a floater against the red-glow background (to help visualize floaters in the middle and posterior vitreous), and then I go off-axis to determine how far behind the lens it is. If the floater is hard to see in off-axis mode then I know that it is safe to treat since off-axis setting only allows for visualization 1-2 mm behind the lens.”

Source: Video courtesy of Paul Singh, MD (USA)

Laser Floater Removal Through a Multi-Focal Lens

In this video, US physician Paul Singh uses the Ultra Q Reflex laser to perform laser floater removal through a multi-focal lens. The videos shows how coaxial illumination provides more spacial context i.e. lens to the retina; when the retina is not in focus he knows that he is in the middle of the vitreous and treatment can proceed accordingly. Average power setting was 6.0 mJ.

Source: Video courtesy of Paul Singh, MD (USA)