This is the first prospective trial to evaluate the safety and efficacy of YAG laser vitreolysis for symptomatic floaters arising from posterior vitreous detachment.
Study design
The single-center trial randomized 52 eyes to receive 1 session of YAG laser (n=36) or sham (16). The primary outcomes were subjective changes using various scales to quantify visual disturbance.
Outcomes
At 6 months, all outcome measures, including symptoms, visual disturbances and vision-related quality of life, supported the efficacy of YAG vitreolysis (all P<0.001). BCVA, however, was no different between groups (P=0.94).
The authors documented 1 case of IOL pitting in the YAG laser group, and 1 retinal tear in the control group. No serious complications or adverse events were noted.
Limitations
The biggest limitations are the small sample size and the short follow-up. As one of the reported risks of YAG vitreolysis is retinal detachment, longitudinal follow-up with a larger group would be needed to exclude this and other potential adverse events. In addition, this study only allowed 1 treatment session, whereas in real clinical practice, it may require more than a single laser session to adequately address the patient's symptoms and pathology.
Clinical significance
While the results from this rigorously designed study are encouraging and have the potential to change the way we view treatment of bothersome vitreous floaters, I would not alter my clinical practice yet. Larger randomized trials with longer follow-up will be necessary to assess the efficacy and safety of YAG laser vitreolysis for symptomatic floaters.