• Laser Vitreolysis for Symptomatic Floaters

    By Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, September 2017

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    Vitreous floaters, which become more common with age, often are bother­some and can hamper visual quality. Shah and Heier performed a trial of Nd:YAG laser vitreolysis, a potential but understudied treatment for Weiss ring floaters, and found that it produced subjective improvement in symptoms and objective improvement in appear­ance.

    The single-center, randomized clinical trial involved 52 patients (35 females) with symptomatic Weiss ring floaters secondary to posterior vitreous detachment. Participants were assigned randomly (2:1) to receive either uni­lateral treatment with Nd:YAG laser vitreolysis (n = 36; mean age, 61.4 years) or sham laser treatment (n = 16; mean age, 61.1 years). All procedures were performed by the same physician. Outcomes were evaluated 6 months postoperatively and included subjective change measured on a 10-point visual disturbance scale, a 5-level qualitative scale, and the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Secondary outcomes included objective change assessed by masked grading of color fundus photo­graphs and by measuring visual acuity.

    At the 6-month follow-up exam, self-reported improvement in floater-related visual disturbance was greater in the treatment group (54% vs. 9%). Improvement in the 10-point visual disturbance score also was superior for the treatment group (3.2 vs. 0.1). On the 5-level qualitative scale, 19 (53%) of the 36 patients treated actively and none (0%) of the sham controls reported substantial or complete im­provement in symptoms. NEI VFQ-25 responses showed that laser treatment yielded better general and peripheral vision, fewer role difficulties, and less dependency. Grading of masked wide-angle photographs demonstrated that 34 (94%) of the 36 patients with active treatment experienced significant or complete resolution of floaters, com­pared with none (0%) of the patients in the sham group. No clinically relevant adverse events were noted.

    The authors concluded that Nd:YAG laser vitreolysis produces moderate improvement in floater symptoms. However, they cautioned that larger studies are needed to confirm long-term stability of outcomes and to fully capture adverse events.

    The original article can be found here.