Laser Vitreolysis for Symptomatic Floaters
By Lynda Seminara
Selected By: Neil M. Bressler, MD, and Deputy Editors
JAMA Ophthalmology, September 2017
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.