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  • Outcomes of Nd:YAG Laser for Floaters

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, November 2019

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    Vitreous floaters can be addressed with the Nd:YAG laser, but research with objective structural and functional outcomes is lacking. Nguyen et al. conducted a retrospective comparative study of eyes with floaters and found that those treated with the Nd:YAG laser had reduced vitreous density but similar visual function as those that were untreated. Because the vision of some treated eyes was superior to that of untreated eyes, a prospective randomized study with uniform laser treatment parameters would be helpful, the authors said.

    The study included 132 eyes (132 subjects; mean age, 56 years); 97 had vitreous floaters and 35 were unaffected. Of the 97 with floaters, 38 previously received Nd:YAG laser treatment; the other 59 had been evaluated but not treated and served as controls. Of the 38 treated patients, 25 were unhappy with their result and were seeking vitrectomy; the remaining 13 were satisfied with their result and remained under observation only. These two groups were comparable in age and visual acuity.

    Visual acuity (VA) was measured with standard Snellen charts, and contrast sensitivity function (CSF) was assessed with the Freiburg Acuity Con­trast Test. Statistical analyses included the Fisher’s exact test to compare prevalence of pseudophakia, posterior vitreous detachment, and myopia. Mul­tivariable linear regression was used to explore differences between the study groups, after adjusting for confounders.

    Compared to untreated patients with floaters, patients treated with Nd:YAG laser had a 23% reduction in vitreous echodensity—but had compa­rable well-being, VA, and CSF.

    The objective measures of CSF test­ing and quantitative ultrasonography yielded no differences in well-being or VA between Nd:YAG-treated patients and untreated controls.

    However, these tests did show improvement in echodensity that was unrelated to well-being. The authors noted that this difference may relate to selection bias, because most patients who presented were unhappy with their Nd:YAG outcome.

    The results indicate that many patients who receive Nd:YAG therapy for floaters remain symptomatic and seek further treatment. The authors suggest that future studies explore whether certain types of floaters are more responsive than others to laser treatment. They favor prospective randomized studies, with uniform protocols, focused on quantitative measures of quality of life and objective assessment of structural outcomes.

    The original article can be found here.