The Floater Doctor

If you are considering visiting Dr. Johnson in the Dallas - Ft. Worth, Texas area to have your eye floaters evaluated and possibly treated, here are some guidelines that will hopefully answer most of the questions you may have and some questions you didn’t realize that you had.

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We no longer use an answering / scheduling service to answer incoming calls. We had used one for years and they were pleasant, but because of the employee turnover and general lack of quality control, we were forced to discontinue the service.  If there are any questions that are not answered here in the web site please email Dr. Johnson. He will make an effort to return to call or email in a timely fashion, but depending on the schedule and other concerns, it may be delayed.

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Doctor Johnson’s practice is exclusively dedicated to treating eye floaters and structures the schedule to spend 60-90 minutes with each patient at each appointment. Because of the limited scope of the practice, there are usually appointment spots available even on short notice. You do not need weeks or months to schedule ahead. Because many of our patients come from outside the geographical area, Dr. Johnson will do his best to accommodate your travel plans. If you have a special request or time constraint, let us know.

Dr. Johnson cannot predict in advance if your floaters can be safely treated. 

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HOW LONG SHOULD I WAIT BEFORE CONSIDERING TREATMENT?
There are no absolutes here, just general guidelines. If you are over 45-50 or so, and have experienced a sudden-onset of symptoms, especially with peripheral flashes of light seen in dark environments, you may have experienced a posterior vitreous detachment (PVD). In this case, I will suggest waiting at least a month for the PVD to go to completion before considering treatment. With an incomplete PVD, the floaters may still be closer to the retina than if they are allowed to naturally move further away. Also, while the PVD is incomplete, you are at a slightly greater risk of spontaneous retinal holes and tears, and so it is better to wait for the PVD to complete. Most will do so in the first few weeks after onset of the floaters. Generally, with uncomplicated and typical eye floaters, there is no sense of urgency to treat and there is no ‘penalty’ for waiting longer.

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IS THERE A LONG WAIT TIME TO SCHEDULE AN APPOINTMENT?
Because of the limited scope of the practice, there are usually appointment spots available even on short notice. You do not need weeks or months to schedule ahead. Because many of our patients come from outside north Texas, Dr. Johnson will do his best to accommodate your travel plans. If you have a special request or time constraint, let us know.

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TIMING OF TREATMENTS – TREATMENT ON THE SAME DAY AS THE EVALUATION?
If you are deemed to be a good candidate for treatment and wish to proceed, we can do the laser treatment procedure right at that first visit. We generally schedule 90 minutes for the first visit to allow plenty of time to talk, discuss, answer question, dilate, evaluate, discuss the informed consent, etc. Treatment itself may take between 20-45 minutes depending on the complexity, amount, and challenge involved.

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I WANT TO TREAT BOTH EYES. HOW DO I SCHEDULE THAT?
If you want to have both eyes treated AND both are good candidates for safe and successful treatment, both eyes can be treated during your visit. Keep in mind that Dr. Johnson will likely only treat one eye on that first evaluation/consultation. If all is well with that eye on day #2, then we may elect to go ahead and treat both eyes. Keep that in mind when scheduling.

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NUMBER OF DAYS TO SCHEDULE
With laser treatment, there is no inflammation or actual healing process, so treatments can be done on consecutive days if desired and needed. If you are traveling from out of the area, the general recommendation is to schedule at least two, but preferably 3 consecutive day treatments to allow for the best opportunity in a short period of time. Almost everyone, even the most ideally treated floaters require at least a second treatment, and some of the more complex treatments may need more.

If you live relatively close (within an hour travel radius), it is preferable to allow a few or several days between treatments, so just schedule the first appointment, and we’ll follow it up from there.

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WHERE TO STAY?
We are located in Arlington, Texas, sitting between Dallas and Fort Worth not too far from the DFW International (DFW) and Love Field (DAL) airports which are major hubs for American Airlines and Southwest Airlines respectively). There are hotels in the area. Please use your favorite travel web site (e.g. hotels.com, expedia, travelocity.com, kayak.com) to find the best deal in your preferred budget.

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WHAT DO I NEED TO BRING? DO I NEED TO BRING/SEND MY DOCTORS NOTES? SHOULD I BE OUT OF MY CONTACTS LENSES FOR AWHILE?
Nothing, No, and No.
I have not found your local doctor’s chart notes and findings to helpful in my own evaluation of your floater condition. Typically, I don’t need to know your spectacle or contact lens prescription, your previous LASIK correction details, previous images of the back of the eye, etc. If you’ve had a particular complicated eye treatment or surgical history, of course I’ll be glad to look at whatever documentation you have, but usually it is not helpful in this regard.
You do not need to be out of contact lenses prior to my evaluation, but it will be helpful if you bring your backup eye glasses, as I’d like you to be able to see me and the educational material after you take your contact lenses out. Bring sunglasses for afterwards.

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RECOVERY TIME: DO I NEED SOMEONE TO DRIVE ME? CAN I FLY, DRIVE, EXERCISE SOON AFTERWARDS?
We do not use any sedation with treatment and there is no patching of the eye after treatment. The eye rapidly recovers from the bright light used during treatment. About 10-15 minutes after treatment the main challenge is the dilated pupil(s). If you have been relatively comfortable after a dilated eye examination (with a good pair of sunglasses, most likely), then you may feel quite comfortable driving yourself.

[Medico-legal disclaimer: We have to advise you that your pupils may be dilated for 2-5 hours and that you should only drive after your vision has return to a fully functional state. If you are quite bothered by the pupil dilation process, then you should allow for another driver or other transportation means.]

What about flying? I tell patients that there are no restrictions on activities and that includes flying.

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SHOWING UP FOR THE EXAM
We are located on the 2nd floor of an office building (not a medical building). There is no charge for parking at or around the building. 

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THE EXAM. COMFORT ISSUES.
After the initial visual acuity and baseline eye pressure testing, the examination and consultation absolutely requires the dilation of one or both pupils. If you have had a recent, thorough eye examination by a qualified eye care provider and only have a problem in one eye, then we are quite comfortable dilating and examining just one eye. It will make the post exam and/or treatment period a bit easier.

We have not found the use of ultrasound, retinal photography, or other imaging techniques to be helpful in the evaluation of the “treatability” of your eye floaters. There are a few examination techniques and ophthalmoscopes that can be used at the time of the examination. All are painless, except that the lights used to illuminate the back of the eye can be a bit bright. A few patients have been sensitive to the light, but it shouldn’t be more than you have experienced at previous eye exams.

Dr. Johnson often uses a diagnostic contact lens at the time of the exam. It provides a better, more magnified, and more stable, blink-free exam. Even if you have never worn a contact lens, you will not feel it. The surface of the eye is numbed with anesthetic eye drops first, and then the contacting surface of the lens is coated with a thick, clear, water-based lubricant so the lens actually floats and glides over the surface rather than irritating or “scuffing” the surface of the cornea.

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TIMING OF TREATMENT
Because many of our patients come from outside the geographical area, we block off plenty of time for that first evaluation consultation (1.5 hours) to allow for the opportunity to go ahead and initiate the first treatment at that first visit. This assumes, of course, that the floater(s) are treatable, understand the risks, have reasonable expectations, all questions have been answered, and both feel confident to proceed.

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THE ACTUAL TREATMENT
The actual laser treatment is completely painless. The same types of contact lenses are used throughout for all the advantages it serves. There are some laser device “clicking/snapping” sounds. Almost always the patient may see a spray of small dark black shadows 'falling' when there is a good transfer of energy to the floaters. This is not only common, but it is a sign that the floater solids are being vaporized into gas bubbles. The bubbles are actually rising to to roof of the globe, but the brain reverses the images, and you will perceive them falling. The small micro-bubbles will only linger and last 10-20 minutes or so. They quickly dissolve and reabsorb.

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POST-TREATMENT EXPECTATIONS
There are no restrictions to activities after the treatment. No patching, no eye drops, no medications. You can go and do whatever you want.  The procedure is surprisingly well tolerated, even with aggressive, consecutive day treatments when necessary. We do strongly recommend that you bring sunglasses with you to your appointment, even if treatment is not performed at the first visit. Pupils need to be dilated at each visit and a dilated pupil can not regulate the amount of light entering the eye.

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 WHAT ABOUT PAIN AT THE TIME OF TREATMENT AND AFTERWARDS?
What pain? Because energy is being applied to inert (non-living) proteins and plenty far enough away from nerves, blood vessels, or other living tissues, there is no expectation for pain at the time of the procedure or afterwards.

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SUBSEQUENT TREATMENTS (IF NEEDED)
Any additional treatments can be performed on consecutive days if needed and desired. This is more applicable to those traveling in from further distances.

Dr. Johnson is usually at his office in Arlington, Texas 5 days a week (M-F). Appointments may begin at 9:45, and the last appointment of the day is typically around 3:15 pm.