The Floater Doctor

Is This a Legitimate Treatment Option?

Yes. Ophthalmic YAG Lasers have been used for more than 20 years. The American Medical Association has established a Common Procedural Terminology Code CPT code associated with Laser Vitreolysis (67031) and our laser is labeled by the FDA for use in the vitreous cavity for vitreous membranes. Commercial insurance plans have reimbursed patients for the procedure with the appropriate documentation.

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What Does it Cost? Will My Insurance Cover it?

The professional fees are described in detail elsewhere (HERE).

We are not contracted with any medical insurance provider and we have opted out of medicare. It is an out-of-pocket, fee-for-service procedure. More (HERE).

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Is This Procedure FDA Approved?

FDA approval refers to the LABELING of the device and approval that it is a safe device for the indications within the package labeling. Our YAG laser is consistent with the FDA requirements. In 2002, the FDA had ruled that a proposed study of laser treatment of vitreous opacities was a non-significant risk device study. They further ruled that a special device exemption from the FDA to use a YAG laser was not required. As such, the use of the YAG laser to treat vitreous floaters can be considered an ON LABEL use of the laser. Ultimately it may not be as important a concept as you may think. The FDA does not regulate what procedures can/can not or should/should not be used with each device they approve. It is up to the individual physician to make that determination. Devices and medications are used “off label” all the time. In the FDA's own words, much of the progress and innovation in medicine occurs when physicians adapt and expand from existing indications.

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Why Aren't More Doctors Offering This Treatment?

The explanation as to why this procedure is not more popular is manifold and multifaceted. Here are a few contributing factors:

1. Very few eye doctors are aware of the procedure, or have seen it performed, or have seen the results of the procedure.

2. Floaters are thought to be benign by the professional community. They are not usually a cause of decreased function and the floaters themselves are not part of a progressive degenerative eye condition.

3. It is technically a very difficult procedure to perform well. There is a slow learning curve. In our experience, it may take 100,000 laser shots or so to really begin to acquire the experience and skill to do it well. (Dr. Johnson has fired >14,000,000 !)

4. There are no official or unofficial teaching or training courses where doctors can learn the basic skills and science behind the procedure of the procedure.

5. There have only been a couple of published articles on the topic. The results with the particular technique and energy levels that were used were not impressive, although it was at least deemed a safe procedure.

6. The pharmaceutical and device manufacturers have not yet realized that there is money to be made treating eye floaters.

7. The common practice of eye care professionals in evaluating eye floaters has been to rule out retinal pathology, reassure, and send the patient on their way.

8. We are aware of some doctors attempting the procedure at sub-therapeutic energy levels and then giving up on the procedure never to try it again. 
   Click here for more on this.

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Won't the Laser Just Break it up into Smaller Pieces? Will I see More Floaters?

The technical details: The YAG laser emits the beam in a cone-shaped pattern. At the apex (or tip) of the cone there is a concentration of the energy. Using focusing lenses, this apex is directed onto the front surface of the floater material. The laser “shot” lasts only 20-30 nanoseconds (0.000000030 seconds), and at that moment the concentrated laser light creates a small plasma-state “bubble”. Plasma is the fourth state of matter, and matter that has been converted to plasma has the electrons pulled away from their usual location and creates a high energy state of the matter. This process actually converts the floater material to a small gas bubble. It is important to understand that the laser does not just break the floater into small pieces, but actually changes it to a gas. The gas is reabsorbed into the bloodstream over the course of a few hours.

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What is the Rate of Success?

Every eye is different and there are too many variables to list here, but it is reasonable to expect 60-90% improvement and decrease in the mass or amount of the floaters. Most patients will need a second (and sometimes a third or more) treatment to clear up most of the rest. There have been a few patients (about 15% of consultations) that have such thin, transparent floaters (usually too close to the retina) that can not be treated. These patients are almost always younger than 30-35 years of age. Younger patients are rarely candidates for treatment.

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How Do You Keep the Eye from Moving Around. I Don't Think I Can Keep My Eye Still.

There is a head strap on the laser that firmly holds the head in place. In addition, the hand-held contact lens stabilizes the eye quite well. The combination allows us to focus on objects that are very small (fibrous strands < 1/20 of a millimeter) with great accuracy. Although we have mild sedatives available, we have only used them once, and afterwards the patient suggested he probably didn’t need it after all. Even very nervous patients will agree afterwards that it is a very tolerable, painless, procedure.

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Will There Be a Change to My Visual Acuity or Spectacle Prescription After Treatment?

Most of the time after treatment, there is not an improvement or overall change in Snellen Chart visual acuity.  The optics of the eye don’t change with treatment.  Unlike LASIK laser vision correction, we are not attempting to improve visual acuity, but we are improving the overall quality of vision which is admittedly hard to define and even harder to quantitatively measure.

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Can Laser Be Done After LASIK, PRK, RK, Cataract Surgery, Retina Laser or Repair?

Yes, but with some occasional technical difficulty. The bottom line is that the efficiency of the laser can drop way down but fortunately, it should not increase any risk to the patient and the optics of the eye should not be affected. (More here).