The Floater Doctor

There are just a few doctors with any significant experience using the YAG laser because:

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FLOATERS ARE CONSIDERED BENIGN AND UNIMPORTANT
Most vitreous eye floaters are not associated with eye health problems. There are rarer causes of floaters such as autoimmune conditions, infection, hemorrhage, and foreign bodies. Eye floaters do not appear in headlines, and they are rarely a cause of ‘objectively measurable’ diminished function or capacity for the patient. Sufferers often continue to work, read, and drive even if perpetually annoyed and distracted by the moving shadows. So within the eye care profession, floaters commonly just don’t register as anything important as long the retina is OK.

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DIFFERENT GOALS AT THE TIME OF EXAM
A patient may go to the doctor with a recent onset floater. They will want to know 1.) What is it?, 2.) Is it going to blind me?, and 3.) What can be done to get rid of it? The eye doctor, on the other hand, just wants to 1.) Determine that it is not part of a retina (or other serious) problem, and 2.) Reassure the patient that it is not a serious condition.

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TYPICAL EYE EXAMS APPEAR QUITE NORMAL

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"Floaters are something the patient sees, but the doctor either doesn't see or doesn't fully appreciate"

Most of our patients could pass any eye examination. Eye floaters generally do not decrease the visual acuity, decrease measured peripheral vision, change depth perception, or affect the health of the cornea, lens, retina or affect the eye pressure. Larger eye floaters may be noted on the exam chart, but usually not much fuss or attention to the floater ensues. The truth is that floaters are also difficult to see on examination when using typical eye examination techniques.

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THOSE WHO HAVE TRIED WILL OFTEN INITIALLY FAIL OR BECOME FRUSTRATED AND GIVE UP TRYING - OR WORSE, HAVE COMPLICATIONS
I will sometimes have a patient tell me that their doctor tried to treat their floater with the YAG Laser and apparently did not improve the patient’s condition. I think those doctors starting out with the treatment may have used the wrong treatment contact lenses and more importantly, inadequate energy settings. They get frustrated, don’t see any progress, and declare that the laser procedure just doesn’t work and probably never try it again. There is a long and slow learning curve with this procedure. There are no shortcuts to competency. We can not emphasize enough that experience matters.

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SPARSE PUBLISHED STUDIES AND RESULTS UNIMPRESSIVE
There are only a few published articles on the laser treatment procedure. They were not well designed with vague definitions of success. I believe the authors used inadequate energy settings to achieve plasma formation and vaporization of the floaters. They did conclude that it appeared to be safe, with no vision-affecting complications.

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IT IS TECHNICALLY A VERY DIFFICULT PROCEDURE TO DO WELL
The laser we use is normally designed for use and commonly used in the front part of the eye. When the focus is pushed further back in the vitreous chamber there are many optical factors conspiring to decrease visibility and lighting as well as reduce the efficiency of the laser energy. It takes a lot of practice to overcome some of these technical and optical challenges. Something that can’t be effectively taught in an 8 hour course. American author Malcolm Gladwell is known for describing the 10,000 hour rule: That is takes about 10,000 hours of focused, deliberate practice to master a skill. 

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THE PROCEDURE DOESN’T FIT WELL INTO A BUSY, GENERAL OPHTHALMOLOGY PRACTICE
One the important factors contributing to Dr. Johnson’s success with the procedure is a single-focused approach without the distractions associated with a general ophthalmology practice. We have a small and low overhead practice that allows us to see only 3-6 patients per day. We will typically spend 1-2 hours per patients. Much of that time may be spend discussing the procedure, answering questions, examining the eye, discussing risks, managing expectations, and of course the treatment it self which can be time consuming, tedious, and laborious. We block off enough time for each patient and rarely have someone waiting to be seen. This unique practice style works well for us and makes for an unhurried, very focused visit. It is a style that will not be duplicated by other established practices and we believe it makes a big difference in the end results and a better experience overall for the patient.

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THERE ARE NO TEACHING, TRAINING, SKILLS-TRANSFER, OR CERTIFICATION PROGRAMS.

A prominent laser manufacturer that is promoting their laser a a floater-treatment laser is, I believe, taking advantage of the marketing opportunity, but NOT dedicated to the education and training of other physicians. This is fine by us from a a competitive standpoint, but unfortunately, this also means that doctor's are offering the treatment of eye floaters without any experience or training. Choose your laser doctor carefully.