CHALLENGING, COMPLICATED and DIFFICULT TREATMENTS
Many of our patients have already undergone previous surgery for cataracts, refractive surgeries, or other eye health related issues. Some of these previous treatments may affect the quality of the laser energy and the efficiency of treatment. Furthermore, they may ultimately affect the patient’s satisfaction with the outcome. Below are some of the common conditions and related comments.
REFRACTIVE SURGERY LIKE LASIK and PRK
Corneal refractive surgery uses a laser to re-shape a front surface of the cornea. The reshaped area of the cornea may be around 5 to 6 mm in diameter. This leaves a surrounding “transitional” zone surrounded by untouched cornea curvature. Having different zones of curvature may diminish the amount of energy delivered by the YAG laser in treating eye floaters. Generally this will not increase the risk of the procedure, but it may decrease the efficiency of treatment. This can usually be compensated for by greater efforts to move the floaters into a treatable “sweet spot”, using more shots of the laser, or increasing the energy somewhat.
CATARACT SURGERY WITH ARTIFICIAL LENS IMPLANT
It is very common for us to see patients who have had cataract surgery. There are some advantages to having a patient with an artificial lens implant in that it is impossible to cause a cataract complication. In addition, you have a perfectly clear lens to work through rather than one alternative of the irregular optics associated with a developing cataract of the lens. The disadvantage is that an implant lens has a diameter of about 5.5 mm, which can limit the aperture for visualizing the floater as well as delivering energy to the floater. The aperture of a widely dilated pupil without an implant lens may be as large as 7-8 mm. Generally, with experience and technique, this smaller aperture challenge can be compensated for with great success.
RK is an older corneal refractive surgery procedure where the surgeon placed deep, radially-oriented incisions in the cornea in an effort to flatten the front curvature of it. This changed the optics of the eye, and generally could correct mild-to-moderate degrees of myopia. There are many problems with this procedure, and there are wide varieties of the number of incisions that were placed in the usually range from 4-16 incisions. This creates an irregularity of the cornea that diminishes the quality and amount of YAG laser energy that can be delivered to the floaters. This can usually be compensated for by the surgeon’s experience a technique. Some of the floaters located posterior or peripheral may be difficult to treat effectively through these corneas.
CATARACT (CLOUDING OR OPACITY) OF THE LENS
A common age-related change is the gradual darkening, yellowing or browning, or outright opacification of the natural lens of the eye. They can range from mildly irregular optics to complete blinding of an eye. When treating eye floaters, the laser energy must pass through the lens. In moderate-to-advanced cataracts, the irregularity of the optics of the lens may diminish the quality and quantity of the laser energy, making it more difficult to treat. With early or mild cataracts, it is not much of an issue. In more advanced cataracts where your doctor is starting to discuss cataract surgery for you, it may be better to wait until after the cataract surgery to have your floaters treated.
PREVIOUS RETINAL PROBLEMS and/or REPAIRS
Many of Dr. Johnson’s patients have had had previous retinal hole, tears, and even retinal detachments. They have had their retinal pathology repaired, or lasered as shown above. As long as their retina condition is considered healed and stable, there should be no problem with using the YAG laser in treating vitreous eye floaters.