A patient recently sent me a link to an old (2007) piece from written by Mark Huffman, who from his bio usually reports on matters of real estate, gas prices and the economy. From the article ( ):

The AP enthusiastically reported on a controversial laser procedure practiced by a Northern Virginia eye surgeon, John Karickhoff, quoting Karickhoff as claiming a “success rate of better than 90%.”Of course, if the 90% claim is accurate, that would mean the procedure has a 10% failure rate — way too high for the not insubstantial risk it involves, other eye surgeons say.

My comments: The lead in paragraph is already problematic. Success is not defined here or elsewhere. In fact, when it come to an entirely subjective phenomenon not related to eye health or pathology, performing any kind of pre- and post-treatment measurements of the culprit floaters is impossible, and even if you could, it would not necessarily correlate with the patient’s symptoms. Logically this first paragraph does not make sense either. What if there was a non-invasive, non-surgical, fast recovery, non-scarring, non-addictive method of treating chronic pain. Pain that was interfering with the patient’s quality of life and activities of daily living. But what if this theoretical treatment was 90% successful and had a 10% failure rate. Now understand… failure is not the same as complications or damage to the body’s normal functions or health of the organs, it just meant that 10% could not be helped to a significant degree. That’s actually an excellent success rate.
I will say that the 90% success rate may be optimistic and it all depends on how you define it. If you include ALL patients suffering floaters, then the success rate is probably lower as that would include the younger patients who are generally not goof candidates for treatment. If instead your are ‘cherry-picking’ a bit and include only those over 50 years with a true posterior vitreous detachment, then the success rate may even be higher.  If you define it as ANY improvement and the absence of complications or damage to critical eye structure, then that would approach nearly 100% – But in my practice I don’t consider ANY improvement to be ‘good-enough-better. In other world, 10-20% percent improvement is not a success as I define it. The article continues:

“Don’t you even think of having that,” a Northern Virginia ophthalmologist advised a patient who had asked about Karickhoff’s procedure. “I have floaters myself,” the surgeon said. “I wouldn’t think of subjecting myself to that procedure and I beg my patients not to do it.”You’re risking catastrophic harm to fix a condition that isn’t even a problem for the vast majority of patients,” the surgeon, who asked not to be publicly identified, said.

My Comments: Any procedure to the eye including the very common cataract surgery and LASIK risks catastrophic injury to the eye. Fortunately these events are rare, but they do occasionally happen. Collectively, our profession has decided that the overall improvement in quality of vision and quality of life is worth this small but potentially devastating risk. There is a certain prejudice against floaters by the eye care community. They are not thought to be important or bothersome enough to justify treatment. The general consensus is just to live with them as evidenced by professor of ophthalmology and cell biology Dr. Robert Frank’s quote:

“The floaters, though disturbing, usually do not interfere with vision, Frank said, and over time, usually settle out. The vast majority of patients can learn to live with floaters, said Richard Bensinger of the American Academy of Ophthalmology. Those patients who demand treatment, he said, “are mostly obsessive-compulsive types” who allow the floaters to drive them to distraction.”

This is pretty much the company line professed by the American Academy of  Ophthalmology as well many, many statements conveyed to me by my frustrated patients seeking my help. You are expected to suffer them, and if you can’t, then you must be psychologically maladaptive. This is an embarrassment for my profession. They should know that there is no intrinsic mechanism within the eye to clear that junk out. These recommendations are something they must have heard in their training,and mindlessly repeat without actually thinking about it, or actually listening to the patient’s frustrations.

And that, people is part of the problem, they just don’t think about floaters as a problem, so why would they be bothered to look for a solution to a non-problem.

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