Every once in a while, I will have a patient who comes to me for an evaluation for their eye floater problem after having treatment elsewhere with little or no improvement in their condition. I appreciate that they are still willing to travel to Southern California to see me after what many patients might consider to be a failure of the laser to treat their condition. The floater treatment community is a small one and those of us who have been treating eye floaters with a YAG laser know the established floater treatment eye doctors. About 3 years ago, one of the YAG laser manufacturers made some minor modifications to their standard YAG laser and have been promoting it as a floater treatment laser. With that marketing push from the manufacturer, I have been hearing more about ophthalmologists offering the treatment of eye floaters with their new YAG laser.

I am cautious not to sound catty and competitive. There are plenty of eye floaters to go around and there is nothing to prevent someone else from firing up their laser and treating eye floaters. But, experience does matter. In Malcolm Gladwell’s Outliers: The Story of Success he argues that 10,000 hours is about the number of hours of practice and/or experience in a skilled activity that is necessary for mastery of that activity. It really is an interesting read. Treating floaters is no different.

I had a patient from Chicago I had seen last year with marked improvement in her eye floater symptoms. She was younger than my typical patient and so even after treatment, she still had some residual eye floaters – very small and peripheral but bothersome to her nevertheless. She had found someone local in Chicago who recently started treating eye floaters at his ophthalmology practice. He treated both of her eyes with no apparent improvement. With hope and desperation, returned to see me in Southern California hoping I might be able to get those last few small residual dots. After dilating her eyes, here’s what I immediately saw:

lens injury from eye floater treatment with a yag laser EXPERIENCE-MATTERS-2I took these photos to help her document what had happened. Not once, but twice the laser surgeon aimed and fired the laser at the posterior surface of the lens. This is really difficult to explain, as the patients floaters were in the posterior (rear) of the eye closer to the retina. The larger of the injuries appears to have ruptured the posterior capsule as seen by the square-shaped outline rotated 45-degrees (diamond shaped). I am surprised she did not need urgent cataract surgery for a traumatic cataract. Because these lens injuries were out in the periphery of the lens, she did not have any symptoms! She really dodged the bullet here.

I am now aware of 5 cataracts caused by the YAG laser. In two cases it was the surgeons first time treating vitreous eye floaters with a YAG laser. In the other 3 (including this one), the doctors were new to the procedure. To be fair, in medicine and in surgery, everyone has to start somewhere at some time. I remember the difficulty and challenges of learning the laser procedure in the first 6 months especially. I would suggest that a laser surgeon interested in treating eye floaters would need about 100,000 laser shots of experience in treating eye floaters before they can be competent-to-good. They need to do a lot more than that to excel.

I now have over 5,000,000 laser shots (update edit: now over 1.1 million as of Jul 2018) and thousands of procedures of experience and I am still learning a little from every patient. Experience matters. I understand the temptation in seeking treatment from your local eye doctor now that he/she claims to have the “Floater Treatment Laser” in their office. It can be expensive to travel and pay the additional room and board while staying here in Southern California. These are your eyes, though. Experience does matter. Make sure your doctor has real, legitimate experience in treating eye floaters. -Dr. James Johnson, “The Floater Doctor”

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