I recently received a follow-up email message from a floater sufferer trying to do his research and due diligence prior to any treatment with me or anyone else. The message was full questions and concerns which are common especially after the floater sufferer has spoken to their local eye care provider, be it general ophthalmologist or retina specialist. Here is the bulk of the message and following it I will deconstruct it and answer and address the main concerns:
“…I need further verification that indeed this will not cause further issues. Dr. A. at the XYZ eye clinic (which I understand is the Mayo Clinic of eye care) even was implying that this was more just a money-making thing, stating that they usually don’t do anything for them there, and the (weiss) rings normally much reduce after ~6 months. He said the treatment is not quite as simple as implied, and may take multiple rounds of treatment. How many of your patients have needed multiple sessions? Dr. A also stated that putting that much energy into the vitreous jelly, it can ricochet off the jelly if it is located in the back and may cause a tear/detachment of the retina, whereas if it is towards the front of the eye, it can cause instantaneous cataracts that are difficult to treat. I know you address the cataract issue, so I am ok there, but what about detachments? Dr. A said he didn’t know of anyone he worked with who did this right now, and it is not commonplace. He also said he would recommend vitrectomy surgery if I really insisted, which they do for retinal detachment and the like. He said none of his retina colleagues were doing it either, and none recommended it. So… the question is what percent of procedures have resulted in retinal detachments…?
“…implying that this was more just a money-making thing”
I am not ashamed to admit that my medical practice is a business that exchanges medical services for money. This is the model for most medical practices, I imagine, unless there is some other source of subsidization either via a government program or other benefactors. Even the highly esteemed XYZ clicic referred to in the original message must pay their overhead which I imagine to be quite substantial. Many American medical practices are contracted with medical insurers to provide care for the insured. For the exchange of services, whether it is the doctor’s time and expertise, or for procedures, such as diagnostic imaging, labs, as well as invasive surgical procedures, the medical practice submits a claim to the insurer, and the insurance carrier pays the medical practice. Understand that the insurance claim only states that an effort was made. The claim codes have no modifiers that reflect success with treatment. In fact the patient could die on the operating room table, and the hospital will still submit a claim to the insurer for supplies, the room, and the professional services.
“…stating that they usually don’t do anything for them”
This is true. I have addressed this at length elsewhere in my web site here.
“…and the (weiss) rings normally much reduce after ~6 months”
A weiss ring floaters is a very thickened part of the vitreous cortex membrane that has peeled away from the posterior (back part) of the retina. Normally it is very loosely attached to the retina, and the weiss ring peels away from the retina along with the transparent ‘plastic-sheet-like” membrane. The weiss ring type floaters do not just fall out of the way unless the whole membrane collapses which it rarely does. If your doctor has suggested waiting 6 months, you are welcome to wait. For typical floaters of all types, there is no harm in waiting 6 months or longer if you wish to test that recommendation.
“…He said the treatment is not quite as simple as implied, and may take multiple rounds of treatment.”
My web site has about 30 individual pages and about 29 blog posts all describing the difficulty and complexity of this procedure. My fee structure is such that the first ( and presumed necessary second procedure ) are bundled together to help set the expectation that it does take more than one procedure. Much of my effort (this web site, emails communication, and phone calls) is spent managing the expectations of potential patient floater-sufferers.
“…How many of your patients have needed multiple sessions?”
Virtually all of them.
“…Dr. A also stated that putting that much energy into the vitreous jelly, it can ricochet off the jelly if it is located in the back and may cause a tear/detachment of the retina, whereas if it is towards the front of the eye, it can cause instantaneous cataracts that are difficult to treat.”
Dr. A does not have experience in treating eye floaters with the YAG laser. This statement reveals it. Laser energy does not ‘ricochet’ around in the back of the eye. From a more practical measure, I have been exclusively treating floaters since 2007, with thousands of procedures of all kinds of complexity. There has never been a retinal detachment in any of my patients. Injury to retina is of course possible, but quite comfortably avoidable with experience and good decision making – which includes NOT offering treatment to those that are not good candidates for treatment. As of 2018, my total laser shot count (that is, the cumulative number of individually aimed and fired laser shots) is over 11 million. None of those 11 million shots of the laser has caused a cataract. The risks exist and I describe it (and the others) in my web site as part of my effort towards transparency and education, but again, I think the numbers show that Dr. A’s warnings are out of proportion to the real risk.
“He also said he would recommend vitrectomy surgery if I really insisted…”
Floater-only vitrectomy (FOV) is an invasive surgical procedure requiring placing three holes in the whites of the eyes, and cutting and removing all (or most) of the vitreous fluid and replacing it with a modified saline solution. Many retina specialists will advise their patients that there is a 100% risk of developing cataracts within a year of the procedure. In addition, there are risks of chronic macular edema, retinal detachment, and infection. The last three risks are low likelihood, but could result in devastating vision loss.
There is risk with everything we do. Drive a car? Risk. Start a business? Risk. Enter a relationship? Risk. And with medical procedures, because health and function are potentially at risk, there are special considerations. Ultimately it comes down to weighing the potential risk of a procedure vs. the potential benefit. The good news is that eye floaters are not a condition that HAS to be treated to save the eye health and visual function. But that is not how my medical practice is promoted. I am trying to improve the quality of vision and quality of life for those suffering significantly bothersome and distracting, and sometimes intermittently obstructive eye floaters – and doing so with a procedure that is acceptable low risk in the hands of an experienced laser surgeon.