I’ve had a few recent email queries from floater-sufferings with some concurrent retinal issues: peripheral degenerations, peripheral retinal holes (possibly lasered and treated or left to ‘probably’ heal on its own, retinal edema or swelling, macular hole, macular degeneration, etc.)

In addition to recent or active conditions, there may be a history of now healed and generally stable retinal issues like previously lasered retinal holes and tears, retinal detachment repairs of various types, previous vitreous hemorrhage, etc.

I thought it might be worth explaining some of my thoughts, concerns, and recommendations in a lengthier blog post here, rather than recreating a more abbreviated response every time someone emails me.

I have less concern about my YAG laser causing or aggravating retinal problems than I am in being temporally associated with any potential for their natural progression and worsening. I’ll explain. The use of the YAG laser to treat floaters has been in existence for more than 20 years, but it still is not mainstream, and many eye care providers still know very little about the procedure, it’s safety record in the hands of an experienced floater-treating doctor. Their default mode is generally to recommend against treatment with the laser and to do nothing at all. I get it. I understand that position. Why would they recommend a procedure they are not comfortable with?

My concern with treating someone with new, recent-onset, or not fully healed or stable retinal issues is that they may naturally progress to a worsened condition. For instance, someone may experience a sudden shower of floaters and flashes of light. It may simply be a common posterior vitreous detachment (PVD), but while that is occurring, the peripheral retina may be at its greatest risk of developing a retinal hole or tear. If we rush into treatment of the very bothersome eye floaters with the laser, and the patient then goes on to develop a retinal detachment, it may be a not-entirely-illogical conclusion that the retinal detachment was caused by the floater treatment even if it was not.

Medico-legally, I have to look at the possible accusations and conclusions that other professionals may direct towards me. If you have your floaters treated, you then develop a retinal detachment, and if your local and trusted eye care provider states that is probably caused by the YAG laser treatment, it may create distrust and doubt at the minimum, and potentially a malpractice lawsuit.

Since floaters are not emergencies, and there is no ‘treatment disadvantage’  to waiting for treatment, I recommend waiting until unstable conditions become stable before pursuing treatment.

Here are a few unstable retinal conditions that warrant waiting until treatment:

  • New or recent-onset posterior vitreous detachment with continued peripheral ‘flashes’ (the vitreous is still ‘tugging’ on the retina placing it at risk for a retinal hole or tear)
  • Recently lasered peripheral retinal tear or hole. The argon laser is used to create local inflammation and eventually, better adhesion of the retina to the underlying sclera. It takes a few weeks for this to occur. It is not instant ‘spot-welding’ as it is sometimes described.
  • Recent retinal detachment repair
  • Macular hole, macular pucker deemed unstable possibly requiring surgery
  • Recent vitreous hemorrhage, sometime associated with new onset (larger) floaters as well as ‘thousands’ of tiny dark specks. These are the individual red blood cells. Red blood cells remain dark with pigment for up to 4 months, so even with an uncomplicated vitreous hemorrhage, it is worth waiting longer before seeking treatment. I’ll recommend at least 3-4 months to allow any chance of spontaneous improvement to occur.

If it has been months since some type of interventional repair or laser and your ophthalmologist has deemed the eye(s) to be stable, it is probably safe to proceed with lasering of eye floaters. If you have a particular situation that is not addressed here, please contact me via the form at the bottom of this page with your details. I’ll do my best to make sense of it.

-Dr. Johnson

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