MY DOCTOR SAID THE LASER IS TOO RISKY – WHAT’S THE WORST CASE SCENARIO?

Occasionally I am asked the above question. I have already addressed the risks of laser vitreolysis elsewhere in the web site which answer most of the questions people will have about risks. What appears to be a simple question: “What’s the worst thing that can happen?” is a reasonable one, but not simply answered. Any and every medical procedure carries some risk, and even an apparently simple procedure like removing a skin mole or wart could conceivable end poorly (even death?!) if the patient is allergic to the anesthetic or antibiotics.

I think this question has a two part answer: 1). The worst conceivable outcome or complication, and 2). The LIKELIHOOD of that event occurring. Ask your eye doctor about their most commonly performed eye surgery – probably cataract surgery. Then ask them to convey the list of possible complications. It should list infection, retinal detachment, dropped lens material into the posterior part of the eye requiring a vitrectomy, chronic macular edema affecting central vision, and the worst possible outcome, blindness.

I find it interesting the double standard applied here. Admonishing eye floater sufferers seeking relief for their distracting-to-obscuring opacities in the vitreous, yet they are champing at the bit to perform cataract surgery for increasing distortion and opacity of the lens of the eye.

So what is the worst possible outcome(s) of laser vitreolysis? First, it would be a direct laser shot to the fovea of the macula of the retina.  Second, would be a direct hit to the natural crystalline lens causing a traumatic cataract. Third, an intractably elevated eye pressure unresponsive to medications or time.

What is the likelihood of any of these event happening? First, I believe the answer depends on the laser operator’s experience. Like any complex skill, it takes a lot of practice and experience to get good, and well as a few lessons along the way to better understand what can be treated as well as what should not be treated. I have been treating floaters exclusively since 2007 with thousands of procedures of experience and several million laser bursts in treating these floaters.. As of the date this is written, no patient of mine has lost vision due to any devastating, traumatic injury such as those listed here. Even so, I am obligated to list these potential negative outcomes in my informed consent form.

One laser manufacturer is promoting their YAG laser as a ‘floater treatment laser’  and any doctor purchasing that laser is promoted by the laser manufacturer web site as a floater treatment ‘specialist’. Remember, it is not the laser that treats floaters, it is the doctor.  In order to mitigate any risk of the procedure, it is imperative to choose someone with experience. The more experience, the better.

The majority of my patients have variously complex vitreous problems. I don’t get the simpler isolated Weiss Ring nearly as much as I’d like. The decision-to-treat and/or the decision-how-to-treat is difficult and humbling at times for me, even with my experience. But complexity does not necessarily correlate to risk.

Ultimately, I have found that the pat, reflexive, dismissive warnings and admonitions by your well-meaning local eye care providers are unfounded and not based on the reality and statistical likelihood of these ‘worst case scenarios’ assuming that the doctor is very experienced and places safety first.

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