Am I a Candidate For Treatment?
(originally published Oct 2012)
Everyday I get email inquiries, or posts in the comments section of this web site from people all over the world describing very briefly (and sometimes in more detail) what they experience and then asking me if they would be a candidate for treatment here in my office in Southern California.
The short answer is that “No, I can’t simply tell you that“.
Every eye is different when it comes to treating floaters. It would be irresponsible for me to tell someone that I could treat them without seeing their eye and without establishing a doctor patient relationship. What I can do is describe some of the typical characteristics that, statistically and empirically, would make someone more likely to be treatable using the laser. So you might go through this list of features and characteristics and see if you are more likely or less likely to be treatable here.
If you are younger, in your teens or older up through the age of 30-35 years or so, you will less likely be a candidate for treatment. Young people can have very bothersome moving shadows, but the source of these shadow floaters is quite often microscopic condensations that site very close to the retina. Floaters that are less than 3-4 mm from the retina are general not candidates for treatment.
If you are older, generally older than 45-50 years, you will more likely be a candidate for treatment. I can treat less than 5% of the younger age group, and 95% or so of the older age group.
The in-between group, 30-50 years of age, is harder to characterize and predict.
ONSET OF SYMPTOMS
If your floater symptoms came on very quickly, out of nowhere, then it may be associated with a posterior vitreous detachment. If the floaters have been there since your teens, or they have been very gradual, then it could be the characteristic floaters seen in younger patients. By the way, it is possible to be in your 40’s, maybe older and still have the same floaters that are typical of the younger patients.
Transparent, thread-like floaters that have very distinct border/edges, or small grape clusters or separate small round dot/specks are more likely to be located very close to the retina and are less likely to be candidates for treatment with the laser.
Larger, less distinct floaters with a softer border or edge are more likely to be further away from the retina, where they may be better candidates for treatment if the floater has a very characteristic ring-like shape or appears to be part of a ring-like shape, in the then it may be a characteristic Weiss ring type of floater. these floaters are the most successfully treated floaters in our practice. A Weiss Ring, by definition, is created as part of a posterior pictures detachment. Not all posterior vitreous detachments (PVD’s) develop Weiss rings or are even symptomatic for that matter. Weiss ring is part of the outer layer of the vitreous that peels off the back wall of the eye. they are dense and so absorbed the laser energy quite well. And they’re usually tethered in a good position in the middle part of the eye.
YOUR DOCTOR’S EXAMINATION
Here is where it gets a bit tricky. Most eye floaters are relatively difficult to see with the usual examination, devices and techniques. The ophthalmic scopes and lenses that we use are very good and designed for the anterior part of the eye to include the cornea Iris and linens and with a quick switch of lenses in the attention of the doctor is then directed to the retina in the far posterior or back of the eye. Usually the vitreous is just something you look through to get at the retina. so when you go to your local eye care provider with the complaint of moving shadows in your vision. The doctor is probably thinking floaters, but is obligated to rule out any retina pathologies such as holes, tears, hemorrhage and detachments. there’s really no incentive for the them to spend any time looking for the floaters or trying to map them out in their location in three-dimensional space. In fact, the diagnosis of floaters can be made based entirely on the patient’s description of moving shadows and the absence of any retinal pathology. What I am saying here is that the doctor does not necessarily need to see the floaters for them to confidently make the diagnosis of floaters. This may lead to a confused answer when I asked the potential patient. If their doctor saw the floaters.
The reason this may be important is that if your eye doctor quite confidently saw a prominent floater in the mid-portion of the eye, and at the time of the examination exclaimed something like: “Oh, there it is. That’s a doozy.” that sounds to me like a positive affirmation that they are actually seeing the floater in question. If on the other hand, they mutter something about eye floaters and that you just had to get used to them than we really don’t know whether they actually saw the floaters are not.
floaters that are readily and obviously seeing in the middle part of the eye are much more likely to be treatable. Define and microscopic floaters associated with younger patients are extraordinarily difficult to see on examination. Sometimes I might spend 10 to 15 minutes trying to find them. And I would imagine that I am more motivated than most doctors to try to find a document these floaters.
Now, as with everything, there are exceptions to these general guidelines. There is what I now call the smokescreen floater. You can read about it on a recent post. All that does is throw up a smokescreen and confuse the picture. For these reasons and more, I find it not very helpful to rely on other eye doctor’s evaluations of eye floaters in the pre-visit screening process.
PRE-EXISTING CONDITIONS OR PREVIOUS SURGERIES
If you have had a previous corneal refractive surgery such as LASIK, PRK, or RK, there may be some decrease in the energy delivered by the laser but generally it’s something that can be dealt with at the time of treatment. I have had many patients with these previous surgeries with quite successful treatments. If you have had previous cataract surgery with implant lens placement, the same prognosis applies. Whereas the corneal refractive surgeries tend to introduce distortion or scarring into the cornea, with cataract surgery. There is the likelihood of having to work through a smaller aperture determined by the diameter of the artificial implant lens.
Many of my patients have had previous laser to the retina to treat small holes or early tears or possibly to prophylactically treat peripheral retinal thinning and pathology. The YAG laser treatment for floaters should not be affected by this previous treatment nor should it put the retina and any particularly increased risk.
If there is any active retinal problems such as inflammation or recent hemorrhage or a history of elevated eye pressure is or any other condition, then it warrants a discussion with the patient as to whether those conditions may country indicate treatment with the YAG laser.
The purpose of this post is purely educational and is not meant to definitively determine whether or not he may be a candidate for treatment with the YAG laser for your eye floaters. It is just meant to answer some of the common questions I receive as well as to generally place you into a more likely to be treatable or a less likely to be treatable category. This is particularly important as many of my patients have to travel long distance with no small expense associated with it.