Patients reported improvement in symptoms of eye floaters after treatment with a laser, according to a small US study.
Floaters become more prevalent with age and although most patients grow accustomed to them, many find them bothersome, and they can worsen visual quality. Three management options exist for floaters: patient education and observation; surgery; and the laser procedure, YAG vitreolysis, of which there are limited published studies on its effectiveness for treating floaters.
Dr Chirag P Shah and Dr Jeffrey S Heier of the Ophthalmic Consultants of Boston, randomly assigned 52 patients (52 eyes) to receive YAG laser vitreolysis (n = 36) in one session or a sham (placebo) laser treatment (control; n = 16).
Six months after treatment, the YAG group reported significantly greater improvement in self-reported floater-related visual disturbance (54%) compared with sham controls (9%). A total of 19 patients (53%) in the YAG laser group reported significantly or completely improved symptoms vs 0 individuals in the sham group. Several measures of quality of life also improved compared with those in the sham laser group, including general vision and independence. No differences in adverse events between groups were identified.
A limitation of the study was its small sample size and short follow-up period.
“Greater confidence in these outcomes may result from larger confirmatory studies of longer duration,” the authors write.
Abstract
Importance: Vitreous floaters are common and can worsen visual quality. YAG vitreolysis is an untested treatment for floaters.
Objective: To evaluate YAG laser vitreolysis vs sham vitreolysis for symptomatic Weiss ring floaters from posterior vitreous detachment.
Design, Setting, and Participants: This single-center, masked, sham-controlled randomized clinical trial was performed from March 25, 2015, to August 3, 2016, in 52 eyes of 52 patients (36 cases and 16 controls) treated at a private ophthalmology practice.
Interventions: Patients were randomly assigned to YAG laser vitreolysis or sham YAG (control).
Main Outcomes and Measures: Primary 6-month outcomes were subjective change measured from 0% to 100% using a 10-point visual disturbance score, a 5-level qualitative scale, and National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Secondary outcomes included objective change assessed by masked grading of color fundus photography and Early Treatment Diabetic Retinopathy Study best-corrected visual acuity.
Results: Fifty-two patients (52 eyes; 17 men and 35 women; 51 white and 1 Asian) with symptomatic Weiss rings were enrolled in the study (mean [SD] age, 61.4 [8.0] years for the YAG laser group and 61.1 [6.6] years for the sham group). The YAG laser group reported greater symptomatic improvement (54%) than controls (9%) (difference, 45%; 95% CI, 25%-64%; P < .001). In the YAG laser group, the 10-point visual disturbance score improved by 3.2 vs 0.1 in the sham group (difference, −3.0; 95% CI, −4.3 to −1.7; P < .001). A total of 19 patients (53%) in the YAG laser group reported significantly or completely improved symptoms vs 0 individuals in the sham group (difference, 53%; 95% CI, 36%-69%, P < .001). Compared with sham, NEI VFQ-25 revealed improved general vision (difference, 16.3; 95% CI, 0.9-31.7; P = .04), peripheral vision (difference, 11.6; 95% CI, 0.8-22.4; P = .04), role difficulties (difference, 17.3; 95% CI, 8.0-26.6; P < .001), and dependency (difference, 5.6; 95% CI, 0.5-10.8; P = .03) among the YAG laser group. Best-corrected visual acuity changed by −0.2 letters in the YAG laser group and by −0.6 letters in sham group (difference, 0.4; 95% CI, −6.5 to 5.3; P = .94). No differences in adverse events between groups were identified.
Conclusions and Relevance: YAG laser vitreolysis subjectively improved Weiss ring–related symptoms and objectively improved Weiss ring appearance. Greater confidence in these outcomes may result from larger confirmatory studies of longer duration.
Authors
Chirag P Shah; Jeffrey S Heier
[link url="https://media.jamanetwork.com/news-item/laser-treatment-reduces-eye-floaters/"]JAMA material[/link]
[link url="http://jamanetwork.com/journals/jamaophthalmology/fullarticle/2643488"]JAMA Ophthalmology abstract[/link]
[link url="http://jamanetwork.com/journals/jamaophthalmology/article-abstract/2643487"]JAMA Ophthalmology invited commentary[/link]