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Comment & Response
April 2018

Methodological and Efficacy Issues in a Randomized Clinical Trial Investigating Vitreous Floater Treatment—Reply

Author Affiliations
  • 1Ophthalmic Consultants of Boston, Boston, Massachusetts
JAMA Ophthalmol. 2018;136(4):449-450. doi:10.1001/jamaophthalmol.2018.0218

In Reply We performed this YAG vitreolysis pilot study1 to determine whether the procedure had any value in helping patients with Weiss ring floaters and if there were any obvious adverse effects. We hope the results inspire larger studies of longer duration to better understand YAG vitreolysis on a variety of floater types.

YAG vitreolysis works through 3 mechanisms: (1) plasma formation at higher energy levels, visualized as small gas bubbles; (2) the mechanical disruption of vitreous tissue; and (3) the severing of vitreous strands, which allows suspended floaters to drift away from the central visual axis. The balance between plasma formation, disruption, and severing depends on the power of the treatment, floater characteristics, and surgeon technique. Even with plasma formation and vaporization of vitreous tissue, the visual axis cannot be cleared as well with YAG vitreolysis as with vitrectomy. A comparison between YAG vitreolysis and pars plana vitrectomy would be very interesting in helping the ophthalmology community determine the differences in efficacy and safety between these 2 potential treatment options for floaters. However, such a comparison was beyond the scope of our study.