Sir,
The option of Nd:YAG vitreolysis as a strategy to attenuate troublesome floaters, as proposed by Larry Benjamin and colleagues,1 is an attractive proposition. Posterior vitreous detachment in particular is an exceedingly common presentation, and notably for some patients the symptoms are of considerable inconvenience.
It is interesting that in their study the conventional fears of cataract, retinal detachment, and cystoid macular oedema associated with Nd:YAG were not realised over a relatively protracted follow-up. Although the technique is described as being selectively successful, it may serve as an accessible management option in the small group of patients who are inordinately obsessive about their vision, or those who simply have a high visual demand.
As with all iatrogenic procedures, following an assessment of the severity of the symptoms and the ocular anatomy, it would be possible to discuss the risks and benefits of the intervention before obtaining consent and arranging treatment via dexterous hands. With regard to actual efficacy, perhaps the closest analogy is that of cataract extraction in the context of concurrent age-related macular degeneration, where the surgeon cannot invariably guarantee visual improvement. Since Nd:YAG equipment is ubiquitous in eye units and significant vitreous floaters (eg Weiss ring on fundoscopy) common, the above approach could potentially and selectively be a useful addition to the application of laser in outpatient ophthalmological practice.
References
Delaney YM, Oyinloye A, Benjamin L . Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters. Eye 2002; 16: 21–26.
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Gandhi, J. Nd:YAG vitreolysis as a treatment for vitreous floaters. Eye 17, 113 (2003). https://doi.org/10.1038/sj.eye.6700356
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DOI: https://doi.org/10.1038/sj.eye.6700356