There are two decades of combined experience with the laser vitreolysis procedure. It has proven itself to be a low risk procedure and an attractive to 1.) Doing nothing, and 2) the invasive and much riskier surgical vitrectomy. Using our experience combined with the others in the US performing this techniques, there have been some short term complications, but no major vision threatening complications such as retinal detachment.

Here is a listing and explanation of the major real and theoretical risks of using the laser for eye floaters:

• Inaccessible Floaters/Inability to Treat Successfully: The optics of the treating laser are designed more for use toward the front of the eye and in the central visual axis  rather than the periphery of the eye. The further back the floaters are, the treatment increases in difficulty and inefficiency. The laser energy can be blocked by small pupils, small lens implants, and made more difficult in "long" eyeballs as is typical in the nearsighted eye. Floaters in the periphery of the eye are very difficult to treat and even though we may see them quite clearly, the laser energy may be so diminished that nothing happens when the laser is activated. Some of this challenge can be compensated for by rapid, vigorous eye movements and gyrations which may allow he floater to move into a more central position. And sometimes not. Fortunately, peripheral floaters, if untreatable, tend not to be as bothersome as centrally located floaters.
• Recurrence of Floaters: The floater material that is directly hit by the laser should be permanently vaporized. That small mass of material should never come back. Immediately adjacent to the laser focal spot, the long collagen molecules may be fractured and broken into small, microscopic fragments. We theorize that one of two things may happen to this material: 1. Some of it is liberated into the fluid portion of the eye and flows out with the natural fluid drainage of the eye (trabecular meshwork), and 2). the fractured collagen molecules become "sticky" and may regroup or clump up to form a newly shaped floater. These "reformed" floaters are usually quite treatable with subsequent, follow up laser treatments. It is actually rare to be able to treat someone in just one treatment session. Most people will need a second and 3rd (and sometimes more) treatments to achieve a satisfactory outcome.This expectation of the need for re-treatments is logistically easier for those that live in the Southern California area. Those that travel longer distances may need to allow for longer stays, or leave open the possibility to return at some future date.
• Inability to Treat Some Floaters: The treatment of eye floaters is highly individualized and dynamic. It impossible to predict exactly how the floaters will behave. That unpredictability is more so in younger patients. There exists the distinct possibility that despite our best, most dedicated and meticulous effort, there may be some residual material that simply cannot be safely treated, or remains inaccessible.
• Retinal Detachment: There has never been a published or unpublished report of a retinal detachment from this procedure that we are aware of. A theoretical risk.
• Eye Pressure: In our experience, we've seen two elevations of eye pressure that respond well to eye drops and resolved over a few to several week period. Discussions with other treating ophthalmologist has revealed a similar rare incidence. We believe the broken fragments of vitreous material (fragments of collagen molecules) will sometimes overwhelm the eye's own natural drainage system and it may may take days (or even months) for the eye to clear that material out. We estimate the incidence to be 3-5 episodes per 1000 treatments based on cumulative reported and anecdotal conversations with other providers. There does not appear to be a direct correlation between the amount of treatment (number of shots or total energy used) and the elevation in pressure. There may be some predictive risk factors such as preexisting elevated eye pressures, previous cataract surgery, and dense floaters in the front, anterior portion of the eye.
• Cataract: A cataract is a change in the clarity of the crystalline lens in the eye. There always exists the potential for the creation of a (traumatic) cataract by the laser, but it would essentially take a direct hit to the lens to do so. There are very few reports of cataract being caused by the laser procedure. If the laser breaks the outer lens capsule, the cataract that develops could be a rapid-onset traumatic cataract and may develop quickly as in days or weeks. A cataract may require surgical treatment.
• Retina Injury: If the laser is aimed and fired directly at the retina, it is possible to directly damage retinal nerve cells. The laser's focused spot size is approximately 4-8 /1000's of a millimeter, so the area affected would be quite small, and possibly without any symptoms. We do not believe that even a direct hit to the retina can cause a retinal detachment. Early when the YAG laser was first developed over 20 years ago, the laser was directly fired at rabbit retinas and they could not induce or cause a retina detachment. We have experienced minor complications to the retina via laser "shock-wave" when forced to work in close proximity. This has occurred when attempting to get "that one" bothersome floater. It is a judgment call as to whether to fire the laser, and it would never be done in the central part of the vision, only peripheral. The shock wave can cause some temporary edema or swelling of the retinal nerve fiber layer or a small sub-retinal (beneath the retina) hemorrhage. Both conditions are about 0.5mm in size. When these have occurred, most of the time they are without any symptoms. When the patient was aware of anything, they might describe a faint, bluish, after-image seen when they quickly close and squeeze their eyes. This is self-limited and may only last a few weeks to a couple months.

The discussion of risks for any medical procedure is part of the informed consent process. We try to present a fair representation of the risks and potential risks of this procedure. Fortunately, virtually all risks listed above can be avoided by the experienced physician being aware of the focus of the laser at all times. Doctor Johnson is one of the most experienced ophthalmologist in this procedure and has enjoyed a very high success rate because of the careful, conscientious, and unhurried approach to each treatment.

Next we will discuss the fees of the procedure and the process for medical insurance reimbursement HERE