Special Focus, Retina, Original Article

The effectiveness of laser vitreolysis for vitreous floaters in posterior vitreous

Wan Ni Goh, Mushawiahti Mustapha, Syed Z S Zakaria1, Mae-Lynn C Bastion

Purpose: To determine the effectiveness of laser vitreolysis in terms of contrast sensitivity function (CSF) and Access this article online
vision‑related quality of life (VRQol) for symptomatic floaters due to posterior vitreous detachment (PVD). Website:
Materials: This is an interventional study that involved 57 eyes of 45 patients with symptomatic floaters www.ijo.in
for more than 3 months. Patients underwent one to three sessions of vitreolysis via Neodymiun‑doped DOI:
Yttrium Aluminum Garnet (Nd:YAG) laser. We examined the CSF using the computer programs Freiburg 10.4103/ijo.IJO_3198_21
Acuity and Contrast Test (FrACT) and VRQoL survey using the National Eye Institute Visual Function PMID:
*****
Questionnaire‑25 (NEI VFQ‑25) before, and 1 month after, vitreolysis. Results: Twelve patients had both eyes
lasered and 33 patients had one eye lasered. The mean CSF improved from 3.20 ± 0.85%W to 2.64 ± 0.63%W Quick Response Code:
1 month after vitreolysis. Each use of the laser showed a significant mean difference in CSF (%W) as
analyzed by paired t‑test before and after the first laser (0.29 ± 0.49%W [P ≤ 0.001]); after the first and second
laser (0.35 ± 0.53%W [P = 0.01]); and after second and third laser (0.21 ± 0.31%W [P = 0.02]). There was
improvement in the median of four subscales in NEI VFQ‑25 scores post treatment: general vision (z = −3.30,
P = 0.001), near activity (z = 3.396, P = 0.001, distance activity (z = −2.788, P = 0.005), and mental health (z =
−2.219, P = 0.026). The mean scores increased to 79.55 ± 9.45 from the baseline 75.06 ± 9.69 (P ≤ 0.001). No
adverse events were recorded 1 month after the laser treatments. Conclusion: Vitreolysis by Nd:YAG laser
improved the CFS and VRQoL in symptomatic PVD patients.

Key words: Contrast sensitivity function, floaters, laser vitreolysis, neodymiun‑doped yttrium aluminum
garnet laser, posterior vitreous detachment

Vitreous floaters in posterior vitreous detachment (PVD) cast Treatments for symptomatic floaters include conservative
shadows on the retina, resulting in reduced quality of vision observation, laser vitreolysis, and pars plana vitrectomy.
and degradation of contrast sensitivity function (CSF).[1] PVD Vitrectomy has been the standard treatment with a significant
prevalence rate was 2.7% in a study in China.[2] Older age, risk of complications, including endophthalmitis, retinal tear,
female gender, and myopia are the risk factors for PVD.[2] retinal detachment, macular edema, cataract, or glaucoma.[1]
Symptomatic floaters were not treated in past decades. Neodymium‑doped yttrium aluminium garnet (Nd:YAG)
However, there is an underestimation of its adverse laser vitreolysis is an alternative treatment. It is non‑invasive,
effects.[3,4]An electronic survey reported that 76% of smartphone painless, short duration, immediate effect, low‑cost,
users reported seeing floaters, and 33% of them had noticeable and convenient, as it can be performed as a clinic‑based
visual impairment.[3] On average, patients were willing to procedure.[11] Nevertheless, clinical studies have demonstrated
accept an 11% risk of death and 7% risk of blindness and were highly variable success rates from 0 to 100% in vitreolysis for
willing to trade off 1.1 years out of every 10 years of their the past 2 decades.[12]
remaining lives to be symptom‑free.[4]
Older techniques have a lower success rate and safety
Visual acuity (VA) was not significantly affected in patients profile. [13,14] Inconsistency in energy delivery, lack of
with symptomatic floaters.[5,6] However, CSF was diminished visualization of the vitreous in full depth, and suboptimal
by 51.2% to 67% in PVD.[6‑10] The National Eye Institute Visual power usage in older techniques caused variable outcomes
Functioning Questionnaire‑25 (NEI VFQ‑25) was utilized in vitreolysis.[15] For this study, we utilized a midvitreous
as the subjective measurement of vision‑related quality of contact lens and multi‑modality Nd:YAG laser specifically
life (VRQoL) in many studies. NEI VFQ‑25 scores were 28.3% designed for vitreolysis by its coaxial illumination technique,
lower among patients with floaters (73.2 ± 15.6, N = 16) than which allowed titration of red reflex by moving the slit‑lamp
in age‑matched control subjects (93.9 ± 8.0, N = 12, P < 0.001).[8]

This is an open access journal, and articles are distributed under the terms of
Department of Ophthalmology Universiti Kebangsaan Malaysia the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
(UKM) Medical Centre, 1Department of Paediatrics, Universiti which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
Kebangsaan Malaysia (UKM) Medical Centre, Universiti Kebangsaan
the identical terms.
Malaysia, Kuala Lumpur, Malaysia
Correspondence to: Prof. Dr Mae Lynn Catherine Bastion, Department For reprints contact: [email protected]
of Ophthalmology, Faculty of Medicine, UKM Medical Center, Cheras,
56000 Kuala Lumpur, Malaysia. E-mail: [email protected] Cite this article as: Goh WN, Mustapha M, Zakaria SZ, Bastion ML. The
Received: 03-Jan-2022 Revision: 05-Apr-2022 effectiveness of laser vitreolysis for vitreous floaters in posterior vitreous
detachment. Indian J Ophthalmol 2022;70:3026-32.
Accepted: 18-Apr-2022 Published: 29-Jul-2022

© 2022 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow

beam to focus the beam on vitreous opacities.[15] for better with assistance from the investigator. Written permission was
visualization. obtained from the author of the Malay version.
Studies have examined symptomatic PVD patients treated NEI VFQ‑25 contains 25 targeted questions, representing 11
with laser vitreolysis and assessed the efficacy of the treatment vision‑related and general health subscales. Individual scores
by looking into their CSF10 and VRQoL.[7,16,17] The majority for all the sections were tabulated according to the described
of studies did not address the differences in CSF in various scoring algorithm published.[23]
ethnicities. Interestingly, a study in Singapore demonstrated
that the Chinese had lower CSF than other races (Malays, Subsequently, the patients underwent slit‑lamp examination,
Indians, Eurasians, and others) among their adult population.[18] Goldman applanation tonometry, and then the eyes were
dilated for vitreous and fundus examination using fundus
Our study aims to determine the treatment efficacy of biomicroscopy, and binocular indirect ophthalmoscopy (BIO),
vitreolysis by evaluating the CSF and VRQoL in patients with and Goldmann 3‑mirror examination. Full pupil dilatation
symptomatic floaters due to PVD in a Malaysian population. was achieved with tropicamide 1.0% (Mydriacyl, Alcon)
The secondary objective was to investigate the safety of the and phenylephrine 2.5% (Myfrin, Alcon). Proparacaine
vitreolysis procedure. 0.5% (Alcaine, Alcon) was applied to anesthetize the surface.
Self‑prepared povidone 5% eyedrop was also added to the
Methods conjunctival sac after the commencement of the COVID‑19
This was a prospective interventional study conducted from pandemic in March 2020. The drawing of the floaters was
June 2017 until Oct 2020. The relevant Research and Ethics correlated to the finding from the ophthalmoscopy. The
Committee approved the study FF-2017-336, which adhered distance from the floaters to the retina was assessed subjectively.
to the tenets of the Declaration of Helsinki. Written informed Next, optical coherence tomography (OCT) (SpectralisTM,
consent was obtained from each subject after a full explanation Heidelberg Engineering, Heidelberg, Germany) was used to scan
of the procedure. the central macula thickness (CMT) before and 1 month after the
Study participants were recruited via referral from private treatment. Color photography of the fundus and vitreous was
ophthalmology centers, health clinics, and patient self‑referral attempted by a fundus camera (TRC‑50DX Type 1A, Topcon, Japan)
by emailing investigators. Flyers in hard and soft copy were to record the floaters. These two investigations were performed by
distributed to promote this study to the public. different technicians with no less than 3 years experience.

Subjects were eligible if they were 18 years and older; had Laser vitreolysis was performed by a single ophthalmologist
symptomatic floaters for at least 3 months; and had been who was trained in vitreoretinal diseases with over 10 years
diagnosed with PVD with the presence of a Weiss ring or any experience using Multi‑Modality Nd:YAG laser (EllexUltraQ
form of vitreous opacity in the mid vitreous cavity. Subjects Reflex™, Ellex Medical, Australia) and contact lenses Ocular
were excluded if there was high myopia (greater than − 6 Karichkoff 21 mm OJKY‑1 vitreous lens, Ocular Karichkoff
diopters); asteroid hyalosis; floaters inaccessible with available off‑Axis OJKPY‑25 vitreous lens, or Ocular Peyman wide field
lasers and lenses; floaters located near to the crystalline lens OPY‑25 (Ocular instrument, Washington, USA). YAG laser
or the retina; the presence of corneal or lenticular opacities or lens was used with polyacrylic coupling gel (Siccapos gel®,
any media opacity that may interfere with treatment; floaters URSAPHARM).
deemed to require more than 5 treatment sessions (where The laser settings were based on the EllexUltraQ reflex™
surgical intervention is the best treatment course), elevated operator manual.[24] The laser was initiated with a lower power
intraocular pressure (IOP) and on IOP lowering medication; of 1.3 mJ and slowly escalated by observing the formation of
found to have a retinal tear or retinal detachment (RD) on initial
gas bubbles from the floaters and observing the disruption
examination, history of RD repair in either eye; maculopathy
and movement of the floaters. The number of shots per session
of any kind; moderate or severe dry eye; ocular surgery of any
was limited to approximately 600 if the floaters could not be
kind in preceding 2 months; or psychiatric problems that may
eliminated with a lower number of shots. Laser power and the
recur or worsen.
number of shots per session were recorded.
The sample size was determined by Cohen’s effect size.[19]
Thirty minutes after the laser, the patient was re‑examined
The recommended sample size was 45 subjects, and a near
to check the IOP, retinal tear, and hemorrhage. Guttae
moderate effect of 0.6 with a power of 80% was selected.
dexamethasone sodium phosphate 0.1% (Maxidex®, Alcon)
Forty‑five patients were recruited for laser vitreolysis.
was prescribed every 6 h for 1 week. Patients were counseled
The VA of recruited subjects was taken with ETDRS, regarding the symptoms of retinal tear or RD and advised
followed by the Freiberg Acuity and Contrast Test (FrACT), to return should they experience floaters and flashes or
which is available online.[20] Automated software with tumbling curtain‑like visual field loss.
monochromatic Landolt C optotype was used. Patients were
Patients were reviewed 1 month later after the last treatment.
required to dark‑adapt for 2 min, and the distance to the monitor
Laser vitreolysis was completed if patients’ symptoms had
was 2.9 m. This gave the mesopic reading. The Weber Index (WI)
resolved, floaters could not be found or were too close to the
was automatically calculated by the program. A higher WI (%W)
retina or lens. If patients were still symptomatic after three
reflected a lower CSF. A brief history was taken from each
sessions, they could continue their treatment but were excluded
patient who also drew the floaters they had seen subjectively.
from the study. Due to financial constraints, the study could
The patient answered the NEI VFQ‑25, which has been not be extended to include patients more than 3 months from
validated in two languages (Malay[21] and English[22] versions), the initial treatment.
3028 Indian Journal of Ophthalmology Volume 70 Issue 8

Statistical analysis was performed using the IBM Statistical Table 1: Baseline characteristics and demographic data of
Package for the Social Sciences software, version 22 (SPSS subjects
22.0, Inc., Chicago, IL, USA). The mean change in CSF in
WI at each session of the laser was compared with paired Parameter Values (percentage
t‑test. A subjective assessment of VRQoL by NEI VFQ‑25 was %) [range]
analyzed by the Wilcoxon signed ranks test. The analysis of CSF Total number of patients 45
was based on the number of eyes; however, the VRQoL analysis Total number of eyes 57
used the number of patients. Other continuous variables (e.g., Mean age (years) (range) 60.4±11.14 [33-87]
VA, IOP, and CMT) were analyzed according to the number Gender
of eyes. The difference in CMT was compared using a paired‑t Female 30 (66.7%)
Male 15 (33.3%)
test, whereas the IOP and CMT values were compared using
Ethnicity
the Wilcoxon signed ranks test. A P value of less than 0.05 was
Malay 24 (53.3%)
considered statistically significant. Chinese 20 (44.5%)
Indian 1 (2.2%)
Results Laterality
Fig. 1 shows the consort flow diagram of the study. Forty‑five Unilateral 33 (73.3%)
patients and 57 eyes were treated. Thirty‑four (75.6%) patients Bilateral 12 (26.7%)
Mean duration of floaters (months) 18±3.59 [4-120]
became asymptomatic within three laser sessions. Six (13.3%)
Refractive error (eyes)
patients remained symptomatic and required additional
Myopia
laser treatment; all of them had mixed or amorphous types of Mild (0-1.5D) 19 (33.3%)
floaters. The remaining five (11.1%) patients did not undergo Moderate (1.5-6.0D) 15 (26.3%)
laser due to the inability to visualize the floaters or the floaters Emmetropia 11 (19.3%)
were adjacent to the retina. Although not symptom‑free, there Hyperopia 12 (21.1%)
were improvements compared to pre‑treatment. Lens status (eyes)
Phakia 36 (63.2%)
Demographical data are displayed in Table 1. The Pseudophakia 21 (36.8%)
female‑to‑male ratio is 2:1. Malay and Chinese were almost Pattern of floaters (eyes)
equal in number. Most patients only complained of floaters in Single Weiss ring 8 (14.0%)
one eye. Most floaters were in a mixed pattern. Clump/cloudy 14 (24.6%)
Multiple mixed pattern (ring/
T h e l ogM A R VA va l u e s we r e n o t s i g nific antly streak/dot/ 35 (61.4%)
changed (median: 0.2 vs. 0.2, interquartile range [IQR]: 0.2– amorphous/cloudy/clump)
0.2 vs. 0.2–0.2, P = 1.00). The baseline CSF ranged from 1.49%W Number of laser sessions (eyes)
to 5.32%W with a mean of 3.20 ± 0.85%W. Table 2 shows the CSF 1 22 (38.6%)
value at baseline, first laser, second, and third laser sessions. 2 10 (17.5%)
When the WI was compared to the previous visit during each 3 25 (43.9%)
visit, there was a statistical improvement in the CSF. Mean laser session 2.05 times
Laser setting
Table 3 shows the comparison of VRQoL before and Mean laser energy per shot (mJ) 2.5±0.55 [1.3-4.0]
after the final treatment. There was a statistically significant Mean number of laser shot per
improvement in four subscales: general vision, near activity, session 348±138 [31-603]
distance activity, and mental health. The mean score was Mean laser power per
75.06 ± 9.69 at baseline and improved to 79.55 ± 9.44 after session (mJ) 850.6±417.6 [74.0-1855.0]
treatment (P = 0.00). Mean total laser power per
eye (mJ) 1730.8±936.5 [135.0-3732.0]
Patients were reviewed 1 month after vitreolysis. Fig. 2 gives
an example of the posterior findings after successful vitreolysis
in a subject from the study. No adverse events were found.
OCT was used to measure the CMT revealed the mean CMT our study ranged from 1.49%W to 5.32%W with a mean of
of 269.19 ± 24.71 µm became 268.77 ± 24.07 µm; however, the 3.20 ± 0.85%W. There was an 18.56% improvement in our study
difference was not significant (P = 0.527) 1 month after laser after vitreolysis. Patients who required more than one session
treatment. The median IOP was 14 mmHg, which was equal showed significant improvement at each subsequent treatment.
before and 1 month after the treatment (IQR = 12–14 mmHg A study mentioned that amorphous cloud opacities
vs. 12–14 mmHg, P = 0.742). required higher energy than solitary Weiss ring to remove
by vitreolysis.[15] Better results and higher patient satisfaction
Discussion scores were notably seen with solitary Weiss rings.[15] This
The study was able to answer the objective of the study. is concordant with our study, all six (10.5%) patients who
Vitreolysis improves the CSF after each session. It safely required more than three sessions presented with multiple
improves at least four of the subscales of the NEI VFQ‑25. amorphous vitreous opacities. Nineteen out of the 22 eyes that
underwent a single session of laser were the eyes with Weiss
Contrast sensitivity function (CSF)
ring or solitary opacities. Most eyes in our study had mixed
The CSF in patients.[5] with PVD from other studies ranged patterns of floaters that needed more than one session, which
from 1.19%W (normal) to 5.59%W (worse),[5,8] whereas, in meant higher total power.
August 2022 Goh, et al.: Efficacy of laser vitreolysis in posterior vitreous detachment 3029

Figure 1: Consort flow diagram

Table 2: Comparison of CSF by Weber Index (%W) before and after laser vitreolysis
Mean Weber Paired differences
Index (%W)±SD
Mean Weber 95% confidence interval Significance
Index (%W)±SD of the difference (2‑tailed)
Pair 1
Baseline CSF 3.20±0.85 0.29±0.49 0.16‑0.42 <0.001
CSF after first laser 2.90±0.82
Pair 2
CSF after first laser 3.04±0.89 0.35±0.53 0.16‑0.53 0.001
CSF after second laser 2.69±0.59
Pair 3
CSF after second laser 2.72±0.66 0.21±0.32 0.08-0.34 0.002
CSF after third laser 2.51±0.66
Analysis by paired t‑test

Table 3: The comparison of VRQoL by NEI VFQ‑25 before and 1 month after laser vitreolysis
Subscales Median Of Interquartile range Median of Interquartile range Z Asymptomatic
pre‑treatment (IQR) Pre‑treatment post‑treatment (IQR) Post treatment sig (2 tailed) P
General health 50.00 50.00-75.00 50.00 50.00-75.00 ‑0.164 0.870
General vision 60.00 60.00-80.00 80.00 60.00-80.00 ‑3.300 0.001
Ocular pain 75.00 62.50-87.50 75.00 62.50-100.00 ‑1.780 0.075
Near activity 66.67 58.33-83.33 83.33 58.33-83.33 ‑3.396 0.001
Distance activity 75.99 58.33-91.67 83.33 75.00-100.00 ‑2.788 0.005
Social function 100.00 75.00-100.00 100.00 75.00-100.00 ‑1.209 0.227
Mental health 75.00 62.50-87.50 81.25 71.88-93.75 ‑2.219 0.026
Role difficulty 62.50 50.00-87.50 75.00 50.00-100.00 ‑1.534 0.125
Dependency 83.33 75.00-100.00 91.67 75.00-100.00 ‑1.180 0.238
Driving 66.67 50.00-83.33 75.00 58.33-83.33 ‑1.754 0.079
Color vision 100.00 75.00-100.00 100.00 75.00-100.00 ‑0.228 0.820
Peripheral vision 75.00 75.00-100.00 100.00 75.00-100.00 ‑1.159 0.247
Analysis by Wilcoxon signed ranks test

A retrospective comparative study by Nguyen et al.[10] as symptomatic floaters may be associated with depression and
found that there was 130% degradation of CSF in untreated anxiety.[4] Our result is encouraging because laser vitreolysis
vitreous floaters. However, there were no significant changes in improved the mental well‑being of our patients.
CSF (P = 0.17) after Nd:YAG vitreolysis in 38 patients, differing
from our study, possibly because there was a control group. Most of our patients’ near vision was affected by floaters,
Our study compared the changes to patients’ baseline. This may especially during reading and looking at the bright screen of
have resulted in some bias. Nevertheless, our study has a larger electronic gadgets due to the white background that causes
number of treated eyes. Both studies were conducted under the floaters to be noticed obviously. Therefore, removal of the
mesopic lighting that introduces a possibility of inaccuracy opacities will improve near vision.[17]
because the impact of vitreous floaters varies depending on Other parameters that were studied
ambient and background lighting. Unlike the previous study,
our study was performed with only a single experienced No adverse effects on the visual acuity, IOP, and macular
vitreoretinal surgeon to provide homogeneity in intervention thickness were noticed, providing reassurance to patients with
and minimize variability in surgeons’ performance. glaucoma and patient prone to macular edema such as diabetes.
However, a formal study is still required.
Visual‑related quality of life
Discussion of laser setting
Subjective VRQoL in Nd:YAG treated patients is measured using
NEI VFQ‑25 in a few studies.[7,16,17] The general composite score in Katsanos et al.[25] proposed that laser vitreolysis was indicated
NEI VFQ‑25 increased from 71.44 ± 12.77 to 88.54 ± 12.73 6 months if the floaters were more than 2 mm from the retina and more
after laser vitreolysis.[16] There was a significant improvement in than 5 mm from the crystalline lens. We excluded patients
subscale groups such as general vision,[7,16] peripheral vision,[7,16] with floaters that were too close to the retina to prevent
role difficulties,[7,16] dependency,[7,16] and near vision.[17] We complications. However, the nature of the PVD with liquefied
had similar findings in the improvement of general vision vitreous causes high mobility in floaters. The impact of the laser
and near vision. Additionally, our study demonstrated shot can cause the further thrust of the floaters nearer to the
significant improvement in distance vision and mental health retina. We abort the procedure when that happened.
August 2022 Goh, et al.: Efficacy of laser vitreolysis in posterior vitreous detachment 3031

Figure 2: Fundus photography before and after laser vitreolysis. (Left) Black arrow shows a single small clump floater in front of the optic
disc; (Right) White arrow shows minimal remnant of vitreous opacity left after vitreolysis. Patient was asymptomatic after one session of laser
so no further treatment was given

A study using the B‑scan ultrasound probe to view the to 2.51 ± 0.66%W. The post vitrectomy CSF was greater because
behavior of the vitreous during laser procedure had found the CSF was worse at the start. Both procedures improved CSF
no movement of vitreous 1 mm or greater around the plasma levels. Unlike laser vitreolysis, which only removes culpable
creation and posterior hyaloid despite a high energy setting of floaters, vitrectomy removes most if not all vitreous opacities.
7 mJ.[15] From our experience, the surgeon should continuously No retinal breaks, infection, or glaucoma were found after a
gauge the distance of floaters to the retina during the procedure mean of 17.5 months of follow‑up in 60 patients after vitrectomy
to avoid retinal hemorrhage from lasering the retina. In for floaters. However, 23.5% of patients had cataract removal
principle, if the retina was in focus behind the floater when in an average of 15 months after vitrectomy. Vitrectomy, the
the aiming beam was in focus on the floater, treatment was more‑invasive technique, is also generally safe with low rate of
not performed. adverse events. Hence, more extensive or dense floaters, and
Shah’s study that only recruited patients with symptomatic in older age patients with cataracts can be given the option of
Weiss ring appearance revealed greater improvement in a vitrectomy.
symptom of floaters (54%) that were treated by laser vitreolysis Safety
than controls (9%)[7] is similar to our study where patients
Complications of laser vitreolysis include elevated IOP leading
enjoyed a high rate of symptom improvement after one
to IOP spikes; cataracts, including posterior capsule defects
treatment session. However, Shah’s study did not include
requiring cataract surgery; retinal tear; retinal detachment;
amorphous floaters unlike ours. They had a mean of 218 laser
retinal hemorrhages; scotomas; and an increased number of
shots with a mean power of 1316 mJ in a single laser session.
floaters.[13,15,26] Many studies show no adverse outcome, with
Our study, therefore, resulted in a higher mean power (1730.8
most retrospective studies with follow‑up of at least 6 months
mJ) and more shots (348 shots) and sessions (mean: 2.05)
being relatively short to conclude the safety of this procedure.
overall. [7,10,14,16]
Our study confirmed this; however, our follow‑up was
The energy of the vitreolysis laser should start at the much shorter.
minimum level and be titrated up according to the optical
breakdown ability in the vitreous cavity. The lower energy Strengths and limitations
levels disrupt floaters without eliminating them.[25] Delaney’s The limitation of our study was the inclusion of floaters of
study using relatively low energy (the total mean energy of 510 various kinds. Another consideration is the treatment period of
mJ) resulted in a 38.3% success rate.[14] Conversely, excessively the study as limiting laser to three sessions does not indicate the
high energy can cause the formation of cavitation bubbles that real‑life situation. Our study excluded those who needed more
move within the vitreous cavity‑causing microscopic retinal than three vitreolysis. The question arises regarding the efficacy
damage.[25] Besides, the tissue evaporation and the mechanical of laser vitreolysis in this group of patients when vitrectomy
effect from the shock waves may cause retinal damage and is not an option. Furthermore, the post‑laser monitoring of
even RD.[25] However, our study safely use a higher total mean 1 month may be too short to observe late complications of
energy level of over 1000 mJ. Nd:YAG laser vitreolysis.
Vitrectomy was stated as a definitive cure for symptomatic The strength of our study was that a single operator
floaters. A study by Sebag et al.[8] treated their patients using 25 performed laser vitreolysis using a standardized technique.
G vitrectomy. Sixteen patients’ CSF improved from 4.0 ± 2.3%W The data were collected for the first time in Southeast Asian
to 2.2 ± 1.5%W. In our study, CSF improved from 3.20 ± 0.85%W patients in a prospective manner.
3032 Indian Journal of Ophthalmology Volume 70 Issue 8

A better study design for future studies is to use a after neodymium: Yttrium‑aluminum‑garnet laser vitreolysis.
randomized controlled group with a larger sample size for the Ophthalmology 2019;126:1517‑26.
treatment efficacy and a longer observation. 11. Luo J, An X, Kuang Y. Efficacy and safety of yttrium‑aluminium
garnet (YAG) laser vitreolysis for vitreous floaters. J Int Med Res
Conclusion 2018;46:4465‑71.
12. Milston R, Madigan MC, Sebag J. Vitreous floaters: Etiology,
Vitreolysis by Nd: YAG laser improved the CSF as measured diagnostics, and management. Surv Ophthalmol 2016;61:211‑27.
by FrACT. Vitreolysis also improved VRQoL as measured by
13. Little HL, Jack RL. Q‑switched neodymium: YAG laser surgery of
NEI VFQ‑25 overall and in the subscales of general vision, near the vitreous. Graefe’s Archr Clin Exp Ophthalmol 1986;224:240‑6.
vision, distance vision, and mental health. No adverse events
14. Delaney YM, Oyinloye A, Benjamin L. Nd: YAG vitreolysis and
were seen in the short term.
pars plana vitrectomy: Surgical treatment for vitreous floaters.
Financial support and sponsorship Eye (London, England) 2002;16:21‑6.
Nil. 15. Singh IP. Modern vitreolysis‑YAG laser treatment now a
real solution for the treatment of symptomatic floaters. Surv
Conflicts of interest Ophthalmol 2020;65:581‑8.
There are no conflicts of interest. 16. Sun X, Tian J, Wang J, Zhang J, Wang Y, Yuan G. Nd: YAG laser
vitreolysis for symptomatic vitreous floaters: Application of
References infrared fundus photography in assessing the treatment efficacy.
J Ophthalmol 2019;2019. doi: 10.1155/2019/8956952.
1. Huang LC, Yee KMP, Wa CA, Nguyen JN, Sadun AA, Sebag J.
17. Souza CE, Lima LH, Nascimento H, Zett C, Belfort Jr R. Objective
V.B.8. Vitreous Floaters and Vision: Current Concepts and assessment of YAG laser vitreolysis in patients with symptomatic
Management Paradigms. 2014. 10.1007/978-1-4939-1086-1_45. p. vitreous floaters. Int J Retina Vitreous 2020;6:1‑5. doi: 10.1186/
771-88. s40942‑019‑0205‑8.
2. Shen Z, Duan X, Wang F, Wang N, Peng Y, Liu DTL, et al. Prevalence 18. Oen FT, Lim TH, Chung MP. Contrast sensitivity in a large adult
and risk factors of posterior vitreous detachment in a Chinese adult population. Ann Acad Med Singap 1994;23:322‑6.
population: The Handan eye study. BMC Ophthalmol 2013;13:1‑6.
doi: 10.1186/1471‑2415‑13‑33. 19. Cohen J. Statistical power analysis for the behavioral sciences.
Academic Press Inc. New York. 2013.
3. Webb BF, Webb JR, Mary CS, North CS. Prevalence of vitreous
floaters in a community sample of smartphone users. Int J 20. Freiburg Visual Acuity & Contrast Test – Homepage.
Ophthalmol 2013;6:402‑5. Available from: https://michaelbach.de/fract/. [Last accessed on
2021 Jul 07].
4. Kim Y‑K, Moon SY, Yim KM, Seong SJ, Hwang JY, Park SP.
21. Azreen RA, Adlina AR, Mohtar I, Ahmad MS, Shatriah I. The study
Psychological distress in patients with symptomatic vitreous
of correlation of quality of life assessment with visual fuction
floaters. J Ophthalmol 2017;1‑9. doi: 10.1155/2017/3191576.
among kelantan glaucomatous patients. Med J Malaysia 2010.
5. Mamou J, Wa CA, Yee KMP, Silverman RH, Ketterling JA, Available from: http://www.e‑mjm.org/2010/CRC_2010_supA.
Sadun AA, et al. Ultrasound‑based quantification of vitreous pdf. [Last accessed on 2021 Jul 07].
floaters correlates with contrast sensitivity and quality of life.
22. Visual Function Questionnaire (VFQ‑25) | RAND. https://www.
Invest Ophthalmol Vis Sci 2015;56:1611‑7.
rand.org/health‑care/surveys_tools/vfq.html. [Last accessed on
6. Garcia GA, Khoshnevis M, Yee KMP, Nguyen‑Cuu J, Nguyen JH, 2021 Jul 07].
Sebag J. Degradation of contrast sensitivity function following
23. The National Eye Institute 25‑Item Visual Function Questionnaire
posterior vitreous detachment. Am J Ophthalmol 2016;172:7‑12.
(VFQ‑25).
7. Shah CP, Heier JS. YAG laser vitreolysis vs sham YAG vitreolysis
24. PROCEDURE GUIDE: VITREOUS OPACITIES. Available from:
for symptomatic vitreous floaters: A randomized clinical trial.
https://www.ellex.com/uploads/Ellex‑Laser-Procedure-Guide-Vitr
JAMA Ophthalmol 2017;135:918‑23.
eolysis‑Opacities‑VB0002H‑A4‑ELECTRONIC.pdf. [Last accessed
8. Sebag J, Yee KMP, Wa CA, Huang LC, Sadun AA. Vitrectomy for on 2021 Jul 07].
floaters: Prospective efficacy analyses and retrospective safety 25. Katsanos A, Tsaldari N, Gorgoli K, Lalos Fotios, Stefaniotou M,
profile. Retina (Philadelphia, Pa) 2014;34:1062‑8. Asproudis I. Safety and efficacy of YAG laser vitreolysis for
9. Garcia GA, Khoshnevis M, Yee KMP, Nguyen JH, Nguyen‑Cuu J, the treatment of vitreous floaters: An overview. Adv Ther
Sadun AA, et al. The effects of aging vitreous on contrast sensitivity 2020;37:1319‑27.
function. Graefes Arch Clin Exp Ophthalmol 2018;256:919‑25. 26. Hahn P, Schneider EW, Tabandeh H, Wong RW, Emerson GG.
10. Nguyen JH, Nguyen‑Cuu J, Yu F, Yee KM, Mamou J, Silverman RH, Reported complications following laser vitreolysis. JAMA
et al. Assessment of vitreous structure and visual function Ophthalmol 2017;135:973‑6.