﻿So why is it so hard to find anybody
with much positive to say about YAG laser vitreolysis in today's video will be looking
at the good, the bad and the ugly of the procedure,
and perhaps that might shed some light on why this is.
Hey, everybody, thank you for watching.
I'm optometrist Martin Oguzie, and this channel is all about helping to see
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So if you like, the predominant sentiment
in the floater community is that YAG laser vitreolysis doesn't work very well.
Now, this is probably true also amongst
the majority of eye care professionals, such as optometrist or an ophthalmologist.
It's also probably the reason why you
won't get this procedure covered by medical health insurance
or even the National Health Service here in the United Kingdom.
So is it really that bad or are we just all overreacting?
Well, there's no doubt that there are many people who have had vitreolysis and are very
happy and there are surgeons that swear by the results of it as well.
But in this video, we're going to go through some
of the good, the bad and the ugly of the procedure as well.
So let's get straight into that right now.
I think the first great thing that is very
reassuring is the fact that YAG laser is a very common and established laser
that has been used for many years now for a whole range of different procedures.
The most common use in application
in the eye care world really is for treating the post-operative
situation that may result from a cataract operations.
And this is the treatment of thickening
of the lens capsule, which is left behind after somebody has a cataract removed.
And it does not in every case of cataract removal
but in some cases we get this thickening and this protein build-up in the capsule
that is left behind and this can make it feel like a cataract is coming back.
Now, the YAG laser is then used in a process
called YAG laser capsulotomy to remove this frosting, if you like.
This frostings build-up of this protein and it does an excellent job in removing
that very, very quickly and has a very excellent success rates as well.
Now one of the great things about
YAG laser is that it's not a laser that just indiscriminately destroys
everything in its path, but it's a laser that comes to a focal point
and at that point is where the whole energy of the laser is focused at,
that means then we can focus it at specific points within the vitreous
in the case of treating floaters.
And this is great because it means
that this laser can be used with great precision and accuracy.
I think the great thing about YAG laser vitreolysis is the fact that it's
a non-invasive procedure that doesn't require a general anaesthetic.
It's usually done with the anaesthetic eye drop
and then you have a special contact lens placed on your eye,
which allows the surgeon to be able to focus at the floaters in the eye as
well, and also stops you from blinking at the same time.
Now, the great thing about this procedure
is that it's a great alternative to invasive procedures, like a vitrectomy.
Another great point about YAG laser
vitreolysis is the fact that it's able to vaporise your floaters,
and that means it turns them into a gas, a gas vapour within the eyeball
and if this is done efficiently,
then it removes the worry about any stray floaters that are left behind.
Now, coming off the back of the good points, the first bad point that I want
to mention is the fact that it's not suitable for all kinds of floaters.
It's particularly good for floaters that are not too thick.
So the ones that are relatively flat and not too deep
and it's also good for floaters that are
located more in the centre of the eye, centre of the vitreous rather than ones
that are close to the lens or a further back towards the retina.
Now, the ones behind the retina are particularly of concern because the closer
you get to the retina, the more problematic it may be and more
risky may be of causing damage to the retina.
Now, the other key worry about floaters that are this far back in the retina is
that if the laser misses any fragments and these aren't vaporised,
then these floaters, even if they are very small, will cast a lot more noticeable
shadow onto the retina and they can become quite annoying after the procedure.
Now, with floaters that are larger and more dense and thicker,
then these floaters tend to be more problematic because the laser
will attempts to vaporise a particular point on the floater, it can start to kind
of break up the floater and cause lots of fragments
and it can make the job of the laser
operator more difficult because you've got a lot more fragments
now try and pinpoint and get rid of and it's very easy to then miss them
and leave lots of small fragments in the eye
and this can be more annoying
to the person than potentially what they had in the first place.
And that is the key bad thing that I can think of as far as YAG laser vitreolysis goes.
So let's move on to what the ugly factor
is. Now the ugly of YAG laser vitreolysis
seems to really be the fact that in a small number of cases, there is the risk
of a secondary glaucoma developing and it
seems to be the case that this risk arises when the operator attempts to treat a thick
floater and this floater result in lots of fragmentation within the eye
and over time, these floaters appear to work their way into the front chamber
in the eye that we call the anterior chamber.
And this is the area where the the aquis
humour in the eye circulates and drains out.
So like a blocked drain, these fragments then start to clog up
the drainage, leading to an increase in pressure within the eyeball.
There is then the risk of this increased
pressure leading to damage at the retinal level
and this is what we call glaucoma.
So that's a particularly nasty concern
and while glaucoma spotted early can be
treated, you know, this is a complication you really don't want to get.
Now, I'm not going to go into why and how
these fragments can work their way into the anterior chamber
but it seems to be a consequence of this fragmentation
process that happens with un-vaporised bits of the floater.
I noticed that there are more good points than there are bad and ugly points.
And I think the reason that YAG laser vitreolysis has received such a bad
press and bad rap is really because of the fact that it is
a procedure that, while it might seem straightforward,
requires quite a lot of technical know how and experience in order to,
first of all know what type of floaters can be treated successfully and also how
to manage the different kind of issues that might arise.
Having experience is critical even to helping a surgeon know which type
of patients and which type of floaters they should not be treating.
So probably some of the problems come when they treat an attempt to treat floaters
that really are not likely to yield successful outcomes.
Now, at the end of the day,YAG laser
vitreolysis may well yield successful results for the right individuals
and people who have, you know, floaters that are well suited to the procedure.
But it may well be that for the majority
of individuals with floaters, YAG laser vitreolysis isn't a viable option.
Now, I want to give credit to the floater to YouTube channel for some
of the information and the clips used in this video.
If you haven't checked that channel, that suggests that you do.
So just to get an insight into, you know,
what is involved in the treatment of floaters with YAG
laser vitreolysis and other methods as well,
he seems to be this kind of rare case
of an ophthalmologist who specialises just in treating floaters.
I'm not sure how active is on the channel at the moment, but there are certainly
a lot of great videos they're worth checking out on floater treatment.
Let me know your thoughts on YAG
laser vitreolysis if you have the procedure yourself.
Let us know how you've got on and whether you'd recommend it.
Thank you guys for watching.
Please subscribe to the channel, hit the notification bell as well
and also sharing this video really helps us out
and I look forward to catching you guys in the next video.
Take care.