Zapping Eye Floaters With Laser Viewed As Risky

Too much risk, too little benefit, surgeons warn

Earlier this summer, the Associated Press wrote a widely-circulated gee-whiz story about an unorthodox treatment to remove the "floaters" that many people encounter in their vision as they age.

The AP enthusiastically reported on a controversial laser procedure practiced by a Northern Virginia eye surgeon, John Karickhoff, quoting Karickhoff as claiming a "success rate of better than 90%."

Of course, if the 90% claim is accurate, that would mean the procedure has a 10% failure rate -- way too high for the not insubstantial risk it involves, other eye surgeons say.

What are floaters? And, if you have them, should you worry about them?

They're basically benign, medical authorities agree. As we age, the eyes internal fluid -- called the vitreous humor -- shrinks very gradually, with some of the collagen breaking off and floating around in the front of the eye.

Floaters can look like specks, filaments, rings, dots, cobwebs or other shapes. They are the most vivid when you are looking at the sky or a white surface such as a ceiling. They move as your eyes move and seem to dart away when you try to look at them directly.

In recent years Karickhoff and a small number of other ophthalmologists have started offering their laser treatment for the removal of these floaters. But other surgeons cringe at the notion.

"Don't you even think of having that," a Northern Virginia ophthalmologist advised a patient who had asked about Karickhoff's procedure. "I have floaters myself," the surgeon said. "I wouldn't think of subjecting myself to that procedure and I beg my patients not to do it."

"You're risking catastrophic harm to fix a condition that isn't even a problem for the vast majority of patients," the surgeon, who asked not to be publicly identified, said.

Controversial procedure

Its a destructive laser. It produces bursts of energy that tears holes in things, Dr. Robert Frank, professor of ophthalmology and anatomy cell biology at Wayne State University, told

The type of laser used in this procedure is called a YAG, Frank said, and is widely used for two purposes. One role is in glaucoma treatment, where it is used to punch small holes in the iris. The other use is to clear matter from the eye after cataract surgery.

But the procedure used when the YAG laser zaps floaters is not widely practiced in the profession and Frank says there are very real safety concerns about it. For one thing, the laser is used to zap material that may be located near the retina.

As I said, this is a rather destructive laser, and the closer you focus to the retina, the greater likelihood you may hit the retina and tear a hole in the retina.

Would it be fair to call the procedure controversial?

I would say that at the very least, it is controversial, Frank said. I know that I have never done it and to my knowledge my retina colleagues here, and elsewhere, have not done it.

Patients seek treatment

Since vitreous floaters are very common, especially among the aging population, more people are seeking answers from their eye doctor, and in some cases, treatment.

The accepted course of action is to have a detailed eye examination to ensure the detaching vitreous hasnt torn a hole in the retina, Frank said. If theres nothing abnormal there but a few floaters, you leave it alone.

The floaters, though disturbing, usually do not interfere with vision, Frank said, and over time, usually settle out.

The vast majority of patients can learn to live with floaters, said Richard Bensinger of the American Academy of Ophthalmology. Those patients who demand treatment, he said, "are mostly obsessive-compulsive types" who allow the floaters to drive them to distraction.

Karickhoff told the AP he became interested in the procedure after he himself developed "a whopper" of a floater in his eye.

While on vacation in Florida, he saw an advertisement promoting laser surgery for floaters. Karickhoff let Fort Myers ophthalmologist Scott Geller operate on his eye and was pleased with the results.

He returned to Northern Virginia, a wealthy area overrun with well-insured, highly-paid government contractors, lobbyists and bureaucrats, and began offering the procedure himself.

Karickhoff told the AP he declines to treat patients whose floaters are small but said he has had great success with those whose floaters are large and bothersome.'s Dr. Henry Fishman expressed skepticism about the procedure.

"Floaters are common and usually not a big deal. Most folks live with them without trouble," Fishman said. While Karickhoff's procedure might be justified in rare cases, Fishman said there is a risk that patients who don't really need the treatment will begin clamoring for it.

"It is not as safe as doing nothing," which is what most cases call for, Fishman said.

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