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Why Few Doctors
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How is it possible that all eye doctors know of the vitrectomy operation for floaters which carries significant risk, but almost no eye doctor in the country has done the laser operation, seen the laser operation, received any training in it, or is familar with it?
The first part of the answer is that the procedure came entirely from European research. The research was done by Franz Fankhouser, M.D. and Daniele Aron-Rosa, M.D., still the most respected laser researchers in the world. Unfortunately, their reports were buried in the European literature except for only one United States paper in 1985 (see World Literature page this web site). So doctors here had almost no opportunity to read about the procedure.
Secondly, a proper laser for the procedure was not readily available. In 1978 Doctor Fankhouser developed a laser specifically for working in the vitreous and published the technique for laser disruption of eye floaters. But his Swiss made laser was very large, and never became well known in the United States. So its production stopped in 1993. By then the market was dominated by smaller lasers. These are the lasers now owned by doctors and hospitals throughout the world. Unfortunately, they were designed for disrupting cataract membranes and most of them can not disrupt floaters in the mid or deep vitreous. A final reason that many doctors have taken no interest in obliteration of floaters is because they are not aware of how helpful it can be to some patients. Certainly some patients can forget about their floaters, but if they are large and near the retina, this is not possible.
Why do some eye doctors, although not familiar with the laser procedure, feel a sincere ethical and moral obligation to warn their patients against the procedure?
The first reason probably is that from the doctor's studies of eye anatomy, it would seem that this treatment might cause retinal detachment. But actually, the entire world literature does not report any retinal detachments . Dr. Karickhoff is familiar with an additional 1,600 cases of laser treatment of eye floaters that are not in the literature, and there were no retinal detachments in those cases either. It is true that a laser working in the vitreous can cause complications, but this almost always comes when cutting membranes or clearing hemorrhage, not from treating floaters.
The second reason is that until fairly recently it was firmly believed by most eye surgeons that any manipulation of the vitreous was harmful. But in the 1970's it was learned that vitreous manipulation and even its complete removal from the eye under controlled conditions can be helpful in many cases. Much of this work and the instrumentation was developed at the Duke Eye Center where Dr. Karickhoff trained and remains on its Advisory Board. In spite of this new knowledge, any operation on the vitreous, even with a laser where there is no incision and no removal of vitreous, is still met with some caution.
(A PERSONAL NOTE): I completely understand and sympathize with the feelings of eye doctors when they first learn of this procedure. When I first heard of the procedure, I said: "I do not think there is any such procedure, but if there is, it is dangerous, and I would never trust an eye doctor who does it." But I had a strong reason to be very curious. In college I had a serious internal eye infection from toxoplasmosis that sparked my interest in ophthalmology. Ten years later I had a recurrence of that infection that left me with a large floater in my right eye that affected driving slightly, was very annoying when reading, and I always saw it when using the direct ophthalmolscope with my right eye. Any time I saw a floater, I had to shift my eye to learn if I was seeing the patient's floater or my floater. So, I called the doctor's office who does the laser procedure for floaters, believing that he was doing an illegitimate procedure, and that he would never let an unknown ophthalmologist, like me, observe it. To my shock he said: "Certainly you can watch a procedure. I would love to meet you because I use the surgical contact lens you designed to examine every floater patient!" So, 24 hours after hearing of the procedure I was in the doctor's office and watched him through an observer's scope attached to his laser completely remove the floaters from the deep vitreous of two patients. One year later, after studying the literature, I had him operate on my floater. The next morning I saw 20/10 with my right eye and since then have had no trouble driving, reading, and do not see the floater when using the ophthalmoscope.
We are aware of only three doctors on this continent with the proper equipment and a large experience with this procedure. We have no confirmation of doctors elsewhere in the world performing the procedure.
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