Dr. Karickhoff treating a patient with eye floaters

Why are most patients told to "live with your floaters" when we have a safe and effective laser treatment for floaters?

This is because most eye doctors are simply not familiar with laser treatment of eye floaters.  That is, they have never done the procedure, never seen it done, never read an article on it, never read a research study on it, had no training in it, and never heard a lecture on it. There is a good reason why they have not heard of it.  This laser procedure came entirely from European research. The research was done by Franz Fankhouser, M.D. and Daniele Aron-Rosa, M.D., the world's most respected laser pioneers. 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)

If a doctor does know about the procedure, why don't they do the procedure?

  • First, 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, these lasers were designed for disrupting cataract membranes and most of them can not disrupt floaters in the mid or deep vitreous.
  • Many doctors are not aware of how helpful laser treatment can be to many patients. Some patients can forget about their floaters, but if the floaters are large and near the retina, disregarding them is not possible.
  • When doctors first hear of this procedure, most assume that the laser used has a parallel beam, like a laser pointer, and if the beam misses the floater it would hit and harm the retina.  This is incorrect.  The laser beam we use is actually a converging beam that come to a pinpoint focus on the floaters and then spreads widely behind the floater.  This is why the entire world literature does not report any retinal detachments from this procedure. 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.
  • Some doctors believe incorrectly that the laser just breaks big floaters into many smaller floaters. Actually the mechanism of the laser treatment is vaporization of the floaters, not fragmentation.
  • Occasionally a doctor does not recommend laser treatment because he tried it and failedDoctors fail with the treatment for one or more of the following problems: the wrong laser - many laser will not work in the mid or deep vitreous; the wrong contact lens -- most of the laser procedures in the world are done with Dr. Karickhoff's lenses; the wrong power--usually far to little power so they are fragmenting not vaporizing; or no instruction -- the only instruction in the world is Dr. Karickhoff's book, "Laser Treatment of Eye Floaters."
  • And finally some doctors don't try the procedure because 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.

Why is the trend strongly toward laser treatment of eye floaters, not towards "live with it" or vitrectomy?

  • Success with the laser is attained in about 95% of the cases done.
  • Complications are rare (about 0.1%) using a laser. Complications are very common (about 60%) with vitrectomy.
  • Dr. Karickhoff was selected and made the only presentation on laser treatment to the American Academy of Ophthalmology (29,000 members worldwide).
  • 289 eye surgeons have purchased Dr. Karickhoff's book and are starting to learn the techniques.
  • Laser treatment equipment has improved by the addition of the three surgical contact lenses designed by Dr. Karickhoff.

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John Karickhoff, M.D. • 313 Park Avenue • Falls Church, VA 22046