Mickey Spillane wrote his book, I, the Jury, in 19 days. So why did it take me 10 years to write and publish my book, Laser Treatment of Eye Floaters.

1. Fact vs. Fiction

First, Spillane’s book was fiction; mine was fact.

2. Limited Existing Medical Literature spurred extensive Research

Second, the medical literature was extremely limited on laser treatment of floaters. No book had previously been written. So, only four chapters in my book could be based on information found elsewhere. The information in Chapter 1 on the vitreous and floater formation is generally known by ophthalmologists. The sources for Chapters 5, 6, and 7 on YAG lasers and laser plasma physics are footnoted. Chapter 7 on the Laser Physics of Floater Obliteration was by far the most difficult and time consuming to research, simplify, and write. But the source for the remaining 24 chapters and the Appendix came almost exclusively from the author’s performing the procedure, experimenting, trial and error, designing new devices, modifying devices, and the many research projects marked in the book. In other words, I had to discover 80 per cent of the book contents before I could write about it.

How does one remember 24 chapters of new information on every thing he learns from doing the {mosimage} procedure? My method was to use buy a spiral bound book, start doing the procedure, and at the end of every day write down what I learned clinically. I’m still doing this. What I learn now goes into the book as revisions.

3. FDA Approval

The third big problem was the U.S. Food and Drug Administration had not approved lasers for this procedure. So I performed a formal study of 200 consecutive, eligible cases that was submitted to the U.S. Food and Drug Administration and done under the supervision of the INOVA Fairfax Hospital Institutional Review Board. After reviewing my study and application, the Food and Drug Administration approved lasers for this procedure.

4. Creating an Education Website

The fourth slow down for this book was there were not enough patients in our practice with highly symptomatic floaters for a large study suitable for publication in a peer reviewed journal. Also, hoping to get referrals from doctors for an unknown procedure were not realistic. The solution was to develop an educational web site so patients suffering from floaters could refer themselves. This meant learning something about domain names, web site construction, web site housing, how to write a web site and how to supply the graphics. Fortunately the best domain name, "eyefloaters.com," was still available. Within a few months our web site, www.eyefloaters.com, was on line. To help gain the patient’s confidence, an unusual amount of information was placed on our web site. There was an immediate response to our web site. Because of the web site patients from 49 states and 23 foreign countries were eventually recruited for our study.

5. Founding a Publishing Company

The fifth hurdle for this book was its rejection by a major book publisher because their medical advisor said "...at present there is no interest in this subject." By definition, that would be true of any unheard of procedure. This rejection was actually a bit of good luck because it stimulated me to take the legal and business steps to found a publishing company that performs traditional as well as internet commerce. In other words, I published the book. The great advantage is this publisher will not lose interest in the book and take it off the market.

It has taken 10 years to perform the 2,000 operations on which this book is based, develop my techniques and devices, complete the 15 research projects and studies reported here, and to write this book. So far, over 250 eye surgeons have bought the book and some are starting to learn the procedure. It is hoped that this book (the only way doctors can learn this procedure) will eventually lead to this procedure being widely offered to patients with visually significant floaters.

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