In 1990 a carpenter complained of something blocking the vision of his right eye. Examination revealed a long floater tightly suspended across his central vision by a thin vitreous strand coming from 12 o’clock. The logical approach would be to cut the suspending strand.

Cutting the strand with intraocular scissors could be done, but the chance of a complication would be high. Although I had never tried to cut a suspensory strand with a YAG laser which is normally used for opening membranes after cataract surgery, it could be tried. It would be my first laser treatment of a floater. So, using the laser, I very carefully focused on the suspensory strand and fired the laser once. I relaxed a few seconds. In preparing for the second shot, I looked and looked but could not find the floater. I assumed that for some unknown reason the optics were poor. I was embarrassed to tell the patient we could not proceed because I had “lost” the floater. I ended the procedure convinced that I could not have cured the situation with one shot, and I had to find the floater tomorrow.

The next morning the patient said the floater was entirely gone and his vision had returned to 20/20. I did a lengthy examination of the center of his vision with different contact lenses and could not find his floater. Thinking the floater had to be somewhere, I used the examining scope worn on my head, and the floater was found curled up like a corkscrew on the retina at the bottom of the eye, completely out of his central vision.

My conclusion was that, at least in this case, using the YAG laser was the easiest, fastest, and safest way to remove a floater in the line of sight. I also learned in subsequent similar cases, to very carefully watch the floater immediately after the first shot and you will see it going toward the bottom of the eye during the next five seconds.

This "lost floater" encouraged me to explore further laser treatment of other floaters.

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