Eyeworld

36 | EYEWORLD | FALL 2024 ATARACT C Contact Charles: scharles@att.net Weng: Christina.Weng@bcm.edu Zhu: dagny.zhu@gmail.com "While YAG vitreolysis is being offered by some as an alternative treatment option, I do not yet think that we fully understand the nuances of this procedure in this context; there has only been one randomized controlled trial of YAG vitreolysis for floaters to date," 4 she said, noting questions about optimal energy settings, number of spots, where to aim, and identifying the ideal candidate. Limited data also suggests that YAG vitreolysis may lack efficacy in a signif- icant proportion of patients. 5 improvement after just a single YAG laser vit- reolysis session. In their mind, subjectively, it's helping, and they'll often request an additional session," she said. She is currently performing additional studies evaluating contrast sensitivity pre- and post-YAG laser treatment. By starting with YAG laser vitreolysis, Dr. Zhu said she is able to offer unhappy post-cata- ract patients a safe, effective, and less invasive treatment option compared to pars plana vitrec- tomy. If patients don't see an improvement with YAG or have particularly dense opacities, she refers the patients for vitrectomy, which almost always resolves the issue. However, her vitrecto- my referrals have decreased significantly since refining her YAG laser technique. Dr. Charles said he thinks there is "a lot of hype" regarding YAG laser vitreolysis, but he considers it to have "a very modest benefit in phakic eyes." He also noted that some retinas and lenses have been hit by good surgeons, "so I'm not a fan of YAG laser vitreolysis, and I don't do it." If a patient's bothersome symptoms persist, he will perform a vitrectomy and only if they have had a prior posterior vitreous detachment. Dr. Weng offered a similar perspective. She said if the patient's symptoms persist after the waiting period, she has an in-depth discussion with them about pars plana vitrectomy. continued from page 35 Dr. Zhu said she is currently studying the impact of YAG vitreolysis on contrast sensi- tivity using a new technology for measuring contrast sensitivity. Traditionally, she said that contrast sensitivity checks are tedious and long, but she has a colleague who has automated the process to be done within minutes using AI and machine learning. "I'm doing a couple of studies looking at patients with that machine before and after YAG vitreolysis treatment, and I think it might help elucidate which patients would benefit from treatment," she said. Ongoing research Vitreous condensation (opacities, floaters) Source: Mohammad Rafieetary, OD

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