Eyeworld

EW NEWS & OPINION August 2015 15 OptiSpheric ® IOL PRO 2 IOL Testing Fast and Automated tProduction instrument for simple and fast testing of IOL batches tIOL measurement in air or in situ according to ISO 11979 standard tMeasurement of all types of IOLs: including multi- focal, diffractive, trifocal and toric lenses tMeasurement parameters: power, add power, cylinder, MTF, toric marks, radius of curvature, through focus scans, energy distribution www.trioptics.com anterior surgeons already use in their practices—so why do so few of them perform it? The first and most obvious reason is that most physicians simply don't know that vitreolysis is an option. The first studies showing the effectiveness of vitreolysis in the 1980s were published in European journals and involved small num- bers of patients. Even today, little lit- erature exists on the topic—a search of the National Library of Medicine's PubMed database revealed that less than 10 studies regarding floater vitreolysis have been published since 1993. Because only a handful of oph- thalmologists perform vitreolysis, there is virtually no instruction on it. Residents and fellows don't learn the procedure during their training and there are few courses offered at academic meetings. However, some surgeons who use vitreolysis have begun to train others in the tech- nique. Karl Brasse, MD, Vreden, Germany, launched the first ever European floater vitreolysis course in January of this year, with more than 40 ophthalmologists from 12 countries in attendance. Without knowing about vitreol- ysis or how to perform it, the safest treatment physicians can offer for floaters is to do nothing. According to I. Paul Singh, MD, in private practice, the Eye Centers of Racine & Kenosha, Wis., after being told that nothing can be done, patients be- come conditioned to not complain about floaters, and without patient complaints, there is no need to find an alternative procedure. In the past, even when phy- sicians did learn about vitreolysis, most didn't add it to their surgical repertoire. Part of the reason is that the procedure was, in a way, ahead of its time. Until recently, YAG lasers weren't designed for use in the pos- terior segment and surgical contact lenses weren't optimized for visual- izing floaters, making it difficult to achieve good outcomes. Ellex Medical Lasers (Adelaide, Australia) tackled this issue in 2012 with the debut of the Ultra Q Reflex multi-modality YAG laser. The Ultra Q Reflex integrates a slit lamp into the laser design and has a coaxial illumination tower, so that the light source, green observation beams, HeNe aiming beams, and infrared treatment beam all share the same axis. This new technology, paired with newer contact lens designs, of- fers better outcomes with vitreolysis than ever before. A low risk, high benefit procedure After entering practice and focus- ing on cataracts and glaucoma, Dr. Singh never thought he would be doing anything in the vitreous. That changed when one patient came to him year after year complaining of a floater disrupting his vision. "Every year he'd ask me, 'What can I do about it?'" Dr. Singh re- called. "I kept saying the same thing everyone else says—you'll get used to it eventually, don't worry about it, nothing can be done." The patient became so frustrat- ed, however, that he flew to the east coast to have Dr. Karickhoff treat it with the YAG laser. Three months later, he visited Dr. Singh again, and his floater had disappeared. "I was shocked because it was a huge floater, and it was gone, and his symptoms were relieved," Dr. Singh said. Seeing this patient's incredible results inspired Dr. Singh to begin performing the procedure himself. "When I saw these patients coming back, in the first 10 or 15 cases [I did], I realized this is something that's truly needed in our portfolio of procedures," he said. "If you look at anything we do in oph- thalmology, there's always that risk/ benefit ratio: how much of a risk are we taking, how much of a benefit are we getting. To me, this is a rela- tively low-risk, high-benefit in-office procedure that takes 10–20 minutes. I think it's very valuable." Dr. Singh thinks that treating floaters with laser vitreolysis has the same impact on a patient's vision and quality of life as removing cataracts. "I don't think we appreciate the impact that floaters have on daily functioning and quality of vision," he said. "There's the potential to help a lot of people. This is going to become, in my opinion, standard of care in the next 5 years." EW Editors' note: Drs. Brasse and Singh have financial interests with Ellex. Contact information Brasse: brasse@augenarzt-vreden.de Singh: ipsingh@amazingeye.com

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