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Eye Care (Expert Forum)
Prophylactic photocoagulation for asymptomatic vitreous traction
Answered by
John C Hagan III, MD, FACS - Ophthalmology
Discover Vision Centers
Kansas City - MO
Our Ask A Doctor Ophthalmology Forum is where you can post your question and receive a personal answer from physicians affiliated with the American Academy of Ophthalmology.
Prophylactic photocoagulation for asymptomatic vitreous traction
by steinhorst, Jul 20, 2007 12:00AM
Hi, I'm 26 years old and have recently been diagnosed with a vitreous traction in my right eye (found in a retina exam after a small trauma to my other eye (left) - which is fine). Other than that my eyes are fine. I have a very diminute amount of myopia (0.5 in the scale used in Brazil), wearing glasses only when driving at night.
The doctor that diagnosed that traction said I didn't have any tears or holes, but prescribed nonetheless prophylactic photocoagulation. I'm totally asymptomatic, never noticed any floaters or flashes. The doctor also told me the traction is quite peripherical, not anywhere near the macula. Since I couldn't find any sort of indication of photocoagulation for cases such as mine (traction without tears, holes or symptoms), I would appreciate your input on whether the procedure is indicated and beneficial.
The doctor that diagnosed that traction said I didn't have any tears or holes, but prescribed nonetheless prophylactic photocoagulation. I'm totally asymptomatic, never noticed any floaters or flashes. The doctor also told me the traction is quite peripherical, not anywhere near the macula. Since I couldn't find any sort of indication of photocoagulation for cases such as mine (traction without tears, holes or symptoms), I would appreciate your input on whether the procedure is indicated and beneficial.
Doctor's Answer
by John C Hagan III, MD, FACS, Jul 20, 2007 12:00AM
, Jul 20, 2007 12:00AM
Greetings Steinhorst. You may have heard the saying, 'Ask three different doctors a question and you'll get five different answers'. That sort of applies here. The treatment of retinal tears, retinal holes, thin areas (lattice degeneration) is very controversial and there are no uniformly accepted guidelines by which Ophthalmic surgeons work.
Depending on the amount of time and effort spent looking for small asymptomatic holes in the retina as many as one in 10 to one in 50 people have them. So all ophthalmic surgeons agree that not every hole needs to be treated.
This is a generalization but in a young individual that is not highly myopic (say -7.00 or more), does not have a family history of retinal detachment, has not had a retinal detachment in the same or fellow eye, that has not had cataract surgery and who is intelligent enough to report symptoms suggestive of a RD (sudden increase of floaters, flashes of light and loss of peripheral vision) and who can be counted on to come in if these develop and who is willing to have an annual examination, then I would not recommend laser or cryotherapy to close the hole.
You can also always get another opinion.
JCH MD FACS Ophthalmologist Eye MD
Depending on the amount of time and effort spent looking for small asymptomatic holes in the retina as many as one in 10 to one in 50 people have them. So all ophthalmic surgeons agree that not every hole needs to be treated.
This is a generalization but in a young individual that is not highly myopic (say -7.00 or more), does not have a family history of retinal detachment, has not had a retinal detachment in the same or fellow eye, that has not had cataract surgery and who is intelligent enough to report symptoms suggestive of a RD (sudden increase of floaters, flashes of light and loss of peripheral vision) and who can be counted on to come in if these develop and who is willing to have an annual examination, then I would not recommend laser or cryotherapy to close the hole.
You can also always get another opinion.
JCH MD FACS Ophthalmologist Eye MD
I just wanted to add my doctor didn't see any holes, only what she described to me as a traction, and prescribed the photocoagulation as a way to prevent the retina from detaching in case the vitreo pulled too hard on it. She said the laser would "glue" the retina a little more to the back of the eye around that tension point.
I found it odd exactly because as far as I know no holes/tears were seen during the exam.
Again, thank you for your attention!
Eduardo Steinhorst