Mr

[Chas321]

Hi,

I delevoped a PVD in my left eye shortly after having LASIK treatment. I'm not sure if it was caused in any way by the LASIK e.g. suction ring. However, I have lots of floaters, stringy lines dots etc.. in my left eye. I recently had YAG laser treatment for floaters but it only made slight improvement. The Surgeon has advised me to have a second treatment. I'm not sure what to do.

Rgds,

Charlie..

[John C Hagan III, MD, FACS]

there is almost universal agreement among Eye MD physicians (ophthalmologists) that using the Yag laser to treat floaters is ineffective and not appropriate. I would not be surprised if your insurance rejects the procedure and you end up paying out of your pocket.

I think the surgeons advise is poor. It it didn't work the first time and the overwhelming opinions of eye surgeons is that it's not helpful there is no reason to consider further treatment.

JCH III MD Eye Physician and Surgeon

[John C Hagan III, MD, FACS]

As to your comment. We do not use names for questions like this in the Eye Forum, nor do we make legal judgments.

JCH III MD

[Chas321]

Thank you. I will consider carefully whether to have furtehr YAG laser treatment. My floaters are annoying though. Should I expect them to diminish over time?

[John C Hagan III, MD, FACS]

Yes, either from dropping to the bottom of the the eye due to gravity or the brain tuning them out.  

JCH III MD

[Chas321]

Thank you. I will hope that they diminish and not affect my concetration so much.

One final question. Is it possible that the LASIK procedure and the pressure it puts on the eye could cause PVD or floaters? It just seemed a huge coincidence to me that at 46yrs old as soon as I have LASIK I have a PVD.

[John C Hagan III, MD, FACS]

There is no way to prove or disprove whether the LASIK was causative.  Most likely it was co-incidental and not causative. Retinal detachment has not been a complication of LASIK. That's good as most LASIK patients are myopic.

At your age about 40% of the population have PVDs.

JCH III MD

[Chas321]

I was not thinking about retina detachment but rather Posterior Viterous detachment. (PVD). Yes I accept that it may have been co-incidental.

However there appears to be a number of organisations e.g.

http://www.usaeyes.org/faq/subjects/floaters.htm

who suggest that PVD is a complication of LASIK. This is due to the extended elevated internal pressure to the eye when the the microkeratome vacuum ring is attached to restrict eye movement.

I have also read a number of patient testimonials indicating evidence of PVD after LASIK.

I guess more research is needed but I believe there is some substance in the theory that LASIK can trigger a PVD in those predisposed to it.

[John C Hagan III, MD, FACS]

Yes, there are articles that suggest that PVD are more common after lasik and also speculation about whether it might cause retinal detachments. There are also articles that suggest that patients with glaucoma might have some damage due to the high pressure that prevents blood flow to the eye for a very short period of time.

There are no evidence based studies that make this conclusion and the association is speculative.

There will always be testimonials to ANYTHING.  Testimonials and anecdotal incidents while compelling to the average person do nothing to the scientist and statatician trying to prove associations.

JCH III MD

[Chas321]

I have found the combination of the floaters and the other complicatiosn I have had with LASIK i.e. halos/starbursts and residual astigmatism extremely difficult to cope with. The floaters in particular effect everyday activities and leisure pursuits to the extent that i'm sometimes unable to concentrate properly. They have not diminished after 12 months but I keep praying that they will over time.I know that opthalmologists generally say just get used to them but until you have to live with them day to day that's easier said than done.If it's proven some day that PVD can be caused by LASIK I will be extremely annoyed with my LASIK company.

[John C Hagan III, MD, FACS]

Chas321, I have had floaters constantly since I was 10 years old. As I sit typing this out if I look for them they are all over my monitor. Look floaters get more common as we get older. After 50 more than half of all people have them.

Dwelling on floaters can be a sign of anxiety, depression, or compulsive behavior. If these are a problem deal with them. That would probably do your floaters a world of good.

JCH III MD

[Chas321]

Dr. Hagan, yes I do admit that post my LASIK I did become stressed, anxious and depressed and still suffer. Indeed i've had many regrets about having it done. I suppose floaters are the visible reminder. As a result I find it hard to adjust to post LASIK vision. I am having behaviour therapy which does help.

[John C Hagan III, MD, FACS]

Good luck. I have use behaviour therapy and have found it extremely helpful.  JCH III MD

[walkietalkie]

Dear Dr Hagan. Just to share. Recently I had blurred vision and seeing clouds. It turned out that I had torn retina which has been lasered and my eye is stable now. Historically I had Lasik done many years ago, which was made slightly undercorrected due to my high myopia. The side effects of Lasik are starburts and poor night vision but with time its getting a bit better, which could be due to my myopia regressing. I knew little about floaters before I had torn retina bcos they never bothered me until now. My eye doctor keeps reminding me to come back immediately should I see new floaters or my vision becomes blurred again. He also told me to keep off certain sports. I do not wish to go on about Lasik but just to say that apart from the side effects which my brain have learn to tune to, overall my quality life has improved bcos of it, though having a torn retina now have made me a bit nervous, though am not unduly worried. Afterall my eyes wasn't perfect to begin with.

[John C Hagan III, MD, FACS]

Thank you for sharing with readers your experience. Glad in summary "it was worth it".

JCH III MD