Laser Treatment of Eye Floaters
John R. Karickhoff. Falls Church, VA: Washington Medical Publishing, LLC, 2005. $225.00.
I have, as I am sure many other practitioners have, been confronted with patients with visually bothersome floaters. As doctors, we feel the satisfaction of ruling out the more serious complications of a sudden onset of visual floaters but find the patient frustrated that we can only offer “verbal” assurance of future reduction of symptoms. Dr. Karickhoff has taken it one step further. He has put forth a text that discusses his passion for the treatment of vitreous floaters with laser intervention. It is an area that is still somewhat controversial. On one hand, we are dealing with a condition that provides very little ocular risk if left untreated. On the other hand, we do run into those individuals who seem to be visually and emotionally disturbed by the condition and look for alternative methods of ridding themselves of this ocular problem. Even among vitreoretinal specialists, the idea of treating floaters close to the retinal tissue might cause even the more skilled surgeons to take a more conservative approach to the disorder. Dr. Karickhoff promotes a more aggressive approach to treatment by using a laser procedure to vaporize the existing vitreous floaters with YAG laser therapy in a selected patient population.
The book is divided into 27 chapters and 10 subsections. The subsections are broken into patient care topics such as present treatment of floaters; selection of the correct laser; benefits, risks, criteria of success; selecting patients; the procedure; and safety and avoiding complications to name a few. The book also has some very nice color photographs of vitreal floaters pre- and postlaser intervention along with laser equipment and selected individuals significant in the area of Dr. Karickhoff’s field of interest.
The author starts the book with a section on the various floater types and the present treatment options for patients. There are several chapters on the type of patient who might be an acceptable candidate for the laser treatment and several tests, with examples in the appendix, that the author has either used or invented to locate and document vitreous floaters.
I found the next section on type of laser and the history of the YAG laser to be one of the least useful in the text. It proved to be the least clinically applicable for the clinical caregiver. The following several sections deal with the risk calculation of patients, the procedure itself, and the complications and success that the author has encountered in his laser treatments of vitreal floaters in his patient population.
The next part of the text identifies the safety considerations and complications from the YAG laser procedure. One might have expected to find this material before the explanation of the laser procedure itself. The concluding sections of the book discuss the equipment such as the surgical contact lenses used in the laser procedure. Several of these laser contact lenses were invented by the author. I found the chapter on selecting the correct gonioscopic fluid to be more in-depth than the clinician reader might find interesting. The final section describes the author’s more memorable cases, and what he believes the future will hold for surgical laser intervention for vitreal floaters.
The old adage “you can’t judge a book by its cover” certainly applies here. The introduction states the author’s intentions of what he believes to be the advantages of laser intervention for eye floaters and the present-day misconceptions of laser treatment of vitreous opacities. Unfortunately, the author fails to bring these intentions and arguments to a direct and thoughtful scientific conclusion for the reader. Rather, the reader is taken more on an autobiographic account of the trials, funding endeavors, personal encounters with other individuals in the medical and laser fields of study, and personal experience with the patients and lasers. The author inserts “research project” ideas randomly throughout the text making it very confusing at times to understand the intent. Does the author want the reader to take up this research challenge or are these future projects for the author? I found these little insertions throughout the text to be more distracting than helpful to the book.
In conclusion, I would compliment the author on his tenacity and desire to promote the use of the laser for the treatment of vitreous floaters, but he is likely to fail to convince the reader, through a logical series of arguments or positions, that this should be considered an alternate treatment option except for the more determined patients. For those who might care to pursue this line of medical treatment, the clinical time and expertise needed seems daunting. Laser treatment for vitreal floaters is presently not an option given to patients in the medical community in my area of practice. It makes me wonder how this concept of laser treatment has been accepted by vitreoretinal surgeons at this point in time. The author takes the reader on a very interesting journey on his efforts to validate his treatment for floaters, but where this text might be used is still in question.
Southern California College of Optometry