27 EyeWorld Asia-Pacific | December 2024 CATARACT Ongoing Research Dr. Zhu said she is currently studying the impact of YAG vitreolysis on contrast sensitivity 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. About the Physicians Steve Charles, MD | Charles Retina Institute, Germantown, Tennessee | scharles@att.net Christina Y. Weng, MD, MBA | Professor of Ophthalmology, Fellowship Program Director, Vitreoretinal Diseases & Surgery, Baylor College of Medicine, Houston, Texas | christina.weng@bcm.edu Dagny Zhu, MD | Medical Director and Partner, NVISION Eye Centers, Rowland Heights, California | dagny.zhu@gmail.com Relevant Disclosures Charles: Alcon Weng: AbbVie, Alcon, Alimera Sciences, Apellis Pharmaceuticals, Boehringer Ingelheim, BVI, Carl Zeiss Meditec, EyePoint, Genentech, Iveric Bio, Novartis, Opthea, Regeneron, REGENXBIO, Springer Publishers Zhu: None Reference 1. Webb BF, et al. Prevalence of vitreous floaters in a community sample of smartphone users. Int J Ophthalmol. 2013;6:402–405. 2. Wagle AM, et al. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011;152:60–65. 3. Zhou I, et al. Outcomes of YAG laser vitreolysis in pseudophakic eyes with visually significant opacities following cataract surgery. Paper presented at the 2023 ASCRS Annual Meeting, May 5–8, 2023, San Diego, California. 4. Shah CP, Heier JS. YAG laser vitreolysis vs sham YAG vitreolysis for symptomatic vitreous floaters: a randomized clinical trial. JAMA Ophthalmol. 2017;135:918–923. 5. Nguyen JH, et al. Assessment of vitreous structure and visual function after neodymium: yttrium-aluminum-garnet laser vitreolysis. Ophthalmology. 2019;126:1517–1526. This article originally appeared in the September 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. dorzolamide/timolol in cases where the treatment is longer to mitigate any transient IOP spike. She said she has never had a retina issue with this treatment. “I presented a case series at the ASCRS Annual Meeting3 where approximately 70% of my patients (n=77 eyes) noticed significant improvement after just a single YAG laser vitreolysis 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-cataract patients a safe, effective, and less invasive treatment option compared to pars plana vitrectomy. 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 vitrectomy 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. “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 significant proportion of patients.5
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