Nd:YAG laser vitreolysis and health-related quality of life in patients with symptomatic vitreous floaters

Abstract

Background: The treatment of floaters has consisted primarily of monitoring. The therapeutic approach is based on surgical removal or Nd:YAG laser treatment. The objective of this study was the assessment of the quality of life in patients treated with Nd:YAG laser for floaters. Methods: Single-center pretest-posttest design in a cohort of subjects treated with Nd-YAG laser with Ultra Q-Reflex technology. Health-related quality of life of the patients was measured before and after the intervention with the Visual Function Questionnaires VFQ-25 and VFQ-39. Anxiety level was measured with the State-Trait Anxiety Inventory. Visual acuity, contrast sensitivity, and safety parameters were also considered. Results: Thirty-four patients were included in the study. For the VFQ-25 baseline, the median was 73.05, interquartile range (19.25) versus a final median value of 93.76 (8.73) with p < 0.01. The baseline median for the extended version VFQ-39 was 74.60 (19.01) versus the final median of 95.01 (6.50) with p < 0.001. Regarding the anxiety, according to the STAI questionnaire, there were statistically significant differences between the baseline and the final conditions, with a baseline median of 38 (11) versus a final median of 18 (19); p < 0.001. When the analyses differentiated between patients with and without myopia, there were statistically significant differences for VFQ-25 and VFQ-39. Conclusions: This study shows an improvement in the health-related quality of life and a significant decrease in anxiety for patients that have undergone Nd: YAG Ultra-Q Reflex laser vitreolysis for floaters vaporization. The effect found is higher in myopic patients.

Complications of Treatment for Symptomatic Vitreous Floaters: A Review

“…However, PPV seems to be the more efficacious, as evidenced by patient satisfaction assessments, long-term option when done by a skilled surgeon with minimal disruption of the vitreous. The percentage of participants that were either "satisfied" or "very satisfied" with the laser vitreolysis ranged from 38% to 100% [32][33][34][35][36][37][38][39] based on subjective accounts, nonstandardized questionnaires, and NEI VFQ questionnaires. Among participants that underwent PPV as treatment choice, the percentages of "satisfied" or "very satisfied" ranged from 85% to 100% 33,[40][41][42][43][44][45][46][47][48][49][50][51][52] based on many of the same assessments used for laser treatment, as well.…”

“…Of the studies discussed previously, all author groups emphasized the importance of proper patient education of possible recurrence, lack of resolution of symptoms, and complications. Risks of intervention that may occur in both Nd:YAG and PPV include hemorrhage (choroidal, retinal, or vitreous) in 1.3% of all cases, and increased IOP in 3.1% of all cases 33,36,39,44,45,48,50. Complications associated with Nd:YAG vitreolysis alone included transient blurred vision in 2.9% of all cases included in this literature review, posterior capsule intraocular lens pitting in 0.7% of cases, and 1 case of worsening floaters 33,34,37…”

“…Risks of intervention that may occur in both Nd:YAG and PPV include hemorrhage (choroidal, retinal, or vitreous) in 1.3% of all cases, and increased IOP in 3.1% of all cases. 33,36,39,44,45,48,50 Complications associated with Nd:YAG vitreolysis alone included transient blurred vision in 2.9% of all cases included in this literature review, posterior capsule intraocular lens pitting in 0.7% of cases, and 1 case of worsening floaters. 33,34,37 In a brief report by Hahn et al, 53 a cohort of physicians voluntarily submitted complications after laser vitreolysis for symptomatic floaters to the American Society of Retina Specialists (ASRS) Research and Safety in Therapeutics (ReST) Committee.…”

“…Garcia et al 39 reported a series of 34 eyes undergoing Nd:YAG vitreolysis for symptomatic vitreous floaters of an average duration of 2.5 years. Participants also reported anxiety from visual disturbance.…”

“…46,[50][51][52] Endophthalmitis was reported in 0.1% of PPV cases. 48 Macular hole, posterior uveitis, 37 PCIOL pitting (0.7%) 34 Increased IOP (0.7%) 39 Retinal hemorrhage (0.4%) 36 Worsening floaters (0.3%) PPV 769 Cataract (55%) 33,41,43,45,47,51 Glaucoma (2.4%) 44,45,51 CME (2.2%) 41,45,46,51 ERM (2.1%) 44,45,47,51,52 Hypotony (0.9%) 44,49 Vitreous hemorrhage (0.8%) 46,[50][51][52] Choroidal hemorrhage (0.1%) 44 Macular hole (0.1%) 45 Endophthalmitis (0.1%) 48 Sclerotomy congestion (0.1%) 49 Posterior uveitis (0.1%) 52 Possible bulbar neuritis (0.1%) 52 possible optic neuritis, and sclerotomy inflammation each occurred in 0.1% of the cases, as well. 44,45,49,52 The percentage of each complication is displayed in Table 3.…”