Studies investigating the structural and functional effects of Nd:YAG laser vitreolysis with objective outcome measures are slim to none. Researchers, however, recently turned that around and found that patients who had vitreolysis for vitreous floaters had a less dense vitreous than untreated controls but similar visual function.

This retrospective, comparative study evaluated 132 eyes of 132 subjects—35 healthy controls, 59 untreated controls and 38 subjects with vitreous floaters who underwent laser treatment. The team used an NEI visual function questionnaire (VFQ-39) to assess visual well-being, quantitative ultrasonography to measure vitreous structure and best-corrected visual acuity (BCVA) and contrast sensitivity function (CSF) to evaluate vision.

Compared with healthy controls, the study authors observed that untreated subjects had worse VFQ-39 scores, 57% greater vitreous echodensity and significant CSF degradation (130%). Compared with untreated eyes, they note that vitreolysis eyes had 23% less vitreous echodensity but no differences in VFQ-39 score, BCVA or CSF. They also discovered that 25 of the vitreolysis patients were unhappy with the results and sought vitrectomy, while 13 were satisfied with observation only. They add that subjects seeking vitrectomy had 24% greater vitreous echodensity and 52% worse CSF.

Since some treated eyes had a less dense vitreous and better visual function than untreated eyes, the researchers recommend conducting a prospective, randomized study of Nd:YAG laser treatment of the vitreous using uniform laser treatment parameters and objective quantitative outcome measures.

Nguyen JH, Nguyen-Cuu J, Yu F, et al. Real-world assessment of vitreous structure and visual function after Nd:YAG laser vitreolysis. Ophthalmology. June 21, 2019. [Epub ahead of print].