PVD and Floaters after LASIK treatment

[Chas321]

I had LASIK treatment over a year ago and immediately afterwards suffered a PVD and floaters in my left eye. Is it true that LASIK can trigger a PVD and even Retina damage due to the elevated pressure caused by the suction ring? I have been told by a Surgeon to whom I sought a second opinion that this is the case. I'm concerned about this as there is no mention of this complication on the LASIK consent form and therefore LASIK companies are potentially inflicting serious damage on people's eyes.

This posting elsewhere on your website confirms there is a link.

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

[floatanddry]

I am with you on this. I did not get PVD, but noticed floaters to an extent I never had pre-Lasik. You can see my details here:

http://www.usaeyes.org/ask-lasik-expert ... php?t=1288

I agree, that this is a complication that needs to be researched and more throughly understood. It is not an appopriate side-effect not be in included in an informed consent form, and honestly to me, Lasik is not worth it to me because of this. Glenn, your opinion and current understanding of the research here would be great.

FD

[Chas321]

Yes like you an otherwise successful LASIK operations has been ruined because of this complication. I know of several people who have either had a PVD and/or floaters after LASIK and yet there's no mention of it on any consent forms. To me this is one of the more serious complications there is as it's constantly visible, extremely noticable, distracting and annoying.

[floatanddry]

Chas,

What was your timeline from LASIK to PVD. Was this in one eye or both?

[Chas321]

I noticed floaters after 2-3 weeks but PVD could have happened sooner. I went to Eye Hospital who diagnosed PVD and specifically asked me if I had LASIK or LASEK. It was as if they had seen it all before. I had it in my left eye only. I'm now thinking of having YAG laser treatment but i'm not sure if this is very successful at treating floaters.

I feel certain that this complication will soon be recognised and LASIK companies will be forced to put it in their consent forms.

[LasikExpert]

Posterior Vitreous Detachment (PVD) is when the clear jelly-like substance in the large globe of the eye separates from the back of the eye. PVDs occur natually and are generally considered a part of the aging process. During PVDs patients may experience arcs of light or flashes, however after PVD vision is normally not affected.

Floaters are opaque particles of the inner eye that move within the clear jell-like substance in the large glove of the eye. Floaters are occur naturally and are generally related to myopia (nearsighted, shortsighted) vision, however occur in people with no refractive error. PVD can induce floater material into the line of sight, as can many other events and maladies.

Lasik, All-Laser Lasik, and Epi-Lasik use a microkeratome to create a flap of corneal tissue. The microkeratome is affixed to the eye globe with suction. This suction will dramatically raise the intraocular pressure (IOP) within the eye globe.

A small study published in February 2006 by the Department of Ophthalmology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany evaluated the incidence of PVD in Lasik patients with healthy vitreous and a partial PVD preop.

In the study, Ninety-five eyes (92.2%) had no PVD preoperatively. Nine eyes out of this group (seven patients, 9.5%) developed incomplete PVD as assessed 1 week postoperatively. Eight eyes (7.8%) had a partial PVD preoperatively and in only one eye was an extension of vitreous detachment observed after the surgery. This is an important distinction. Intuitively one would expect that a patient with a partial PVD would have that PVD expand, yet this happened to only one of the eight preop partial PVD patients.

The study concludes that Lasik may in rare cases lead to new occurrence of PVD or extension of a previously existing partial PVD, however None of the preoperatively measured parameters could predict the occurrence of PVD by Lasik.

Even if Lasik does not cause a PVD, the rise and drop of IOP can stir up existing floaters. Floaters often become ignored by the brain if they stay in the same location. Move them and they suddenly are "visible" again.

Whether or not floaters or PVD should be in an informed consent is an issue of law. We include an article about Lasik floaters with this information to inform the public of a potential problem after Lasik even if it is considered very rare.

The IOP issue is of great importance regarding a compromised retina or patient with very high myopia. I have aften suggested investigating an alternative such as PRK, LASEK, or PIOLs instead of Lasik for those with a elevated risk of retina damage, plus a full exam by a retina specialist before any elective ocular surgery.

[Chas321]

Yes I have read the study before.

Are you also saying that I should have had LASEK instead of LASIK as this would have reduced the chances of PVD or Retina damage?

Also i'm a little puzzled why LASIK companies don't examine the eyes for the possibility of vitreous damage before recommending LASIK. Surely by now they know about potential for PVDs etc.. due to suction ring. It sems to me unforgiveable that they continue to subject eyes to this elevated pressure knowing that it can lead to internal damage which cannot be fixed.

[LasikExpert]

A routine examination by a competent eye doctor will included an evaluation for prior PVD or other ocular health issues. If there is no indication of a compromised ocular health, there would be no qualified reason to switch from Lasik to PRK or LASEK.

The study cited noted that patients with prior partial PVD did not have the PVD expand after Lasik, which would indicate that Lasik is not always traumatic to the vitreous. PVD occurs naturally and normall does not interfere with vision, making PVD a moderate risk in medical terms. I doubt the PVD itself actually has cause a degradation to your vision. It is the floaters stired up by Lasik and/or PVD that are problematic.

All these points may be medically accurate, but that does not do much to help you with your floaters.

[Chas321]

Yes it is the floaters which have dimished my satisfaction with the LASIK treatment. I will always associate their arrival with LASIK and therefore wish that I never had it done. If PVD and/or floaters had been mentioned on the consent form at least I would have had the opportunity to assess this possible complication. Slight exaggeration but it's like going for a heart operation and being told the risks but only afterwards being told that by the way you could have died.

As to treatment I guess the options are Vitrectomy or laser. The former has too many risks and the latter does not seem very effective at least not on my type of floaters - wispy strings, dots and cobwebs.

[LasikExpert]

Your third option is to do nothing. The brain does a reasonably good job of eventually ignoring bad information from the vision system.

[Chas321]

Yes I realise that other option is to try and ignore them. However, i have had them for a year now and I notice them all the time to the point of distraction which under certain circumstances e.g. driving can be dangerous. My concentration and focus is impaired. I guess my brain has not adjusted as yet. When I move my head it's like a snow globe effect.

I doubt if LASIK companies examine the health of the eye to extent you refer to and therefore couldn't really care less if they are exacerbaing an already unstable eye condition. It's really bums on seats as far as they are concerned.

[Chas321]

Glenn - By the way my prescription pre-op was -6.25 in both eyes with -0.5 astigmatism. I was told that I needed to have LASIK. Is this correct as it seemed to me that LASEK wasn't an option?

[LasikExpert]

Based only upon your prescription, LASEK could have been an option, but you were just at the edge of where Mitomycin C would likely be needed to reduce the probability of corneal haze. Mitomycin C is strong medicine that is appropriate when required, but probably best avoided if possible.

Again, based only on your prescription, Lasik would not be contraindicated (double negative there) and would have been an appropriate option for sure.

[Chas321]

And as to the floaters would your advice be to do nothing and just live with them. It is a sobering thought to think that I will have them for the rest of my life.

[LasikExpert]

I do not know of any treatment for floaters that is commonly used and appropriate, however an evaluation by a retinal-vitreous specialist who specializes in floaters seems appropriate, and then follow that advice. If you Google "vitreous floaters treatment" you will find many articles about floaters and potential treatment.