Thursday, September 23, 2010

Using Lasers to Treat Vitreous Floaters: Laser Vitreolysis in the UK and Europe

In July, I decided to write about the use of lasers to treat eye floaters. I found three doctors in the United States specializing in this technique. After obtaining information about their practices, I wrote about their experiences in treating floaters. That article has drawn worldwide response, with over 1000 page views and still counting. In doing the research for that writeup, I learned that there were other doctors, in other parts of the World, also treating floaters and decided to contact some of these and see if they would be interested in sharing their stories as well.

I was able to identify at least six doctors in the UK and in Europe who perform laser vitreolysis. I  asked them to fill out the same questionnaire that I had used for the American doctors, and five of them agreed, with one declining. These are the stories of the five who agreed to participate.

Laser Vitreolysis in the UK and Europe

I won’t get into the details of what floaters are, what causes them and how are they treated. The answers to those questions and more are contained in the first report. (Using Lasers to Treat Vitreous Floaters: Laser Vitreolysis)

In that report I also discuss what laser vitreolysis is all about – what kind of floaters can be treated, and how the procedure is done.

What I would like to introduce in this report, is a short synopsis of the discovery of the ophthalmic YAG laser and its first use in treating anomalies in the vitreous.

The Ophthalmic YAG Laser and its Use in the Vitreous

As I have previously reported, the first laser, a ruby laser, was invented in 1960 by Ted Maiman at Hughes Research Laboratories in California. The first YAG laser was built in 1964 by Guesic, Marcos and Van Uteit at Bell Labs, and was a continuous wave (CW) laser. CW YAG lasers are still  used in surgery for cutting and coagulation of tissue. The first pulsed lasers for ophthalmology (Q-switched and mode-locked) were independently developed by Danielle Aron-Rosa in France (mode-locked) and Franz Fankhauser in Switzerland (Q-switched) in the mid-1970s and commercialized several years later by several companies.

Mode-locked lasers were difficult to maintain and eventually were replaced by Q-switched devices, which are smaller and more easily maintained.

In 1983, the first ophthalmic YAG lasers won FDA marketing approval in the U.S. and by 1984 or 1985, there were at least thirty different companies marketing Q-switched YAG lasers to the ophthalmic community. Today, there are probably five or six  major suppliers of ophthalmic YAGs, and these lasers are found in just about every general or refractive ophthalmologist’s office, primarily for performing posterior capsulotomies (the removal of opacified posterior capsular tissue following intraocular lens insertion during cataract removal procedures).

It was probably Dr. Fankhauser, using his Lasag Q-switched laser in the late 1970s or early 1980s that first performed work in the vitreous to cut vitreous strands, using special optics that he had designed. According to Dr. Scott Geller, the first doctor to specialize in this technique in the U.S., he heard about the work that Dr. Fankhauser was doing and visited him in Switzerland in the early 1980s. He was impressed with what he saw and decided to begin using his ophthalmic YAG laser in the vitreous upon his return to the United States.

Dr. Geller probably performed his first laser vitreolysis in 1985 or 1986 and began to specialize in treating floaters by about 1989.

Dr. John Karickhoff believes he did his first floater, an opacified string stretched across the visual axis in early 1990, with no knowledge that the procedure had been done elsewhere. Thinking that the procedure was only suitable for strands he did not do it again until 1999. He himself had developed a bothersome floater, learned about Dr. Geller and had Dr. Geller treat his floater. He then observed Dr. Geller perform the procedure on isolated floaters, learned about the technique used and brought this technique back into his office and began performing the procedure in earnest at that time.

The third U.S. doctor to specialize in treating floaters, Dr. James Johnson, had opened a LASIK practice in 2007. He had seen Dr. Karickhoff’s web site and bought his book Laser Treatment of Floaters. He found the technique intriguing, enjoyed some early success in treating floaters and, within a year, had closed his LASIK practice and began specializing in performing laser virtreolysis.


That brings us to the doctors specializing in this technique in the UK and Europe.

European Doctors Specializing in Treating Eye Floaters

In my research, I identified six doctors who use lasers to treat eye floaters. Five agreed to participate in this survey. I will begin with the three doctors doing the procedure on the European Continent.


Bern, Switzerland – Dr. Franz Fankhauser




First, you must understand, this is the son of the inventor of the pulsed YAG laser. When I first made contact with Dr. Fankhauser, I thought I had reached the father, but quickly learned that the father, who is in his mid-80s, is retired, but taught his son how to treat floaters and still comes into the office once a week to check up on his son.

Dr. Franz Fankhauser (the younger) follows in his father’s footsteps in practicing ophthalmology.

He obtained his MD degree from the University of Bern Medical School, Bern, Switzerland. He did  further studies at the following medical schools: Stanford University Medical School, Dept. of Ophthalmology; Community Hospital Neumünster, Dept. of Surgery, Zurich, Switzerland;  Tuft’s University Medical School, Dept. of Ophthalmology, Boston, USA; Bascom Palmer Eye Institute, University of Miami, Miami, USA; Residency at University of Zurich, Dept. of Ophthalmology, Zurich, Switzerland; UMDS at the University of London; an MBA degree from the Leipzig Graduate School of Management, and his PhD from the Dept. of Ophthalmology of the University of Dresden, Dresden, Germany. He has also worked  for two ophthalmic laser producers, Schwind Eye-Tech-Solutions and Wavelight GmbH.

In May 2008, he joined his father’s eye practice, Augenzentrum Fankhauser AG as CEO, and continues in his father’s tradition of providing excellent ophthalmic care to his patients.

Treating Eye Floaters

Dr. Fankhauser began treating eye floaters in 1993. He got involved because of his father as a logical continuance of his father’s family business. He uses, as did his father, a LASAG Microrupter II YAG laser for his work on floaters, using a prototype delivery system. Dr. Fankhauser told me that he has treated hundreds of patients, with about an 80% success rate, defined as a significant improvement of the disturbance. It usually takes betweeen two to five treatment sessions, depending on the type of floater being treated. The practice charges approximately 2900 CHF (Swiss francs), including both pre- and post-operative examinations.

His practice can be reached at the following address:

Franz Fankhauser MD PhD MBA
Augenzentrum Fankhauser AG
Gutenbergstrasse 18
CH-3011 Bern
Switzerland
Tel. +41 31 301 9880
Fax. +41 31 301 9881


Antwerp, Belgium – Professor. Marie-Jose Tassignon



Professor Marie-José Tassignon completed her undergraduate study and her degree in ophthalmology at the University Hospital Brussels (AZ VUB) and her doctoral degree at Rijksuniversiteit Leiden. She began her professional career at the University Hospital Brussels in the early 1980s, working her way up to become Associate Professor in ophthalmology. In 1991 she joined the Ophthalmology Department at the University Hospital Antwerp, and in 2008 was named its Medical Director. It was the first Department of Ophthalmology in Belgium to offer refractive surgery to  its patients.

Since 1991, she has lead the department and it has experienced a steady growth. Professor Tassignon has established an international reputation in the field of ophthalmology, mainly in the subspecialities of cataract, corneal and vitreo-retinal surgery. She has proven to be an outstanding clinician and successful director of the Centre for Ophthalmology over the past 15 years. Not only has she managed to advance medical care, but the Centre's research activities have also expanded and earned international recognition.

Professor Tassignon has developed and patented an intraocular lens that has zero posterior capsule opacification – eliminating the need for post-catarct laser surgery to remove the usual opacification. This particular lens is called "bag-in-the-lens" which is in contrast to the classical "lens-in-the-bag" concept of fixation. This new lens in not implanted in the capsular bag but supported by the capsular bag.

In addition to being Medical Director of Antwerp University Hospital, she has previously chaired both the European Society of Cataract and Refractive Surgery (ESCRS) and the European Board of Ophthalmology (EBO).

Treating Eye Floaters

Although Professor Tassignon does not take eye floater patients directly, she does treat those patients that have been referred by other ophthalmologists and who fit her treatment criteria(1). She began treating eye floaters with the YAG laser in 1999. She started these treatments because of her familiarity with YAG laser surgery in ophthalmology (secondary cataracts). She recognized the challenge to treat vitreo-retinal stands for vaso-proliferative retinal pathologies. She uses the Lasag Microrupter II laser, as did Prof. Fankhauser, its inventor.

To date, because her practice is not a primary floater clinic, but only by referrals, as noted above, she has treated about 150 patients. Her success rate depends upon the type of floater encountered, and since only “well suspended” floaters respond well, her success rate is only about 25% to all type of floaters. Most floaters take either one or two laser sessions, rarely three. Since there is a dedicated social security number for treating floaters in Belgium, the charge is about 250 euros.

Professor Tassignon can be reached at her office at the University Hospital Antwerp as shown below:

Marie-José Tassignon, MD, PhD, Febo
Head of the Department of Ophthalmology
University Hospital Antwerp, Belgium
UZA - Ophthalmology Centre
Wilrijkstraat 10
B-2650 Edegem
Belgium

tel. 00 32 3 821 33 77
fax. 00 32 3 825 19 26



1. T.Van Dorselaer, F.Van de Velde, M.J.Tassignon: Eligibility criteria for Nd-YAG  laser treatment of high symptomatic vitreous floaters. Bull.Soc.belge.Ophtalmol., 280, 15-22, 2001


Nantes, France – Dr. Eric Mehel




After eight years of medical school at the University René Descartes PARIS,  Dr. Eric Mehel moved to Nantes to specialize in ophthalmology. This, after his eight years in residence at CHU Hotel Dieu, in Paris under the direction of Professors QUERE and PECHEREAU. At the Hotel Dieu Hospital he held various posts, including as Head of Clinic and Hospital Doctor. He also taught in the Ophthalmology Department at the Hospital.

He now specializes in all areas of ophthalmology, including cataract removal and refractive surgery. Dr. Mehel is the head ophthalmologist in Nantes at a private practice, in association with several other specialized ophthalmologists. They are grouped around a technology platform that allows efficient treatment of all ophthalmic areas and diseases.

The treatment of floaters with a YAG laser is done only in Dr. Mehel’s office.

Dr Mehel operates exclusively at the Sourdille Clinic, located in Nantes, acclaimed as a  reference center dedicated exclusively to ophthalmology.

Treating Eye Floaters

Dr. Mehel began treating eye floaters about two years ago. He did this because he saw the need to help people suffering from this problem. He knew about the use of YAG lasers to do this because of his knowledge of the work of Dr. Geller in the U.S. He uses the same Microrupter II laser from Lasag as does Dr. Geller. To date, he has treated about 300 patients. He describes “success” as allowing his patients to resume a normal life. It usually takes between 3-6 sessions to remove floaters and he charges approximately 250 euros for the service.

His practice can be reached at the following address:

Docteur Eric Mehel
88 rue des Hauts pavées,
44000 Nantes Clinique Sourdille,
Place Anatole France 44 000
Nantes, France
Tél :06  42 30 41 16
Tél : 02 51 77 10 50




And, two of the doctors performing the procedure in the UK:


Altrincham Cheshire, England – Mr. Brendan Moriarty



Mr Brendan J. Moriarty MA (Cantab), MB, B.Chir, FRCS FRC Ophth, MD  qualified in medicine from Cambridge University. He trained in ophthalmology at the Bristol Eye Hospital, the Western Ophthalmic Hospital (London), the Prince Charles Eye Unit (Windsor) and St Paul's Eye Hospital (Liverpool). In 1987 he was appointed as fellow to the Dept. of Glaucoma at the Moorfields Eye Hospital in London.

He also has extensive experience in third world eye care and was Medical Director to Project ORBIS, the internationally renowned 'flying eye hospital'. He remains a visiting expert in glaucoma and cataract surgery to Project ORBIS and is a regular volunteer and advisor. In addition, he spent two years as fellow to the Medical Research Council, devising laser treatment to prevent blindness from sickle cell disease. During his time in Jamaica, he established free cataract facilities and introduced the rubella prevention programme to tackle childhood blindness. He was recognised for this work by the International Man of Achievement award in 1989.

Brendan Moriarty now holds a consultant post at Leighton Hospital in Crewe, Cheshire. He consults privately in Altrincham at the Prospect Eye Clinic, and in Macclesfield at the Regency Hospital.

His special interests are cataract surgery, glaucoma and laser treatment of floaters and visual rehabilitation in macular degeneration. He is a member of the UK, European and American Societies of Cataract and Refractive Surgeons and he is regularly invited to lecture internationally on glaucoma and macular degeneration. NICE, the National Institute for Clinical Excellence, have recently recognised Mr. Moriarty's expertise in surgery for Macular Degeneration by appointing him Special Advisor.

Treating Eye Floaters

Mr. Moriarty first started using the YAG laser in the vitreous in 1986 when he was working in Jamaica. He did a study with Professor Jampol from Chicago on the use of the YAG laser to treat tractitional retinal detachments in patients with sickle cell retinopathy. He then started using the YAG laser to treat floaters about 10 years’ ago after reading some articles, particularly Larry Benjamin’s article in the British Journal of Ophthalmology. He got involved because he had become very aware of how disturbing it was to have floaters when he had one temporarily in his left eye and questioned the received wisdom of many Health Care Professionals, namely that ‘nothing could be done’.

As he puts it, “I started treating floaters because I have had a significant number of patients who are severely disabled by it.” The laser he presently uses is the Lumenis Aura. He has had this for over 2 years’ and is delighted with its performance, particularly in light of the fact that often one needs to use about 1,000 to 1,500 mjs per eye in a treatment session. The only modification he has used for his delivery system is the Karickhoff contact lens for treating the mid-vitreous.

He claims he treats about 100 patients per year, so that he has treated approximately 1000 patients over the ten years he has been treating floaters.

Success very much depends on the type of floaters and their position. He presented a paper at MEACO in Dubai in 2007 where he indicated that he was able to get between 60% and 70% of patients cured and about a further 20% significantly improved. There remains about 10% of patients who do not feel that the treatment has made any difference. This is largely caused by floaters being within 2 mm of the retina and therefore not accessible by the laser.

It usually takes about 2 – 4 sessions to treat patients which are separated by a period of 4 – 6 weeks. For private patients without insurance he charges £950 per eye. This includes all treatments required to treat one eye.

His practice can be reached at:

Brendan J Moriarty
Consultant Ophthalmic Surgeon
The Prospect Eye Clinic
Suite 1.2, 20 Market Street
Altrincham, Cheshire
WA14 1PF

To make appointments or refer a patient to the Prospect Eye Clinic, please book online or contact Deryn Fawcett:
Phone: :  00 44 (0) 161 927 3177
Fax: 00 44 (0) 161 927 3178



London, England – Mr. Steven Bailey



Mr. Steven Bailey completed his specialist training at Moorfields Eye Hospital, and was included on the Specialist Register in 1992. He has been part of the corneal and external eye disease and contact lens services at Moorfields since the late 1980s. He has been in private medical practice as an ophthalmologist since 1989.

He has a special interest in keratoconus and is experienced in corneal collagen cross-linking (C3-R).

Mr. Bailey has been performing laser assisted refractive and therapeutic procedures since 1992. He trained in LASIK surgery in November 1995 and became one of the pioneers of this surgery in the UK. He was amongst the first eye surgeons in the UK accredited in the application of WavePrint wave-front guided laser treatments. He is one of only a few surgeons in the UK who have gained the Royal College of Ophthalmologists Certificate of Competence in laser refractive surgery and is an examiner for this qualification..

He was one of the early users of botulinum toxin ( BOTOX Cosmetic) at Moorfields and he is very experienced in its application for medical and cosmetic uses.

He lectures internationally and teaches on medical and optometric post-graduate training programmes. He has had papers on human physiology and ocular medicine and surgery published in peer-reviewed journals.

Treating Eye Floaters

Mr. Bailey became involved in treating eye floaters in 1999, because of patient demand for this service. He uses both Zeiss and Litetechnica YAG lasers in treating floaters, and has treated about 200 patients.

In terms of success, he said that all but one patient had improvement of their symptoms, and that those with discrete, axial, floaters do best. He defines success as a subjectively satisfactory improvement in symptoms without complications. It usually takes either one of two sessions to remove floaters. In his office, the charge for treatment is the cost of a one-hour consultation and necessary tests at  395, with the laser treatment costing  500 plus  175 for the use of the laser facility.

His practice can be reached at the following address:

Mr C Steven Bailey, BSc FRCS FRCOphth DO
99 Harley Street
London
W1G 6AQ
England
T: +44 (0)7973 691727
F: +44 (0)20 7431 2008

(This is the contact form from his website to make an appointment.)

The Netherlands

Since this article was written, I have heard from another European ophthalmologist that wrote to tell me that he, too, has a practice to treat floaters, in the Netherlands. Dr. Feike Gerbrandy said that he has treated a little over 100 eyes since he began using his YAG laser to treat floaters in September 2009. He is still treating about 30 of those eyes that require further laser treatment, but that his success rate to date is about 92%.

In addition, he is working with a vitreoretinal surgeon, Dr. Marco Mura, who has performed vitrectomies on four patients with floaters that were so extensive that the laser treatment failed.

Dr. Gerbrandy can be contacted at the following address:

Feike Gerbrandy, MD

Oogziekenhuis Zonnestraal
's-Gravelandseweg 76
1217 ET Hilversum
Netherlands
0031-8 88 77 77 77

www.oogfloaters.nl
info@floaterlaser.nl

13 Comments:

At 4:26 PM, Anonymous Anonymous said...

Thank you very much for a lot of useful information on how to treat the vitreous floaters! At most, I appreciate the direct contacts of the European specialists. I come from the Czech Republic and my wife starts having very negative psychological response to her floaters. We've heard that there was somebody in Switzerland who could maybe help her, but until now, I was unable to found his website.

 
At 6:42 PM, Anonymous Danijel said...

Thank you so much for the two articles. This is a very usefull summary. I was planning on going to Florida, but now I think Switzerland is much closer! Cheers from Croatia!

 
At 3:17 PM, Blogger Diamond said...

Thank you I was thinking I had to fly out to California. A few day trips to London at around £13 each is a massive saving!

 
At 10:52 AM, Anonymous Anonymous said...

I'm glad that I've found your irvaronsjournal.blogspot.com blog. What a unique blog! I like how detailed each of the entries are. They are well balanced - funny and informative - and the pictures are nice too.

 
At 4:57 AM, Anonymous Anonymous said...

Thank you - prior to finding this I was only aware of the operation being done in the US

 
At 2:27 PM, Anonymous Anonymous said...

Thank your very much for bringing such useful information.

 
At 1:51 AM, Blogger Derek said...

Thank you so much for the two articles. This is a very usefull summary.

Doctors United

 
At 12:26 PM, Anonymous Anonymous said...

WOW!
This is all I can say. Very comprehensive and informative. If doctors would act like this we would probably have a solution for the floaters right now!!
Thanks for your work!!

 
At 10:26 PM, Anonymous Anonymous said...

Thank you for posting this information. I am post-op 3 and 4 weeks from my cataract surgery. I had not been warned that the floaters I have had since my detached retina laser surgery in 2005 would be much, much more visible then they had been with cataracts intact. I guess I need to give it some more time to see if they go away, but I am so very frustrated. I was better off prior to the removal of my cataracts than I am now. I could have lived with blah color and at least I could see with my glasses. If my floaters don't significantly go away in 3-6 months then at least now I know there are a couple doctors in the USA who will be able to help me. Thanks again for being there and sharing your expertise on the subject.

 
At 10:29 PM, Anonymous Anonymous said...

Thanks for the information. I will probably be checking into securing a doctor in the USA to see if he can help me with my floaters post cataract surgery. My doctor told me it could take a year for them to go away! This is way too long.

 
At 8:04 PM, Anonymous J. Turbes in CO said...

This information is encouraging, as I have a large circular floater in one eye (my "best one", of course...) dead center covering 50% of the view field that stays there no matter what I do.

Here in the U.S., the ophthalmologist at my HMO (health maintenance org.), Kaiser-Permanente, said (1) it will gradually go away and (2) I'll "get used to it" and (3) there's only vitrectomy and no other choice.

When driving, it actually makes me nauseous to try and look past it. So clearly (sorry) I'm going to have to do something -- even if it requires a trip to Europe for a more proactive/agressive approach.

 
At 2:06 AM, Blogger Jman said...

Dear Irv,

thanks so much for compiling this information. Me too, from the first internet search, I had the feeling it was only done in the US. Now, thanks to you, I realised there are several in Europe , and even one in my country of residence!

 
At 9:21 PM, Anonymous Anonymous said...

Thank you soooo much!!

 

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