Thursday, August 05, 2010

Using Lasers to Treat Vitreous Floaters: Laser Vitreolysis – Part 2

Dr. Scott Geller was the first ophthalmologist in the United States to use a laser to treat eye floaters. He was trained by Dr. Franz Fankenhauser of Switzerland, probably the first ophthalmologist to use his YAG laser in doing work in the vitreous.

When I asked Dr. Geller how he got started using his laser to treat floaters, he told me that he would like to think about it and write about his experience. Here, in his own words are his recollections:

The Origin of Clinical Laser Vitreolysis

Scott Geller MD

In the mid 1980’s I had just started my practice. During residency at Sinai Hospital in Detroit, which was affiliated with the Kresge Eye Institute, my chief, Hugh Beckman MD had a focused interest in ophthalmic lasers (which were just gaining widespread use), and had one of the best laser research labs under the direction of Terry Fuller PhD. The Q-Switched YAG had just been approved by the FDA for general use (1983), and I took the very first clinical course from Leeds Katzen MD in Baltimore.

At that time it was rare for an ophthalmologist to have his own laser. Most ophthalmologists used argon lasers owned by their hospitals. Trabeculoplasty had just been described, and YAG capsulotomy/iridotomy had just been introduced.

Not really cognizant of ophthalmologist jealousies and hospital politics, my request that the Department of Surgery of my hospital purchase an argon and YAG was unanimously opposed by the existing ophthalmic attending staff. The new kid on the block must have been out of his mind!

So I made the decision to buy my own. Those were the days when medicine was a profession free of government price fixing and manipulation, and I felt sure I could recover the substantial cost of acquisition, even without an established patient base.

That year the Academy Meeting had about 6 companies marketing the newest thing, the ophthalmic YAG laser. (This must have been 1983 or 1984.)

I came upon the LASAG company display and met the young President of the division, Heinz Greuder. The laser he was making was huge, easily 4 or 5 times the size of the other manufacturers. And so was the price….easily $300,000 in today’s depreciated dollars.

I asked why the price difference, and was asked a question in return: “What exactly do you know about laser physics, Dr. Geller?” Even though I had taken a course, my knowledge of the mechanics was basic, that is, not much. “Sit down with me for twenty minutes and let me educate you.” I was given the complete rundown of the optics, beam quality, precision, aiming etc. This laser was capable of both Q-switched and free running modes, allowing trans-scleral photocoagulation, and what we now call selective laser trabeculoplasty for glaucoma. “Prof. (Franz) Fankhauser made this laser especially to work in the vitreous…’ll get referrals from your Retina colleagues to cut diabetic membranes !! “

I was convinced. I wanted the best machine made – the top of the line – and this was it. Part of the deal was that the company would send me to the University Eye Clinic in Bern, Switzerland, to take the laser course being offered by the world’s most experienced ophthalmologist, Prof. Fankhauser. I had the rare opportunity to study under the master, and learned the delicate techniques needed to work 2 or 3 mm from the retina or the crystalline lens. I was the only American of the 6 or 7 ophthalmologists there.

I do not remember who eye floater patient #1 was. But I do recall that it was a significant fibrillar mass in the mid vitreous obstructing vision in a phakic patient.

I had taken extensive training from the Master, and I knew the envelope of safety. I had absolutely no hesitation in applying this knowledge and ability to a condition no ophthalmologist had pursued – obstructive vitreous eye floaters.

That first success was followed by many others, and I had developed a reputation that resulted in a worldwide patient base.

I presented my first paper on clinical results at the International Congress of Ophthalmology, Singapore, 1989. This was followed by presentations at the European Society of Cataract and Refractive Surgery, Prague, 1997; European Congress of Ophthalmology, Istanbul, 2000; Florida Society of Ophthalmology 2002; and the World Ophthalmology Congress, Berlin, 2010.

In 2000, I trained John Karhickoff MD (and lasered his floaters). He has subsequently written the only textbook on the subject. Several other foreign ophthalmologists have been trained and advised, and have set up their own facilities.

But after doing 10,000 – 20,000 laser vitreolysis procedures over a 25 year period, nothing puzzles me more than the lack of interest of most ophthalmologists. And the dogmatic belief that it doesn’t work.

I have a simple answer to that…………ask the patient.!!

For the rest of the story, please see Part 1; Using Lasers to Treat Vitreous Floaters: Laser Vitreolysis


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