Laser Vitreolysis for Vitreous Floaters

Vitreous floaters, also known as “mouches volantes”, are usually harmless. For some people, however, they are very bothersome in everyday life, for example when reading, working at a screen or looking at a bright background. In laser vitreolysis, these opacities are broken up or partially dissolved in a targeted way using a special YAG laser. The treatment is performed on an outpatient basis and takes only a few minutes.

What are vitreous floaters?

Vitreous floaters are small condensations of collagen fibres in the vitreous body of the eye. They usually develop as a result of age-related changes or a posterior vitreous detachment (1). The opacities cast shadows on the retina. Those affected see them as moving dots, threads or strands, especially against a bright background. Because the opacities move with every eye movement, they can significantly impair focused vision.

How does the YAG laser work?

The YAG laser works on the principle of photodisruption. The laser energy creates tiny, precisely targeted micro-explosions that mechanically break up or partially vaporise the opacities. The energy acts only within the vitreous and not on the surface of the eye.

What does the treatment involve?

1. Preliminary examination and consultation: your pupils are dilated and we examine the vitreous and retina carefully. Together we discuss whether your floaters are suitable for vitreolysis.
2. Treatment: the pupil is dilated with eye drops and the eye is numbed with drops. You sit at the laser device, much like during a routine eye examination. A contact lens is gently placed on the eye so that the laser can be focused precisely. Individual laser pulses are then aimed at the opacities. The treatment usually takes 5 to 15 minutes.
3. Follow-up: depending on the laser energy used, it takes place 1 to 7 days after the treatment.

How effective is the treatment?

Success depends strongly on the type of opacity. Dense, well-defined opacities, such as a so-called Weiss ring after a vitreous detachment, respond much better than diffuse, widespread haze. In randomised trials, treated patients reported an improvement in their symptoms more often than patients who received a sham treatment (2, 3). Overall, however, the scientific evidence is still limited (4, 5).

Several sessions are often needed to achieve the desired result. With diffuse opacities, the hoped-for improvement may not occur. Since the vitreous is constantly changing, new opacities can also appear at any time.

Are there any risks?

Vitreolysis is a gentle procedure. As with any eye procedure, however, complications are possible (5):

• Raised intraocular pressure (rare): this can be treated well with eye drops or tablets.
• Fluid accumulation in the central retina (macular oedema, rare): this is treated with anti-inflammatory medication.
• Extremely rare: damage to the retina, vitreous haemorrhage or clouding of the natural or artificial lens.
• In very rare cases: loss of vision requiring further treatment or surgery.

We will be happy to discuss any open questions with you in person during the consultation.

What should I keep in mind after the treatment?

• Do not drive: because of the dilated pupils, you may experience glare or blurred vision for the first few hours. Please do not drive on the day of treatment.
• Eye drops: for one week, apply anti-inflammatory eye drops (Yellox®) twice a day.
• Warning signs: if you see flashes of light or notice a dark curtain in your field of vision after the treatment, please contact your ophthalmologist immediately.

What are the alternatives?

• Wait and observe: vitreous floaters are usually harmless, and many people get used to them over time.
• Dietary supplements: preparations containing antioxidants can have a positive effect on how floaters are perceived (6).
• Surgical removal of the vitreous (vitrectomy): the vitreous is removed surgically. This is a considerably more invasive procedure with higher risks such as infection, retinal detachment or development of a cataract (1, 4).

Who pays for the treatment?

Vitreolysis is not included in the Swiss tariff catalogue (TARDOC) and is therefore not covered by health insurance. The cost is CHF 300 per eye per session. The preliminary and follow-up examinations, on the other hand, are covered by health insurance.

Further information

• Vitreous floaters, mouches volantes (EyePedia)
• Posterior vitreous detachment (EyePedia)
• Laser Vitreolysis (EyeWiki, American Academy of Ophthalmology)
• YAG laser vitreolysis – information for the public (NICE)

Sources and scientific publications

1. Milston R, Madigan MC, Sebag J. Vitreous floaters: Etiology, diagnostics, and management. Surv Ophthalmol. 2016;61(2):211–227. Link

2. Shah CP, Heier JS. YAG Laser Vitreolysis vs Sham YAG Vitreolysis for Symptomatic Vitreous Floaters: A Randomized Clinical Trial. JAMA Ophthalmol. 2017;135(9):918–923. PubMed

3. Ludwig GD, et al. Efficacy and safety of Nd:YAG laser vitreolysis for symptomatic vitreous floaters: A randomized controlled trial. Eur J Ophthalmol. 2021;31(3). PubMed

4. Kokavec J, et al. Nd:YAG laser vitreolysis versus pars plana vitrectomy for vitreous floaters. Cochrane Database Syst Rev. 2017;(6):CD011676. PubMed

5. National Institute for Health and Care Excellence (NICE). YAG laser vitreolysis for symptomatic vitreous floaters. Interventional procedures guidance IPG741. Link

6. Ankamah E, et al. Dietary Intervention With a Targeted Micronutrient Formulation Reduces the Visual Discomfort Associated With Vitreous Degeneration. Transl Vis Sci Technol. 2021. Link