A new laser system (Tango Reflex, Ellex) combines specialized Nd:YAG vitreolysis settings for floaters with settings for trabeculoplasty, capsulotomy and iridotomy in one unit.
“It’s an exciting time because for so long floaters have been ignored,” said Inder Paul Singh, MD, a glaucoma specialist at the Eye Centers of Racine and Kenosha, WI. “And it is one of the most common patient complaints I see in my office.”
In its YAG mode, the platform delivers a truncated ultra-Gaussian energy beam that can vaporize floaters with less energy and it uses a coaxial illumination configuration to maximize visualization of the floaters, Dr. Singh said.
Although some clinicians fear that a higher dose of energy will cause damage to nearby structures in the eye, in fact dispersion of energy does not increase in proportion to the increase in intensity, he said.
“I realized early on how much of a misperception some people have about the physics behind the YAG laser,” Dr. Singh said.
For example, 1 mJ of laser energy disperses in a convergence zone of 100 µm, while the convergence zone of 5 mJ is 150 µm.
In addition, the platform features a truncated the energy beam. Since it has a sharper rise and fall, 30%-40% less energy is needed to treat floaters when compared to standard lasers. It can vaporize floaters at 3 to 4 mJ, but Dr. Singh said he often uses settings in the 5-6 mJ range.
Dr. Singh uses 200 to 800 shots per floater depending on the size and density of the floater. Since the laser delivers a 4-nanosecond pulse, the energy dissipates before the next shot is fired, therefore preventing a build up of energy.