We are not trying to be biased, but Yag laser is only good for patients whose eyes have finished the PVD (Post Vitreous Detachment) nature process, and have a well suspended Weiss Ring in the middle of a eye ball. The advertising video below shows Dr Johnson is promoting Yag laser on Ellex offical video channel, but he never told us the side effect of the laser. Once a doctor start to do advertising for a profit-driven company, then it is easy for him to lose the full perspective. We are not blaming on Dr Johnson for the mistakes he made ( as he also stating in the video: there is a ” learning curve”). We have to admit Yag laser is much less invasive than the FOV( Floaters Only Vitrectomy), but it is very necessary for us to give the rest of the floaters sufferers out there a fair warning, and that is why we as Floaters Activists need to unite together to raise awareness and searching for better and safer solution other than Yag Laser.

Following unfortunate incidents with Yag Laser, Dr Johnson changed the content of his website,  Below is a direct quote from his web page:

http://www.thefloaterdoctor.com/age-factors-in-laser-treatment-of-vitreous-eye-floaters/

AGE FACTORS IN LASER TREATMENT OF VITREOUS EYE FLOATERS

AGE IS AN IMPORTANT FACTOR IN PREDICTING IF YOU ARE A CANDIDATE FOR TREATMENT When we are firt contacted by someone out of the area with a description of their eye floater problem, it is usually followed by the question “Do you think I’m a candidate for treatment?“. Our first question to them is: “How old are you?“. Without knowing anything else, the age of the floater sufferer is the most important predictor of the type and location of the eye floater and consequently the potential for candidacy for treatment with the YAG laser. Common vitreous degeneration, resulting in the subjective awareness of eye floaters, is not a well studied topic in the field of ophthalmology. Particularly regarding the types of floaters in younger people, which will be explained below. Fortunately, Dr. Johnson does not need to know why or how the floaters formed in their particular situation, but he does need to know what can or cannot be safely and predictably successfully treated. Please read through the following generalizations, but understand that there is overlap of characteristics and the age groupings are broad generalizations. THE YOUNGEST GROUP: THE TEENS TO THE EARLY 30’s In this medical practice, the youngest group is the most frustrating group to work with. They do have real vitreous floaters as defined by some condensation of the otherwise and preferably clear vitreous fluid. Their floaters tend to be microscopic filaments, threads, and small clumps and more important is that they are very consistently physically located too close to the retina to safely and successfully treated with the YAG laser. The YAG laser that Dr. Johnson uses in treating floaters has a very specific focal point where all the energy is focused. That focused energy needs to be kept away from the delicate structures of the eye, such as the lens towards the front, and the retina and optic nerve in the posterior portion of the eye. The floaters in young people tend to sit less than 1-2 millimeters from the retina. Any movement of the floaters tends to be translational and not away from the retina. So although Dr. Johnson uses the eye movements to his advantage, these fine, delicate and microscopic floaters generally do not move away from the retina. In addition, because these floaters are so close to the retina, the shadows cast on to the retina are usually quite distinct which makes them so bothersome to the patient. The laser operator has many more optical obstacles in his way. The light reflected from these microscopic entities has to pass through many optical tissues as well as multiple lens elements in the microscope before they can be seen. Floaters in young people are often something that the patient sees, but the doctor doesn’t see. It is impossible to simply just increase the magnification. Microscopes don’t work that way. So here’s the question that we are asked by young patients over and over again: “Do you think I’m a candidate for treatment?” My usual answer is “probably not based on your age alone“. That said, there have been some notable exceptions of younger patients that I have been able to treat. But these situations are exceptional. Dr. Johnson will not turn any one away from the door because of their age, but we feel it is simply being respectful to convey the statistical likelihood as to the potential for treatment in younger patients. Ultimately, it does take an in-person evaluation to determine it for sure. READ OUR FAQs FOR YOUNG PEOPLE WITH EYE FLOATERS THE IN-BETWEEN AGE GROUP: 30-45 YEARS OLD In our experience, age group commonly has generally clear vitreous fluid with multiple, cob-web like strands of condensed vitreal collagen. These strands (or groups of strands) typically reside in the posterior 1/3 of the globe. They move quickly like they are tethered by elastic fibers. In other words, they will move across or near the central vision with head movement, then return to its preferred, stable position. As far as the “treatability” of these floaters, it is difficult to predict. They are more treatable than the typical 20 year old, but not as treatable as a group compared to a 60 year old who probably has much more material, mass, and volume to treat. In addition, the fibers tend to be fairly dense and ‘rubbery’, requiring good energy delivery which is sometimes difficult working in the posterior 1/3 as well as peripheral regions of the vitreous space. That all said, we have enjoyed some notable successes in this age group with greater than 50% treatability and success. We find that many of these otherwise healthy patients with long careers ahead of them do appreciate the improvement in the quality of vision when they are treatable. THE OLDER AGE GROUP: 45 AND OLDER The age group that is by far the most successfully treated is the older patient. This group makes up the bulk of our patient base. They have often experienced a posterior vitreous detachment (PVD) or have more widespread degeneration of the vitreous larger clumps and masses. The vitreous detachment may occur quite rapidly as there is a posterior movement and shift of this fluid. As this occurs, the vitreous body moves forward separating from the retina. The patient may experience a sudden onset of a large floater, or multiple scattered floaters, or thousands of small round specks scattered all throughout the eye.

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Weiss Ring Floaters A Weiss ring floater is a particular sub-type of floater that is always associated with a PVD, but a PVD does not necessarily produce a Weiss ring floater. These floaters are classically ring-shaped, but quite often they are not. These floaters are the most consistently, predictably, safely and successfully treated floaters. Treatability of Older Patients The good news is that even though the floaters associated with a PVD are typical larger and more extensive than with the younger age groups, these floaters are more successfully treated. They are usually clustered away from the critical eye structures (retina and lens), and the density of the Weiss ring-derived floaters absorb the laser energy readily and are definitively vaporized. There is some fragmentation of the floater into microscopic pieces that may benefit from further treatment or they may be so small as to be optically invisible. As with all patients, the other, cloud-like floaters that may also be present can be treated, but tend to have more of a tendency to regress or reform. This effect is described in detail on the Expectations of Laser Treatment page which may require more overall treatment effort.

 

Below is a direct quote from his web page about why Yag laser is not for young patients:

http://www.thefloaterdoctor.com/young-floater-faqs/

FAQ’S FOR YOUNG PEOPLE WITH EYE FLOATERS

By DrJohnson | June 11, 2013 | Floaters | 21 |

I am contacted by young people from all over the world suffering the angst and anxiety caused by persistent and unrelenting moving shadows in their vision. As my practice has evolved over the last several years I have come to accept the conclusion and realization that most young people with eye floaters are not good candidates for treatment with the YAG laser. Those who we think might be exceptions are often proved not to be exceptions at all. Those who is been told they have had a posterior vitreous detachment(PVD) at the young tender age of 30 end up not having a PVD at all. In some cases it is just the phrase that their local eye doctor uses to describe floaters. I am starting to run out of different and unique ways of responding to these general inquiries. The typical e-mail message or comment goes something like this:

“I am  X years old and my floaters look like [ insert description of crystal worms, squiggly lines and dots here ]. My eye doctor told me that my eye is perfectly healthy but that nothing could be done. Do you think I am a candidate for treatment with the laser? Do you think they will get worse/get better over time?  Is there something I can take to make it better?”

 

 

Although I empathize with this patients frustration and their hopeful and optimistic search for some solution to the problem, in attempting to answer this question specifically to them, I would be entering into a doctor-patient relationship without having had the opportunity of meeting the patient or examining the eye. This puts me at a distinct disadvantage as well as to some medicolegal risk. If you are reading this because I responded to your inquiry and directed you here, please do not be offended by any lack of personal attention to your important questions. You will more likely learn more from this more extensive post then you would from a brief e-mail reply.

The following, in no particular order of organization or importance, are some important ideas, observations, and answers to your questions about floaters in younger patients. They will hopefully answer your questions as well as the questions you have not yet thought of.

• The floaters that young people have are not the same as the floaters that older people have. The floaters that young people have do not “age” and become the floaters that older people have. If you are 30 years old there is no reason to believe that in 10 years time your floaters will then become treatable with the YAG laser.
• There are no scientific studies or publish articles that address this problem of floaters in younger patients adequately. All of my comments or recommendations are based on my understanding of the anatomy of the eye, and my observation and examination of people with bothersome vitreous condensations in both the younger and older age groups.
• In my experience, most eye care providers are not particularly interested in eye floaters. They do not think about them much, and in our education, training, and general practice not much time or attention is given to eye floaters. There is no standardized way of describing floaters and there is no common language amongst these professionals to describe the type, location, density, and or behavior of these vitreous densities in the eye. As such, I have not found it helpful to review the medical charts provided by other doctor’s offices. this is not in any way meant to diminish distiller capacity of these eye doctors, it is just to say I have not found them to be helpful in the context of determining whether somebody is a candidate for treatment or not with my laser.
• Simply put, a floater is caused by condensation or clumping of the (usually individual ) protein strands interspersed throughout the vitreous fluid. The collagen that makes up these floaters is “sticky” in its natural state. The stickiness is probably due to intermolecular attraction. When these protein strands have stuck together, they are very difficult to separate.
• Floaters are not made up of living, breathing cells. Unlike other living cells in the body, they do not have an active metabolism. They do not take up oxygen, and they do not respirator carbon dioxide. They do not imbibe nutrients, sugars, minerals, medications, herbs, etc. They are for all intents and purposes fairly inert material. As such, I do not believe that they will be responsive to oral or subsequent blood borne nutrients or supplements.
• Collagen proteins that make up your eye floaters have been in your eye your entire life. It was not secreted into your eye. It is not made up of abnormal or foreign proteins. They do not bother your otherwise healthy eye. There is no reason the body’s immune system or any other system meant to get rid of abnormal material would recognize your floater as abnormal. There is no natural turn-over of vitreous material or filtration system that would normally clear that material out
• Tiny little microscopic floaters are suspended in place by a complex system of elastic fibers. They are neutrally buoyant. They do not sink from gravity. There is no reason to believe that in a young person, your floaters will sink to the bottom of your eye and out of your visual field or otherwise disappear like your eye care providers suggested would happen.
• Based on my experience with examining younger patients with floaters, the floaters typically reside less than 2 mm away from the retina and often quite a bit closer than that. Although it may appear to be floater sufferer that the floaters are moving quite a bit, the actual movement within the eye may be just a couple of millimeters and typically they remain about the same distance away from the retina and do not move far enough away to allow for treatment with the laser. It is not safe to discharge the laser that close to the retina. This is the primary reason why I cannot treat most younger people with eye floaters.
• Did your eye doctor described you as having had a posterior vitreous detachment? I doubt it and would be very surprised if that were true. Posterior vitreous detachments are very rare in younger patients. I have found that some doctors use that term as a generic description of floaters.
• Is it possible to diagnose somebody with floaters without actually seeing the floaters? Why yes.It is by a “diagnosis of exclusion”. when you go to your local eye care provider complaining of “moving shadows in your vision”, the standard of care And general obligation of that eye doctor is to “rule out” any condition that could blind you, or for which they could be sued for medical malpractice if they were to miss the diagnosis. Essentially this means that they are obligated to look very carefully at your retina for any retinal pathology such as retinal holes, tears, or early detachments. Once those conditions have been eliminated as possibilities, and based on the patient’s description of moving shadows, is quite simple to make the diagnosis of vitreous floaters. The microscopically small vitreous condensations often seen by young patients are extraordinarily difficult to find on eye examination. I believe many doctors will “imply” that they have seen the floater when they are actually diagnosing it by exclusion.
• Just because your doctor actually does see some vitreous irregularities does not guarantee that what they are seeing is responsible for your symptoms. There are some eye floaters that I call “smoke screen floaters” that can easily confuse the examiner (including myself) at times. Occasionally these floaters are noticeable in the middle part of the eye where they can safely be treated. They may also have this similar shape or  morphology consistent with what the patient describes. More than a few times, I have successfully treated these only to find that the patient is still seeing the exact same floater. The floater may eventually be found upon closer examination as a microscopic condensation sitting less than 1 mm away from the retina. If you think you are an exception because your doctor told you they could clearly see your floaters, you may be wrong and are of not that exceptional after all.
• If you have asked me if you are floaters will get worse, I cannot answer you.
• If you have asked me if you are floaters will get better with time, I cannot answer you
• If you have asked me what you can take or supplement for your floaters to get better, I cannot answer you.
• If you have asked me if I am familiar with Vitreox or any number of other patent remedies or herbal concoctions, I will tell you that may have not been proven to help. I have more extensive thoughts on this topic. You can read it here.
• If you are asking me if there is anybody close to where you live who treat eye floaters, I have already provided that information here.
• On the main landing page of my website in bold and in red there is a link to the page that describes my fees. On every other page as well as from the menu there is a link to the page on my website that describes my fees. If you are still having trouble finding that information, please click the following link for information about fees.
• If you are considering a surgical vitrectomy or floater-only vitrectomy (FOV) as it is sometimes referred to, there are a few things you should know. I consider the vitrectomy as the “gold standard” procedure. If the intent is to remove all of your vitreous, then it stands the best chance to remove all of the floaters along with it. The FOV is an invasive surgical procedure that alters some of the fluid dynamics and protective effects of the vitreous fluid. After surgery, there is a fairly high incidence of formation of lens cataract which may require more surgery. If a cataract surgery is necessary, you will lose the normal focusing and accommodating behavior of the eye. The two eyes will no longer be balanced for focus. In addition, because most younger people have not had a posterior vitreous detachment, the process of the vitrectomy may transmit traction to the retina and put that patient at higher risk of retinal detachment caused by the surgical procedure. That risk goes down somewhat when somebody has had a PVD. The practical reality, though, is that retina specialists are generally reluctant to offer the FOV because they do not consider floaters to be enough pathology to justify the risk. This is true even with very prominent and impressive appearing floaters in older people, and would be even more true when the floaters in question are essentially imperceptible and very difficult to document their very presence. The medical legal risk to the surgeon is too high to justify and invasive procedure for something they can even see. So although the surgical vitrectomy is a theoretical option, you would be very hard-pressed to find somebody willing to perform that procedure on you even if you were directly asking for it.

Is there any reason, then, that a young person would even consider coming to visit Doctor Johnson at Vitreous Floater Solutions? It is possible that there might be some value in coming to visit Doctor Johnson for a thorough evaluation of a young person floaters. It may be that although your local eye care provider competently examined your eyes, they were not able to definitively prognosticate as to whether or not you have floaters that are potentially treatable. Because my practice is exclusively dedicated to treating floaters and I have experienced in treating floaters, I can more definitively describe the problem and determine whether your particular condition is treatable with the laser. I should at least be able to remove the uncertainty that may accompany your condition. Knowing for sure that it is, or is not treatable may help you move towards accepting your condition and moving on with your life rather than always wondering what really is going on and whether you are one of the few exceptions to the rule. -Dr. Johnson