Some people call them floaters. Eye doctors call them
"vitreous opacities." Emily Flynn of Dunedin, New Zealand, called
hers "a little fuzzball." She flew halfway around the world to have
it removed.
FALLS CHURCH, Va. —
Some people call them floaters. Eye doctors call them vitreous opacities. Emily
Flynn of Dunedin, New Zealand, called hers a little fuzzball. She flew halfway
around the world to have it removed.
After more than 100
pinpoint zaps from a laser beam during a half-hour visit to a northern Virginia
office park, the fuzzball was gone, obliterated within the clear, gelatinous
goo that fills the eyeball.
The surgeon, John
Karickhoff, has done the same procedure more than 1,400 times over the past 15
years and claims a success rate of better than 90%, with minimal risk of
complications. Still, many ophthalmologists have never heard of the procedure —
and most would recommend against it. The procedure has drawn regulatory
scrutiny in Florida.
They are harmless,
usually just bits of membrane that have become dislodged from other parts of
the eye. Karickhoff estimated that 95% of people who have floaters ought to
leave them alone. But for that 5%, they can be a legitimate problem.
"I've had
musicians who couldn't read the sheet music quickly enough because the floater
would get in the way," said Karickhoff, who has tried for years to get the
procedure accepted into the medical mainstream. "It can ruin a patient's
quality of life."
Only a handful of
doctors in the United States — perhaps as few as two — regularly treat floaters
with laser surgery.
"Patients usually
are told to learn to live with it," Karickhoff said. "By the time
they come to see me, they've already seen two or three other doctors."
Richard Bensinger, a
spokesman for the American Academy of Ophthalmology, said most ophthalmologists
believe the procedure is unnecessary. He acknowledged the laser treatment is
often successful and carries little risk, but most doctors believe any risk is
unacceptable for treating a benign condition like floaters.
If patients insist on
treatment, Bensinger said the laser treatment can be a better choice than the
more common alternative, a vitrectomy, which involves removing most or all of
the eyeball's internal fluid.
The vast majority of
patients can learn to live with floaters, Bensinger said. Those patients who
demand treatment, he said, "are mostly obsessive-compulsive types"
who allow the floaters to drive them to distraction.
But Oliver Hill, 60,
of Waynesburg, Pa., said many eye doctors are too dismissive of how irritating
a floater can be. He compared it to trying to read a book while holding a
pencil directly in front of one of your eyes.
"It just drove me
right up the wall," said Hill, who had his left eye treated in June 2005
and returned to Karickhoff in November to treat a floater in his right eye.
In Flynn's case, her
optometrist in New Zealand had told her that floaters were common and not
harmful, and that she should learn to live with it. She learned about
Karickhoff from his website.
Before having the
surgery, Flynn said she would get headaches as she read and often tried to read
with one eye shut to keep the floater out of her line of sight.
"That eye was
effectively dysfunctional," Flynn said.
Karickhoff said he
knows firsthand that floaters can be troubling — he had what he called "a
whopper" of a floater in his own eye.
He was skeptical when,
on a Florida vacation, he saw a newspaper ad touting laser surgery for
floaters. But he sat in on a surgery performed by Fort Myers ophthalmologist
Scott Geller and later allowed Geller to operate on his eye. The procedure was
a success.
Not long after,
Karickhoff began performing the procedure himself. Both Geller and Karickhoff
have since operated on thousands of patients.
Last year, the Florida
Board of Medicine investigated a complaint against Geller filed by a
72-year-old woman who complained that the surgery merely broke up one large
floater into a bunch of smaller floaters. But the board dismissed the complaint
after hearing testimony from Karickhoff on how the procedure works.
Karickhoff, who has a
clean record with the Virginia medical board, said he can tell by examining the
patient's eye if the floater is a serious distraction or a minor annoyance. He
declines to treat those "who are making a mountain out of a mole
hill" because such patients will almost never be satisfied.
There is little
peer-reviewed literature about the procedure. What does exist shows the
procedure to be generally safe, but the results about its effectiveness are
mixed.
Karickhoff said
studies have not replicated his success rate because they have not fully
emulated his technique, which requires a laser beam of a specific intensity,
and because they have not always chosen ideal candidates for surgery.
Geller likened laser
treatment of floaters to "an orphaned surgical procedure" that has
been unable to overcome entrenched skepticism.
Despite that
skepticism, Karickhoff said the medical community has not been completely
unresponsive. He has written a medical book about the procedure, and said he
received mostly positive feedback when he presented his work in November at the
national conference of the American Academy of Ophthalmology. And insurers
frequently cover the procedure, he said.
Manfred von Fricken,
chief of ophthalmology at Inova Fairfax Hospital,said he has seen many of
Karickhoff's patients who have benefited from the surgery.
"It's an
innovative approach," said von Fricken, who agrees that eye doctors are
too often dismissive of patient complaints about floaters. "He's thinking
out of the box, and I think it's pretty imaginative."