How risky are ophthalmology procedures?

[MstaKing10]

Don't want to come off as insensitive, but for those of us who see 40-60 patients a day in the retina world with real severe disease and real blindness or near blindness, it would be hard to examine you, see you have an essentially normal eye exam then listen to you complain for 30-40 minutes about your floaters while John Doe next door has endophthalmitis in severe pain and about to go blind and the other guy next door has a macula off retinal detachment with light perception vision.

Again, not trying to minimize your symptoms but seriously, there are worse things in the world. A good buddy of mine in medical school was diagnosed with cancer, fought through it in during medical school, graduated on time and is now a healthy and successful heme/onc doc. Don't think for a second he allowed pesky cancer to force him to quit or choose another path (which he would have been very justified in doing).

Everyone is different, put perspective is important.

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[collosalmockery]

In 12 years of seeing patients and having seen thousands of patients with "floaters" and PVDs I have yet to encounter one that has had to alter their career paths or needed psychotherapy because of them.

That's what I'm finding so peculiar about your postings.

Yes, I can admit that there is a spectrum when it comes to "floaters" and yes, certain career paths would make floaters more bothersome than others but with certainty, there are hundreds of orthopedic surgeons, fighter pilots, astronauts, whatever who have floaters and it's not affecting their career paths.

I'm also not clear on whether you yourself have had the surgery to remove these floaters. Have you? If not, why not? You seem to advocate PPV as a treatment for floaters.

If so, then why are you not able to pursue your desire of being an orthopedic surgeon?

I totally understand your skepticism given your vast experience in eye clinic. My parents have PVD floaters but they never even mentioned them till they found out I was depressed due to floaters and they just could not understand how I could be depressed because of something so benign that my parents have had for years. Its a spectrum, as your correctly said, some people are unlucky to get the severe form of floaters.

I have had PPV in one eye only. I developed a small tear during the surgery which was successfully treated. Due to that I do not want to get PPV for my other eye. It is a personal decision but I am also aware of many patients who have had amazing results from PPV and their life is back on track. I will get PPV in other eye in future once I am done with my residency etc. For now, I can close this eye in hospital and use my floater free eye, some days I put a bandage patch on the bad eye. I look weird but whatever.

I am an advocate for PPV in the sense that once the the patient has been made correctly made aware of complications and risks, if they insist, they still should be offered PPV. And risk should be presented to them in an honest non-scary way. Yes there is some chance of blindness but chances of successful surgery are higher.

If you can spare some time, I urge you to please read this thread http://floatertalk.yuku.com/topic/4026/spare-money-FOV-s-right-5-Sept-11-left-20-Sept-11

 

[tm12]

I am an advocate for PPV in the sense that once the the patient has been made correctly made aware of complications and risks, if they insist, they still should be offered PPV. And risk should be presented to them in an honest non-scary way. Yes there is some chance of blindness but chances of successful surgery are higher.

My impression is physicians who are not strong proponents of PPV for floaters would never do it and those who are will be the only ones willing to do it. How do the rest of you practice? Anecdotally, physicians who are not comfortable doing a procedure and are "forced" to do it end up regretting it.

 

[collosalmockery]

Don't want to come off as insensitive, but for those of us who see 40-60 patients a day in the retina world with real severe disease and real blindness or near blindness, it would be hard to examine you, see you have an essentially normal eye exam then listen to you complain for 30-40 minutes about your floaters while John Doe next door has endophthalmitis in severe pain and about to go blind and the other guy next door has a macula off retinal detachment with light perception vision.

Again, not trying to minimize your symptoms but seriously, there are worse things in the world. A good buddy of mine in medical school was diagnosed with cancer, fought through it in during medical school, graduated on time and is now a healthy and successful heme/onc doc. Don't think for a second he allowed pesky cancer to force him to quit or choose another path (which he would have been very justified in doing).

Everyone is different, put perspective is important.

I totally agree with you on that. Mac off RD and endophthalmitis are serious emergencies and should be given a higher priority. But please do not ignore the "rants" of a floater patient. At least the ones who do have severe floaters and whose quality of life is decreased significantly because of them. If it is of any value, I have a doctor's note to wear sunglasses during clerkship. Sunglasses dilates my pupil and decreases perception of floaters. So yes, it is not as serious as some acute emergencies you gave examples of but in the long run it does have severe effects on life.

 

[collosalmockery]

It seems this thread has been hijacked. This will be my last posting on this thread about floaters.

Degenerative Vitreous Syndrome and quality of life

In the latest issue of the American Journal of Ophthalmology, Wagle and associates present interesting new information about the negative impact symptomatic degenerative vitreous floaters have on the quality of life of sufferers. As Sebag notes in his discussion article in the same edition, investigators found that these patients were willing to take an 11% risk of death and a 7% risk of blindness to get rid of symptoms related to floaters.

Using an objective qualitative measure called Utility Value, patients in the study expressed that floaters have a similar or higher impact than the ocular diseases of AMD, retinopathy and glaucoma as well as the systematic diseases of mild angina, mild stroke, colon cancer, and asymptomatic HIV.

They also found that Utility values did not improve for patients who had had the condition for a long time. This tallies with the anecdotal evidence sufferers have long been posting in support forums and the results of our survey where only 2% of respondents felt their floaters had improved over time, while 78% thought they had got worse.

Frequently sufferers report that they are treated dismissively, even told that they are imagining their symptoms. People are almost invariably told that things will improve after a few years. This study we hope, will give primary carers pause for thought when they counsel patients at time of diagnosis.
References

1. Wagle AM, Lim W-Y, Yap T-P, Neelam K, Au Eong K-G. Utility values associated with vitreous floaters. Am J Ophthalmol 2011;152(1):60–65.
2. J. Sebag Floaters and the Quality of Life. Am J Ophthalmol 2011;152(1): 3-4.e1

Source: http://oneclearvision.org/node/119

 

[KHE]

It seems this thread has been hijacked. This will be my last posting on this thread about floaters.

Degenerative Vitreous Syndrome and quality of life

In the latest issue of the American Journal of Ophthalmology, Wagle and associates present interesting new information about the negative impact symptomatic degenerative vitreous floaters have on the quality of life of sufferers. As Sebag notes in his discussion article in the same edition, investigators found that these patients were willing to take an 11% risk of death and a 7% risk of blindness to get rid of symptoms related to floaters.

Using an objective qualitative measure called Utility Value, patients in the study expressed that floaters have a similar or higher impact than the ocular diseases of AMD, retinopathy and glaucoma as well as the systematic diseases of mild angina, mild stroke, colon cancer, and asymptomatic HIV.

They also found that Utility values did not improve for patients who had had the condition for a long time. This tallies with the anecdotal evidence sufferers have long been posting in support forums and the results of our survey where only 2% of respondents felt their floaters had improved over time, while 78% thought they had got worse.

Frequently sufferers report that they are treated dismissively, even told that they are imagining their symptoms. People are almost invariably told that things will improve after a few years. This study we hope, will give primary carers pause for thought when they counsel patients at time of diagnosis.
References

1. Wagle AM, Lim W-Y, Yap T-P, Neelam K, Au Eong K-G. Utility values associated with vitreous floaters. Am J Ophthalmol 2011;152(1):60–65.
2. J. Sebag Floaters and the Quality of Life. Am J Ophthalmol 2011;152(1): 3-4.e1

Source: http://oneclearvision.org/node/119

I can not seem to access the actual article so if anyone has a link that would be appreciated.

That being said, to me a study that claims that vitreous floaters affects people's lives THE SAME OR MORE than glaucoma, retinopathy, macular degeneration, COLON CANCER, and strokes is HIGHLY SUSPECT in it's methodology or wording of it's questionnaire.

I would be willing to bet $1000 that if you walked into a cancer ward and asked everyone who had colon cancer "would you rather have colon cancer of vitreous floaters" the rate of people selecting the floaters would be exactly 100%.

In fact, with the exception of "mild angina" I would bet that same $1000 for every condition listed.

 

[collosalmockery]

I can not seem to access the actual article so if anyone has a link that would be appreciated.

That being said, to me a study that claims that vitreous floaters affects people's lives THE SAME OR MORE than glaucoma, retinopathy, macular degeneration, COLON CANCER, and strokes is HIGHLY SUSPECT in it's methodology or wording of it's questionnaire.

I would be willing to bet $1000 that if you walked into a cancer ward and asked everyone who had colon cancer "would you rather have colon cancer of vitreous floaters" the rate of people selecting the floaters would be exactly 100%.

In fact, with the exception of "mild angina" I would bet that same $1000 for every condition listed.

I do not think you can compare diseases like that. Yes, AMD patients would want to rather have floaters, but once they have floaters and gotten rid of AMD, they'd want to get rid of floaters.

Moreover, can we say that people with asymptomatic HIV are suffering less than people with AMD? I do not think we can generalize and say people will be willing to switch diseases. Suffering is a very subjective thing, one's suffering might be peanuts if inflicted on someone else. So I think faulty comparison.

You can read the paper here. Data was collected from 266 people, a significant sample. http://www.medhelp.org/user_journal...AL-DOCUMENTS-PEOPLES-CONCERNS-ABOUT-FLOATERS-

 

[LightBox]

I do not think you can compare diseases like that. Yes, AMD patients would want to rather have floaters, but once they have floaters and gotten rid of AMD, they'd want to get rid of floaters.

Moreover, can we say that people with asymptomatic HIV are suffering less than people with AMD? I do not think we can generalize and say people will be willing to switch diseases. Suffering is a very subjective thing, one's suffering might be peanuts if inflicted on someone else. So I think faulty comparison.

You can read the paper here. Data was collected from 266 people, a significant sample. http://www.medhelp.org/user_journal...AL-DOCUMENTS-PEOPLES-CONCERNS-ABOUT-FLOATERS-

Ok, ok, we get it. Some people have very symptomatic floaters. Now can someone kill this thread?

You can't blame your regular 'ole Ophthalmologist for being wary about doing YAG vitreolysis for floaters, or your retina doctor for FOV.

I think more Ophthalmologists would consider these procedures if: (1) they could be absolutely assured that they would not get sued; and (2) some reputable study or academic physician actually developed a reliable protocol for YAG vitreolysis.

Currently, the 3 doctors doing YAG vitreolysis for floaters in the U.S. come off as being like cars salesmen (i.e. very very sketchy).

I have an open mind to doing these procedures, but not if my medical license or reputation is at stake. At the end of the day, it is not worth it to help someone with a 20/20 eye with symptomatic floaters....compared to the possibility of losing my livelihood.

 

[collosalmockery]

Ok, ok, we get it. Some people have very symptomatic floaters. Now can someone kill this thread?

You can't blame your regular 'ole Ophthalmologist for being wary about doing YAG vitreolysis for floaters, or your retina doctor for FOV.

I think more Ophthalmologists would consider these procedures if: (1) they could be absolutely assured that they would not get sued; and (2) some reputable study or academic physician actually developed a reliable protocol for YAG vitreolysis.

Currently, the 3 doctors doing YAG vitreolysis for floaters in the U.S. come off as being like cars salesmen (i.e. very very sketchy).

I have an open mind to doing these procedures, but not if my medical license or reputation is at stake. At the end of the day, it is not worth it to help someone with a 20/20 eye with symptomatic floaters....compared to the possibility of losing my livelihood.

hmm, so I guess your livelihood is more important to you then helping patients? So far the three YAG laser docs have not been charged with malpractice. One is doing it for the last 20 years i.e. Dr. Scott Geller. If he was really blinding people by his "unproven" procedure, I think by now his license probably would have been revoked. Or maybe you believe he is invincible?

 

[LightBox]

hmm, so I guess your livelihood is more important to you then helping patients? So far the three YAG laser docs have not been charged with malpractice. One is doing it for the last 20 years i.e. Dr. Scott Geller. If he was really blinding people by his "unproven" procedure, I think by now his license probably would have been revoked. Or maybe you believe he is invincible?

Actually, yes, my "livelihood" (which means my career) does mean more to me than performing a procedure that 99.9% of ophthalmologists do not consider standard of care.

If I lose my livelihood, I cannot help the type of patients that comprise 99.9% of my practice (e.g. glaucoma, diabetic retinopathy, cataracts), and for whom there are well-accepted treatments.

Collossal, you seem incredibly naive about the realities of practice in the real world. You're still a medical student, right? That would explain a lot. In the real world, a practitioner does not perform a procedure that is not accepted by 99.9% of his/her colleagues. Sure, Dr. Geller and those other two eye docs are doing YAG vitreolysis for floaters. Bravo for them. So if people with symptomatic floaters want those procedures, go ahead and see them -- no one is stopping you from consulting with them. Oh, and by the way, I doubt Dr. Geller and company are doing these procedures out of only the goodness of their hearts. Why not e-mail them and ask them if they would do your case for FREE?

 

[fzwarrior]

Wow. I wasn't expecting my original question to spark a floater war. I think the question was answered though. The general consensus seems to be small risk but serious consequences if things go wrong. Thanks!