Surgeon experience affects choice of intervention for symptomatic floaters

A survey reports practice patterns in the retina community involving surgical intervention for symptomatic floaters in healthy patients.

Issue: November 25, 2015

Vitreoretinal surgeons may be more likely to intervene for symptomatic floaters if they have performed pars plana vitrectomy for floaters in the past and perform more vitrectomies each year, according to a study.

Symptomatic floaters can interfere with daily functioning and affect patients’ quality of life. Either Nd:YAG vitreolysis or pars plana vitrectomy can be performed to treat this problem, but there is controversy whether retina specialists should proceed with surgical intervention in otherwise healthy eyes.

“Usually the retina community wants to operate on a problem that we can objectively see and assess and measure,” corresponding author Sunir J. Garg, MD, told Ocular Surgery News. “But with floaters, many times what we are able to see may or may not correlate with what the patient is noticing, so unlike diabetic edema, we often can’t document the level of pathology besides the patient’s self-report. So, whenever that happens, we’re always reluctant to take a healthy eye and subject them to surgery, which of course has potentially significant albeit rare risks.”

In a study, published in OSLI Retina, Garg and colleagues surveyed vitreoretinal specialists in order to assess current attitudes, beliefs and practice patterns associated with the treatment of symptomatic floaters in healthy eyes.

Surgeon experience

The cross-sectional, Internet-based anonymous survey, consisting of 10 detailed questions, had a total of 159 responses among 2,600 retina specialists.

To reduce symptomatic floaters, 40 respondents said they would perform pars plana vitrectomy (PPV), while 110 specialists reported that they had previously performed PPV for floaters.

Of the respondents likely to intervene for symptomatic floaters, 33 of 40 specialists performed more than 100 vitrectomies per year.

“Part of it may be related to surgeons’ comfort with vitrectomy, and the more procedures you perform every year, generally speaking, the more comfortable you are with the surgery and the more patients you feel comfortable taking into the OR,” Garg said. “The flip side is, doctors who do fewer vitrectomies per year are generally more conservative and, perhaps, may have a more stringent criteria that they look for before they consider operating.”

There was a statistically significant difference in the likelihood of performing an intervention for symptomatic floaters (P < .0001) and in one’s tendency to choose PPV for themselves if they experienced floaters (P < .001).

Among the 110 respondents who previously performed PPV, 55% would themselves elect for a procedure to eliminate symptomatic floaters and 35% would be likely to perform PPV in the future. Of those who had not performed PPV to eliminate floaters, only 8% would elect to have a procedure performed for themselves and 4% would be likely to intervene in the future.

“There is a little bit of a disconnect between what doctors do and what they would actually like to have done for themselves,” Garg said.

Barriers to PPV

Respondents unlikely to intervene for symptomatic floaters identified three barriers: 86% reported the surgical risks involved with PPV, 58% reported unrealistic patient expectations, and 32% reported a fear of possible ridicule from the local retina community.

“I think this is an idea that the retina community continues to struggle with, and you’ll see some doctors who will feel more comfortable addressing this problem than others,” Garg said. “There still is a sense that other members of the retina community may look at surgeons with some skepticism because there’s been this long tradition of reluctance to address this problem surgically.”

In the future, Garg would like to further investigate a larger group of patients to evaluate quality-of-life outcomes from PPV intervention, as well as gather long-term safety and complication data.

“Trying to find more objective ways to measure the density of the floaters or how much visual disturbance the floaters cause the patient would help the retina community document the level of pathology,” he said. – by Kristie L. Kahl

Reference:
Cohen MN, et al. Ophthalmic Surg Lasers Imaging Retina. 2015;doi:10.3928/23258160-20150909-11.

For more information:
Sunir J. Garg, MD, can be reached at Mid Atlantic Retina, Wills Eye Hospital, 840 Walnut St., Suite 1020, Philadelphia, PA 19107; email: sgarg@midatlanticretina.com.

Disclosure: Garg reports no relevant financial disclosures.