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OUR BOOK

Laser Treatment of Eye Floaters

by John R. Karickhoff, M.D.

Hard back, 6 x 9 inches, 232 pages, 137 illustrations,
Washington Medical Publishing, LLC, 2005.  $225.00 U.S.

 

To order this book through fax or mail click here

To order this book online


The revolutionary, effective, and safe office procedure described in this book solves the floater problem for most patients.

Every eye doctor should have this book so they can knowledgably advise,  refer, or treat patients with visually significant floaters.

ImageAlthough intended for doctors, this book will be easily understood by patients.  This is the world's only physician authored book on this subject.  There are no courses, lecture series, resident training, or videos.  This book is the sole source of extensive information on this topic (see Table of Contents below).  The book is based on over 1,200 operations by the author, our FDA/ IRB supervised study of 200 eyes (success in 92% of patients and zero significant complications), our many research projects, and techniques and devices the author designed for this procedure.

Learn from the book:

  • Our 16 techniques to treat Weiss rings and other floater associated with posterior vitreous detachments (success in 96% of cases);
  • The treatment techniques for each of 20 types of floaters;
  • The unusual success and safety of this laser treatment;
  • If you are a candidate for this procedure;
  • Indications and contraindications;
  • Eight methods to examine for floaters;
  • Laser plasma physics of floater vaporization;
  • CPT codes to receive payment in 100% of cases;
  • Eight ways the retina is protected on every shot;
  • How to test your laser for suitability;
  • Our evaluation of different lasers;
  • Selection of contact lenses and gonio fluid;
  • How to avoid potential complications;
  • Hundreds of original observations; and
  • Hundreds of other necessary facts.

Laser treatment of eye floaters:

  • is a painless, non-invasive (no intraocular infections), 20 minute office procedure;
  • there are no restrictions on activities;
  • there is almost always full recovery in 24 hours;
  • very low complication rate (0.16%);
  • low complication rate justifies treatment of visually significant floaters;
  • it is a precise obliteration of the floaters without removal of vitreous;
  • is equally appropriate for general ophthalmologists and retinal specialists;
  • is effective in approximately 92% of cases done;
  • is much safer than vitrectomy (see Chapter 2);
  • is much less expensive than vitrectomy;
  • largely vaporizes floaters, not break them into smaller floaters
  • there is no bleeding because there is no blood supply to floaters;
  • has a CPT code and is covered by all, or nearly all, insurance companies including Medicare;
  • uses equipment with which all eye surgeons are familiar (a YAG laser and a surgical contact lens); and
  • laser treatment of eye floaters is an off-label use of the YAG laser (see FDA and Floaters page).

TABLE OF CONTENTS OF BOOK

INTRODUCTION...13

FLOATERS AND PRESENT TREATMENT OPTIONS

CHAPTER 1: THE VITREOUS, FLOATER FORMATION, FLOATER TYPES, AND CLINICAL COURSE

The vitreous...18, Floater formation...18, Floater types...20, Course of Floaters...22

CHAPTER 2: FLOATER TREATMENT OPTIONS

Do nothing ("Learn to live with it.")...23, "Sunglasses"...23, "Herbal/medical"...24, Vitrectomy...25, Laser treatment...28, Why laser treatment is unknown...28

CLINICAL HISTORY AND EXAMINATION FOR LASER TREATMENT

CHAPTER 3: SYMPTOMS, FLOATER HISTORY, JUSTIFICATION FOR TREATMENT

Symptoms...31, Four factors in symptoms...31, Karickhoff symptom severity formula...32, Incorrect assumptions...33, Patients see what doctors can not...33, Floaters affect visual acuity...34, History...34, Justification for treatment...34

CHAPTER 4: THE FLOATER EXAMINATION

Pertinent data...36, The order...36, Karickhoff "Floater Finder"...37, Direct ophthalmoscope...37, Indirect ophthalmoscope...38, Contact lens...39, Hruby lens...39, +90 diopter hand held lens...39, Locating a floater with the Karickhoff Patient Assisted method...40, Macular test...41, Demonstrating the floater to the patient (Karickhoff method, commercial method)...42, Scanning Laser Ophthalmoscope...43

OPHTHALMIC YAG LASERS: HISTORY, PHYSICS, AND

OPTICS OF FLOATER VAPORIZATION

CHAPTER 5: HISTORY OF OCULAR YAG LASERS

Early history...44, Development of mode-locked (picosecond)
YAG lasers...45, Development of Q-switched (nanosecond) YAG lasers...45

CHAPTER 6: SIMPLIFIED EXPLANATION OF FLOATER VAPORIZATION

Using vaporization and obliteration...48, Optical breakdown and plasma formation...48, Similarity to a lightning strike...48, Conversion to a gas...49

CHAPTER 7: LASER PHYSICS OF FLOATER OBLITERATION

How a laser works...50, Optical break-down in eye surgery...51, Plasma shields...52, Fundamental vs. the multimode operation...53, Continuous vs. pulsed emission...53, Nanosecond vs. picosecond lasers...54, Q-switching vs. mode-locking...54, Vaporization without burning...57

CHAPTER 8: LASER OPTICS FOR FLOATER TREATMENT

Proper illumination...60, Aiming beams...61, Converging treatment beam...61

CLINICAL STUDIES OF FLOATER LASER TREATMENT

CHAPTER 9: INFORMAL STUDIES

Tsai...62, Geller...62, Delaney...62, Karickhoff...62

CHAPTER 10: OUR FORMAL STUDY OF 200 CONSECUTIVE, ELIGIBLE FLOATER CASES

Done under the guidelines of the U.S. Food and Drug Administration and supervised by our hospital Institutional Review Board...64, Inclusion and exclusion criteria...65, The procedure...66, Monitoring procedures and statistical methods...66, Conclusions...68, Deficiencies of the Study...70

BENEFITS, RISKS, CRITERIA OF SUCCESS

CHAPTER 11: BENEFITS, SUCCESS, AND RISKS OF THE PROCEDURE

92 per cent overall...71, Case selection...71, Two basic approaches to achieve success...71, Vision frequently improved one to three lines...71, Low risk procedure...71

SELECTING PATIENTS

CHAPTER 12: SURGICAL INDICATIONS AND CONTRAINDICATIONS

Indications...73, Contraindications...74, Relative contraindications (only good eye)...76

CHAPTER 13: YOUNG PATIENTS WITH FLOATERS

Transparent threads...77, Syneresis clouds...77, Fibrin strands...77, Finding the floater...78, Karickhoff Patient Assisted Method...79

THE PROCEDURE

CHAPTER 14: THE PROCEDURE, AND DISCUSSION OF IT BEFORE, DURING AND AFTER

Discussing the vitreous face...80, Discussing multiple floaters...80, Discussing gas bubbles...81, Evaluation and procedure plan...81, Which eye first...81, The procedure...82, Post-operative instructions...83

CHAPTER 15: HOW OTHER EYE STRUCTURES AFFECT THE PROCEDURE

Cornea (RK and LASIK)...84, The lens...85, Small posterior capsulotomy...85, Contracted anterior capsule...86, Cataract...86, Intraocular lens...87, Multifocal intraocular lens...87, Intraocular contact lens...88, Floaters near the lens...88, Iris...88, Floaters near the retina...89, Vitreous...89

CHAPTER 16: TREATMENT: GENERAL CONCEPTS, 20 FLOATER TYPES AND TECHNIQUES

General concepts...91, Obtaining optical breakdown...94, Non-fibrous floaters...95, Fibrous floaters...96, Weiss rings...97, 16 techniques for Weiss rings...104, Very small floaters...108, Fan-shaped floaters...108, Peripheral floaters...109, Syneresis floaters...110, Non-suspended syneresis floaters...110, Suspended syneresis floaters...111, Syneresis cloud hidden below...112, Weiss ring-syneresis cloud combination ("Floater Duet")...113, Tiny, white 114, Floaters from retinal cryopexy and the argon laser...114, Floaters in high myopia...115, Laser floater treatment following vitrectomy...115, Asteroid hyalosis treatment...115

CHAPTER 17: TECHNICAL DIFFICULTIES

Aiming problems...116, Difficulty seeing the floater...116, Losing the floater...116, Low brow...117

SAFETY AND AVOIDING COMPLICATIONS

CHAPTER 18: THE U.S. FOOD AND DRUG ADMINISTRATION AND FLOATERS

Dr. Karickhoff's application and approval...118, FDA policy...119

CHAPTER 19: RETINAL PROTECTION

Historical lack of retinal detachments...120, Eight ways the retina is protected...120

CHAPTER 20: AVOIDING COMPLICATIONS

General lack of complications...122, General rules...122, Preventing pain...123, Preventing corneal complications...123, Preventing contact lens problems...124, Preventing gonio fluid complications...125, Preventing elevated pressure...125, Preventing retinal damage...129, Preventing retinal hemorrhage...131, Preventing macular damage...134, Absence of retinal detachments...134, Preventing cataract formation...135, No accelerated vitreous degeneration...136

CHAPTER 21: FOLLOW UP, RETREATMENT

Examination immediately after treatment...137, Examination the day after treatment...137, Re-treatments...138, Follow up examinations...138

EQUIPMENT

CHAPTER 22: SELECTION OF A LASER...139

CHAPTER 23: SELECTION OF DIAGNOSTIC AND SURGICAL CONTACT LENSES, DESIGNING A SURGICAL CONTACT LENS

Diagnostic contact lenses...149, Karickhoff Laser lens...149, Fundus Laser Lens...149, General concepts of treatment lenses...150, Seven treatment lenses...151, Karickhoff 21 mm. lens...151, Karickhoff Off-Axis lens...152, Peyman 12, 18, and 25 mm. lenses...153, Lasag CGV lens...154, Abraham posterior capsulotomy lens...155, Abraham iridotomy lens...156, Designing a surgical contact lens...157

CHAPTER 24: SELECTING, MAKING, DILUTING GONIOSCOPIC FLUID

Problems with gonioscopic fluids...159, Methylcellulose vs. Ethylcellulose...160, Gonioscopic fluid substitutes...162, Making gonioscopic fluid...162, Diluting methylcellulose...163, Air bubbles in the gonioscopic fluid...163

CHAPTER 25: OTHER EQUIPMENT

Cameras and photographing floaters...164, Elbow support...166, Room light...167, Foot rest...167

LOOKING BACK—LOOKING FORWARD

CHAPTER 26: PATIENT SATISFACTION AND 15 MEMORABLE CASES

CHAPTER 27: FUTURE USE OF THE YAG LASER IN THE VITREOUS

Treatment of persistent vitreous hemorrhage...172, Treating macular holes and membranes...172, Treating subhyloid hemorrhage...172

APPENDIX:

A) Office work up form...174
B)  Operative permit...175
C) Pre-operative instructions...176
D) Post-operative instructions...177
E)  Explanation of multiple floaters...178
F)  Summary of the world literature...179
G)  Insurance codes...183
H) Karickhoff Floater Finder...184
I)  One year follow up form...186
J)  Karickhoff Mosaic Matcher ©, (Corneal Endothelial Cell Estimates at the Slit Lamp in 15 Seconds)...188
K) Karickhoff Flying Corpuscle Viewer TM (Macular function test when the macula can not be seen)...190
L)  Karickhoff Simplified Outflow Facility Testing...194
M)  Karickhoff Vitreous Treatment Lenses... 200
N)  Designing the ideal laser for floater treatment...201
O)  Dr. Karickhoff's contributions to laser treatment of floaters...205
P)  Dr. Karickhoff's contributions to ophthalmology...207
Q)  Curriculum Vitae...210-226
R)  About the Author...227

 
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