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Episode 5. Vitreous floater treatment. YAG Laser vitreolysis vs Vitrectomy (PPV)? Which is better?

Shannon Wong, MD

3,815 views

Our patient had cataract surgery with the Bausch and Lomb LuxSmart extended-depth-of-focus (EDOF) lens in Taipei, Taiwan in November 2025. He is experiencing halos, glare and light scatter that makes him feel unsafe driving. The ophthalmologists in Taiwan recommended that he not undergo intraocular lens exchange. Because his visual symptoms prevent him from driving safely, he chooses to travel to see Shannon Wong, MD in Austin, TX for consideration of intraocular lens exchange to his right eye.

We share his journey from Taipei, Taiwan to Austin, Texas. He explains the visual side effects that he is experiencing and his reasons for wanting surgery to improve his quality of vision.

He underwent the following eye surgeries in Austin, Texas at Austin Eye with Shannon Wong, MD:
8/18/2026: Intraocular lens exchange to remove the luxSmart extended depth of focus IOL and receive the PureSee extended depth of focus IOL inside the capsular bag
9/2/2026: Premium lens replacement for the left eye with the PureSee lens implant with the puresee placed into reverse optic capture with the optic anterior to the anterior capsular rim and the haptics inside the capsular bag
9/16/2026: YAG laser capsulotomy to the left eye to treat posterior capsule opacification

He was experiencing light scatter from his right eye and was scheduled to have intraocular lens exchange on 9/22/2026.

He ultimately chose to not have IOLX on 9/22/2026. He determined that his vitreous floaters were to greatest nuisance or impediment to his vision. He found an ophthalmologist in Dallas that he wanted to see for possible YAG laser vitreolysis. Due to the size and number of floaters that he was describing, I recommended that he consider pars plans vitrectomy to treat his visually significant floaters.

0:01 background history
0:50 his vitreous floaters with images that he created
1:58 patient conversation with him describing his vision and his floaters
3:49 how the ophthalmologist explains vitreous floaters, Weiss ring, posterior vitreous detachment (PVD), yag laser vitreolysis and pars plans vitrectomy treatment of bothersome vitreous floaters
7:08 closing assessment and plan for our patient
12:26 summary

16 Comments

@DoctorKrad 21 hours ago

One thing I really appreciate about this series is that it shows patients that the journey to the finish line isn’t always a straight line. Sometimes, adjustments or changes in direction are necessary to ultimately achieve the best outcome. That’s why having an attentive surgeon who truly listens to a patient’s symptoms and concerns is so important.

I also agree that a vitrectomy would likely have a significantly greater positive impact on the patient’s vision than YAG vitreolysis. Great job, Shannon👏

@drj6418 23 hours ago

In the interest of transparency, how much $ are all of these procedures costing this man out of pocket?

@DrSimonChen 19 hours ago

An excellent conclusion to the series, Shannon. Your relentless attention to the patient’s detailed reports and the different contributors to his visual symptoms is commendable. Given the diffuse floater burden described, I agree that vitrectomy would be far more likely than YAG vitreolysis to provide meaningful floater-related relief. However, IOL-related glare remains a separate issue, and he needs to understand that no procedure can promise a flawless visual system. I also appreciated your support for allowing more time before another intervention.

@Elizabeth-gl1uy 20 hours ago

I appreciated the dedication to problem solving by both patient and surgeon. Interesting and informative. Thanks for sharing.

@3100fps 22 hours ago

Been following the 8000-mile travel series. This was the clearest explanations and illustrations of problems this patient is having. The examples her provided were excellent. I just don't see the level of treatment by DR Wong readily available in most parts of the United States or anywhere else.

@rdallinboardman 16 hours ago

It’s cool to see how AI is helping him express via pictures his symptoms to Dr. Wong. While all the patient’s assertions may not correlate perfectly, it gives a great history of symptoms to understand what the patient is experiencing.

@davissunglasses 22 hours ago

Great video series, thanks.

@guymerola1033 22 hours ago

He should consider the Rayner Galaxy lens for the other eye. Just received FDA approval. I received them in Brisbane 14 months ago and I'm 20/20 at all distances. And I was a former LASIK patient. 69 year old male.

@racheyyjoy 21 hours ago

Go Dr. Wong! 🎉

@soccer24six 21 hours ago (edited)

8:30 This is sooo good
I feel ur pain!!
Iykyk

@kimwood8156 18 hours ago

Dr Wong performed my lens replacement which was life changing.

I can truly understand nearly every issue Stan is having. I have PVD floaters in both eyes with the Weiss Rings and an appearance of what could best be described as curtain like films swaying back and forth in my visual field. Exhausting to deal with and have had no improvement in the 17 or so months since it began. I’m living in an area where options are dreadfully limited so not likely to be able to treat them for a while.

@generic_official 22 hours ago

I believe Stan should wait for one of the new accommodating lens implants, such as the OmniVu, Juvene, Lumina, or FluidVision. Clarity at all distances, no glare or halos.

@Willy_jackson9 23 hours ago

Sailing by Christopher Cross

@ebenlaubscher4153 4 hours ago (edited)

Very analytical personality is the crucial factor in this case . Stan won’t be happy ,ever . Never use a hydrophobic IOL in these personality types . I would have used a double C haptic hydrophilic IOL like a Rayner or I-Flex IOL . Because of his younger age even a hydrophobic IOL will develop PCO .So you might as well use a hydrophilic IOL and do the YAG later . Position the haptics horizontally .Even a Rayner Rayone EMV would be a good choice . DYSPHOTOPSIA AVOIDANCE IS MY MAIN CONCERN . Plan for it !!!

@michaelstone7514 22 hours ago

This man has to stop having eye surgery. Too many procedures are putting him at greater and greater danger of blinding him. He should take a few months to evaluate his vision let his eyes heal. Maybe the floaters will go away on there own.

@Teango 23 hours ago

You have to be a millionaire to be getting all these procedures done, since they are not covered by insurance. Imagine us the people who don't have money like that and need RLE surgery to be able to see, and we sacrifice so much to come up with the money for the procedure, and then the procedure turn out to not be not as successful as we hoped. Something needs to change in the eye medicine field to make these procedures affordable for everyone. I really need RLE and I just can't come up with $40,000 or more to have this procedure done, to then find out that I will have issues after the procedure or that the premium lenses that I got implanted just didn't work for me and then I'll be stuck with them because I would have to pay again all that money to exchange the lenses for different ones.