September 25, 2025 • 30 mins
In this episode, Dr. Matthew Tennant discusses the common issue of floaters in ophthalmology, exploring their physiological basis, patient experiences, and the limitations of current treatment options. The conversation delves into traditional methods like vitrectomy and YAG vitreolysis, highlighting their risks and effectiveness. Dr. Tennant also introduces PulseMedica, a startup developing innovative technology aimed at providing a safer, non-invasive solution for treating floaters, emphasizing the potential of femto laser technology. The episode concludes with reflections on the future of floater treatment and the ongoing challenges faced by both patients and clinicians.
This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca
Learn more about PulseMedica at https://www.pulsemedica.com/
Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.
This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca
Learn more about PulseMedica at https://www.pulsemedica.com/
Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:09):
Hey everybody, I'm XAEO Mednik and welcome to another episode
of Blindspot. This episode is sponsored by THEA Pharma Canada.
THEA Pharma Canada is the Canadian subsidiary of THEA, Europe's
leading pioneering and innovative eye health brand. Founded in nineteen
ninety four by Henri Chibre. With five generations of history,
the Chibret family has been dedicated to I care for
(00:30):
more than one hundred and fifty years. Their commitment to
improving lives is born of their pioneering spirit. They continue
to lead the worldwide preservative free movement in eye care.
They've created innovative delivery systems. They've focused on making products
accessible and cost effective for patients. They live this mission
every day because everyone should have the same opportunities to
see the world through healthy eyes. So thank you THEO
(00:53):
Pharmer Canada for supporting Blindspot. Floaters are one of the
most common presenting symptoms that patients complain of in the
with theomology or optometry clinic. Yet despite that, there's not
much we can do for patients who present with this symptom.
Of attractomy is fairly dangerous and aside from that there
isn't really much that's efficacious in order to treat this symptom.
(01:14):
So what exactly are floaters, how risky are vitrectomies, and
what's on the horizon for potential treatment plans. I'm joined
today by retina specialist doctor Matthew Tennant. Doctor Tennant is
a clinical professor at the University of Alberta Department of Ophthalmology.
He's past president of the Retina Society of Alberta and
past Vice president of the Canadian Retina Society. He chaired
(01:34):
the Royal College of Physicians and Surgeons of Canada working
group to develop the first Retina specific area of focused competency.
He did his fellowship training at Will's Hospital and currently
works at the University of Alberta. He works with the
startup company Pulse Medica, which we'll speak about in today's podcast,
which is developing a platform to potentially treat floaters. All right,
doctor Matthew Tenant, welcome to the podcast. Thank you so
(01:57):
much for joining me.
Speaker 2 (01:58):
Yeah, thanks for having me on.
Speaker 1 (02:00):
So we're talking about floaters today, and we're talking about
something that fits as I try to make most episode
fits within the confines of blind Spot kind of something
where we think we know what we are offering to
patients and we have a paradigm, but maybe there's a
shift in that paradigm that needs to be reconsidered. So
before we talk about the treatment of floaters, which is
(02:21):
a challenging issue, you just describe, I mean most of
them all just an optometrists listening to this know what
floaters are, but maybe they don't know exactly what it
is path of Physiologically, Well, we'll tell patients there's a
change to the vitreous to the jelly of your eye.
Sometimes we'll actually look in the eye we'll see a
vitreous capacity that we can say, oh, yeah, you've got
a big floater. But a lot of the times we'll
(02:43):
be seeing patients and they'll be talking about floaters and
we'll look at the back of their eye. We might
not necessarily see anything specific. So how would you describe
physiologically a floater before we start getting into how we
would tackle it with a treatment.
Speaker 2 (02:56):
Sure, So the most common cause for floaters is it
what's going to post your vitrious attachment When protein is
pulled off of the retina from the vitreous, the vitreous
then separates and leaves most commonly a weis ring, so
a ring of protein in the central part of the vision.
I'd say that's the most common thing, but of course
(03:17):
there's a variety of other causes for floaters, inflammation, hemorrhage.
These are the other less common causes. I would say
that the most likely trouble for the patient is there's
an optical change and so for whatever reason, the focus
of the eye separates, or the focus of the eye
creates a an itis of protein within the visual axis,
(03:40):
and so it's not always possible for the physician to
see that properly because you're focus when you're looking in.
If you're not lining up perfectly with what the patient's seeing,
you're going to miss it. And so it's easy for
us to see a weis ring, but often just the
density of the floater is mob for us, but for
(04:01):
the patient it's severe. I would say, often we're left
somewhat in the in the dark in terms of when
we look in, we don't see too much, and yet
for the patient it's it's very very significant. Of Course,
the obvious weiss ring is easy to see, and you
can talk to the patient about that. But I would
say many times a patient is not sure. You know,
(04:21):
they're they're looking at looking out, they're seeing significant changes.
You're looking in, You're not seeing too much change. And
so that can be difficult from a clinician standpoint because
it's obviously very bothersome to the patient, but perhaps not
so obvious when you look in clinically.
Speaker 1 (04:36):
Yeah, and that's one of the problems, I mean a
lot of things with op thealmology. One of the reasons
we go into it is we can say that patients
will tell us an issue, we can see it, we
can treat it. And this is one of those things
where they'll kind of say, this is really really bothering me.
And it's not that we don't believe them, but we
can't always see it. And the way you explain that
makes sense because when we're doing and I'm not a
RETTA specialist in mccorney specialist, but I still obviously do
(04:59):
retinal exam but we're scanning the retina three sixty, but
we're not necessarily always scanning the vitreous to that same
degree three sixty at different depths of the vitreous where
we would be able to see those opacities, and even
if we are, those opacities still might not be visible
to us in the same way that they're visible to patients.
One thing that I was taught in residency, and I
don't know if this is true. Maybe it's just based
(05:21):
on one study that was easy to communicate relate to
patients was that when a patient would come in with
a PVD a posterior vitorous detachment, we'd say, you know,
I know, the floaters are frustrating right now. A third
of people they'll kind of go away or the brain
will fully adjust, a third of people they'll kind of
stay there, but they won't be overly bothersome, and a
third of people they're going to be a pretty big nuisance.
(05:42):
From your experience as a retina specialist, then, granted you
might be seeing some of the more or not might
be you are seeing some of the more extreme scenarios.
Do you think that statistic holds up?
Speaker 2 (05:53):
Yeah, So outside personality plays a large role in in
floaters as well, in terms of you know, if you're
if you're a perfectionist with regards to vision, then if
you get an if you get a change, you've you've
developed p v D and optically the vision is not
the same. That's a that is a significant problem. I
(06:18):
tell patients, you know, over time, your brain will adjust.
I'd say that's probably the most important part. And that's
where personality comes in and your your outlook on life
In terms of if you're able to put up with
UH slightly reduced vision as a result of the vitreous change,
I don't, I don't know.
Speaker 1 (06:40):
I don't know.
Speaker 2 (06:40):
If they actually all ever really go away completely, Like
if you compare it to the other eye, you always
have a change. And and so it's it's tough because
for those people where it's visually disabling, you know, what
what do you do about that? That that, to me,
I would say, is the most important thing. And then
we'll be talking talking about this, But then what are
(07:01):
the risks of doing something that perhaps is the most
important part? You know, are you able to put up
with floaters knowing that it'll likely improve just because you'll
get used to it, or is it significant enough that
you should do something about it?
Speaker 1 (07:14):
Yeah, And that segues really nicely into what can we
do for it? And we're going to talk about pulse medica,
which is kind of a newer treatment that you're involved with.
It's a company that involves a new treatment, you're involved
with the treatment floaters. But before that, I want to
talk about the traditional paradigm, which does carry a lot
of risk to it. And I mean if a trectomy
has been in the past, even the presence a way
(07:36):
that a lot of people will say, Listen from the
general ophalmologists or from my standpoint, when I see a
patient and they're saying, my floaters are bothering me, my
message will be and I'm curious what your message is
when they're actually sent to the retina specialist, is my
message will be, you know what there is of atractomy
that could be done for it if it's really really
bothering you. I really don't recommend it because it's a
pretty big procedure. It's not like, I mean, every surgery
(07:57):
has its risks, but it's certainly more risk laden than
cataract surgery is. And I would only recommend that if
this is a significant hindrance on your life. And like
you said, that's personality based, that's symptom based, And what
though would you tell a patient are the actual risks
of the tractomy for floaters, because it's easy for us
(08:18):
to kind of say, listen, it's a riskier procedure, and
it's easier for patients to say, yeah, I get it's
a risky procedure, but I'm really bothered by it. I
want to take that chance. You do a lot of
attract to mees as a retina surgeon. What are the
actual risks that patients and perhaps sophomologists don't even fully
understand when you're undergoing that procedure because it sounds like
(08:38):
a good idea when you're desperate and you just want
to get rid of those floaters.
Speaker 2 (08:41):
Yeah, there's two parts of it, I guess, you know.
I think of when I compare let's say, cataract surgery
to attract me for floaters. So cataracts tend to worsen
like they will worsen with time, whereas floaters, you know,
unless you have uvi iitis or some other cause for
worsening floaters, most of the time, they they don't worsen
like they happen they're bad, your brain adjusts then they
(09:03):
stay able the same, so they're not harmful apart from
the problem with your vision. Uh, and so that's the
first step. They're a relatively stable phenomenon to risk of surgery,
and so we know it's it's high. It's it's actually
surprisingly high considering you know, everyone gets a PVD, So
what's the difference with the tracting that the risk is
(09:24):
two to two point five percent risk of rental detachment
with floatoectomy with the tractomy, So that's very high, you know,
one and forty and and so you know, if I
tell what I tell patients is you have a problem
which is likely not going to get worse, will probably
improve with time, but it's never going to go away completely.
(09:45):
And if you have surgery and you get a rental detachment,
I promise you your rental detachment is going to be far
worse than just having these floaters. And then and then
from there then usually what I do is I get
them to think about it, because you know, it's hard
to make it a same quickly in the office, and
you know they have all these you know, well should
I get it done? Should I not? And then are
(10:05):
they able to put up with it? So usually I
give them three to six months to think about it,
and then the people who and then I actually get
them to call me back, so I don't book an appointment.
They'll call me back. If they decide they want to proceed,
then I'll have one more meeting with them. So I
do make it somewhat difficult because I want to really
make sure that the people who are having have attract
me really are bothered by it and really decide that
(10:28):
this is intolerable. It means to be done well.
Speaker 1 (10:30):
As you say, one in forty risk is not small.
And then you're also taking into account they're the risk benefit, right.
The benefit when you're doing the tractomy for retinal detachment
is obvious, right, like you need that to be done
or else you're going to lose your vision, whereas if
the benefit for for flow directomy is I mean, you
haven't lost your vision, it's just the quality of the
(10:51):
vision's down. So there's that whole kind of calculus we're
doing always maybe calculus is a fancy word for just
saying risk benefit that we're doing whenever we're just siding
whether or not we want to operate on a patient.
In terms of the mechanics or the technique of how
you do have attrectomy, will you do it a little
bit differently than if you're doing it for a retinal detachment.
And I guess what I mean is, are you a
(11:13):
little bit less intensive on how much you're releasing the
vitreous traction in the case of a float erectomy as
opposed to a retinal detachment when you've already got evidence
that that vitreous traction has led to a tear.
Speaker 2 (11:27):
Yeah, you're right, So I don't think I really because
I'm worried about rental detachment. The risk is high. I'm
really focusing on the vitreous base to make sure that
first I'm not creating any terrors when I'm removing the
vitreous and two that if there's any abermalities whatsoever, I
would treat them. So if there's lattice, if there's any
areas of traction tups, I would treat those with laser,
(11:49):
hoping that that would reduce my risk for a subsequent
tear formation and detachment. But agreed that I will also
perhaps be a little bit less of restive with removal
of vitreous So I'll remove like the white ring, I'll
move central floaters, but I'm not spending quite as much
time with with peripheral shaving. If if I don't think
(12:13):
that that's going to be visually significant. You know that
being said, patients are pretty observant. So if you leave
too much of a skirt of vitreous, then they'll they'll
see that, you know, there'll be no vitreous in the center,
and then there'll be some vitreous in the periphery. So
it is a balance. And these are cases that it's
funny because I'm perhaps the most nervous about because I
(12:34):
know that right now, the retin's great. You know, they're
they're not having a problem at the moment apart from
the vitreous condensations, and I have a one in forty
chance of creating a retinald detachment.
Speaker 1 (12:46):
Moving to things that are maybe a little bit less
concerning treatments, I mean, there's a lot of stuff that's
probably I don't want to call it voodoo, but stuff
that's unproven in the literature, and then there's some stuff
that is maybe proven to an extent. The first thing
that comes to my mind, and maybe I have some
other ones you want to talk about, is yag vitriolysis.
And I know that some studies have shown that using
the YAG laser to target maybe a weis ring or
(13:07):
target some of the vitrious capacities that can be effective
in reducing floaters. I've seen some studies that have said
shown positive results, but it doesn't seem like it's something
that's really taken off. So what's kind of the general consensus,
Not that I'm putting you to the task of speaking
for all retina specialists, but what's the general consensus on
(13:27):
YAG vitriolysis for symptomatic treatment of floaters.
Speaker 2 (13:31):
So I'd say the general consensus is, if you have
a very obvious waste ring, and you have a lot
of time in your hands as a specialist, you could
potentially break up that weis ring with YAG, thereby reducing
the size and the prominence of that within the visual axis.
And so it is possible to do. It doesn't eliminate floaters,
(13:51):
but it does make prominent floaters less obvious. There are
risks in terms of location. Within the literature, there are
known harm that can occur in terms of if you
happen to laser the retina or too close to the
ret and you can damage the ret and you can
cause hemorrhage, breaking blood vessels and such. But I'd say
the main problem is it's not particularly effective, and it's
(14:14):
very time consuming in terms of both for the patient
and for the clinician. As we talked about, it's not
always possible to identify exactly what the patient is seeing
compared to what the clinician can see. And also it's
in a three dimensional space and an object which is moving,
and so you know, lining up all that with your
YAG can be frustrating. I've done it once, had a
(14:37):
very very i would say, educated patient who spent a
lot of time thinking about the various risks and benefits.
And I had gone to California to spend money to
get treatment in one eye, and then ask if I
could help with his other eye, and I don't know,
he couldn't look back to California. And so you got
me motivated to see if actually the treatment would work.
(14:57):
And there's a special lens you can get in a
personal lens. I read the book. There's there's a specific
book an expert on flutoectomy with the egg fits your lysis.
And I did all that work and then I worked
on his eye and it was incredibly frustrating, incredibly frustrating
because it's somewhat hard to aim a yegg deep within
(15:20):
the vitreous cavity, and because of the lining up of
what you're seeing, you're never sure, am I too close
to the retina? It's like it's it's a it's a
stressful and not very effective treatment. And then you know,
if you have an ability to do with attract me,
which I do, then you'd be like, why am I
Why am I wasting the patient's time? Why am I
(15:41):
wasting my time doing this? And so the combination of
those two things makes it not very effective for anyone,
for the clinician and for the patient. But if you
if you don't have the ability to do of atractomy,
then you know it's and you have a very prominent wispring,
then it is something that could be tried to break
(16:03):
it up into smaller bits. But it hasn't. It hasn't
really taken off because of those two difficulties.
Speaker 1 (16:10):
Yeah, I was gonna say, could be tried, but doesn't
sound like something you're you're overly endorsing or enthusiastical.
Speaker 2 (16:16):
I don't know, like maybe someone else has better expertise
and I'm sure they do, but just to me, I
was like, what this is so useless.
Speaker 1 (16:25):
Which brings us, which brings us to pulas Medica. And
I actually reached out to puls Medica because I was curious.
I came across this new technology and it's the website
of Polsmdica says it's developing a platform that's intended to
be the first safe, effective, and non invasive system to
screen and treat victrio retinal disease starting with symptomatic vitorios opacities,
so eye floaters. I'm really really curious, because you're involved
(16:47):
with this company, to tell me a little bit about
this technology, first of all, how it works, and then
we'll maybe get into some of the efficacy and where
you think it's going. And the reason I thought this
was a good topic was one because everything you've just
said is really important for general up them all just
an optometrists to know. But also because it could be
exciting that there might be a more effective, perhaps less
dangerous option to treat this extremely common symptom that we're
(17:10):
so hesitant to take on. So what is Paulsmedica?
Speaker 2 (17:14):
Yeah, So puls Medica is an Edmonton startup from the
University of Alberta, and so Near who's the CEO of
the company, as a PhD person from the University of Alberta,
and I met him years ago when he was still
a PhD candidate and he was working with themtal laser
(17:35):
technology and so we were doing exploring different ophthalmology related
opportunities with them TOAL laser, and then he graduated in
him and his mentor I started up Pulse Medica, and
so this company is a technology focused company. And to
be truthful, my beginning interest actually was treatment of vitrimact
(17:55):
attraction and so I thought it would be wonderful if
you could treat traumatic attraction laser as opposed to surgery,
just cut the strands of vitreous that were attached to
folia and break that apart. And and so I'm still
hoping that that will be eventually used with this company.
But from a business standpoint, bituomatic attraction is relatively rare,
(18:16):
floaters are very common, and so the company from a
business standpoint realized that this technology could potentially be used
for floaters and so there I would say their their
expertise is multi factorial in terms of first moving floaters,
So can you track moving floaters? And with SLO and
(18:39):
oct technology, is it possible to track them in real time?
And then second, can you then integrate a laser system
to do the same tracking and then apply laser within
that focused area? And then and then three what kind
of laser technology is most amenable to taking care of floaters?
(19:05):
And so we've talked about YAG laser. So YAG laser
is disruptive in terms of a little explosion, but the
speed at which you can put in laser is relatively
slow in terms of I think you can do ten
bursts in a second or something like that Venttal laser
you can do one hundred thousand bursts like one hundred
(19:27):
thousand laser spots within a second. And so the ultimate
goal is to identify a moving floater, track it, figure
out exactly what the three D shape is, and then
mulsify it get rid of it completely with Vental laser
by applying multiple spots in a safe fashion. And so
we're not there yet, but it is pretty amazing like
(19:49):
within a relatively short period of time what Pulse Metic
has been able to do in terms of develop the
technology for tracking. So they're able to do that attract floaters,
like visualize them and then track them. And then they've
been working on safety in terms of making sure that
it doesn't damage tishoot and and so once that, once
(20:09):
that is done in terms of making sure that there's
they know what distance they can apply the laser to
the vitreous without damaging the retina, then you're able to
create a situation where you can apply the laser at
a distance from the retina, which is automatically safe because
the system is tracking where the retina is, where the
(20:30):
floater is, and then and then with the Femto laser
get rid of them completely.
Speaker 1 (20:35):
It's really it's really crazy. So, I mean most of
us when we think of the femto laser, we're probably
thinking about the lasik because femtos to create lasi flaps.
But with the femto there, I guess what you're saying.
The main difference from the yet there's many differences from
the yags, wavelengths and a lot of fun stuff that's
probably too physics for the audience, But it sounds like
the rapidity of that scanning technology allows for both easier
(20:56):
detection of these moving floaters and then once you've detected it,
you may only have a certain amount of time before
that floater is moving around. So the rapidity of the
actual laser in addition to the detection aspect of it,
can lead to dissolution of that floater really quickly.
Speaker 2 (21:14):
Other part is the safety part in terms of because
it's multiple bursts, you can you can titrate the power generating.
So if you with the same level of power, if
you if you put in a bunch of spots, that
will create more energy and more disruption of the floater.
But it's it's very tight tradable, so you you can
(21:34):
figure out exactly how much is needed to get rid
of the floater without causing any damage or that that's
our goal in terms of you can up it by
such a minute amount each time multiple spots and tell
tell there's there's there's no floater, and yet no extra
energy is applied. So think of it like poster caps
(21:55):
lotting me with the egg. So you could do it
at a very low energy level on multiple spots, or
you could increase the power and do like a few
or whatever. But that but that ability to tight trate
is like one like for YAGG for us it's like
one two, one two point five or whatever. So so
the energy, the energy titration is relatively you know, it's big,
(22:20):
like your options are limited or is this the limit?
There is no limit to the amount of titration you
can do. And so the hope is with with an
automated system, you can you can figure out exactly how
much energy is needed and use no extra energy, so
zero extra energy, but also solve the problem in terms
(22:41):
of got murder your floaters, whereas for YAG, like YAGG floaterectomy,
you can't really do that because you only have certain
power levels you're able to do and you can only
do ten a second, and so by then the floater
is moved or whatever. And so the Fentral laser is
is a is a we feel a better technology for
(23:02):
this particular problem. And and by chance the U of
A team originally that's their expertise is Fenttal laser, so
they have a lot of expertise in working with femto.
And then what they're developing now is this octslo scanning
tracking mechanism, and so it is it is like the future,
and the question is you know the timing of that future,
like in the end it'll be possible. But it's just
(23:23):
a question of you know, are we the company that
does that, is some other company does that? But in
the end, that'll be a better solution than the tectomy
if we're successful in getting rid of visually significant floaters.
Speaker 1 (23:36):
Has this been tried on patients by any company that's
using this similar type of technology.
Speaker 2 (23:41):
No, I don't even know right now. I don't think
there's any fenttal laser companies out there working for floaters,
and so no, and so I don't know if it's
too optimistic, But the hope is that by next year
sometime we'll be working in the first in human trial
and probably starting off like I've been working with them
terms of like despite the fact that we do have
(24:02):
we're creating the safety data. You know, what's the best
patient for this sort of problem, So probably would be
a pseudofak patient with a prominent floater right behind the lens,
like it's far away from the retin as possible, and
then you know, gradually become more comfortable to technology and
then go from there.
Speaker 1 (24:20):
It's really interesting how would the platform kind of look
like in terms of I mean, I'm guessing as you
were describing your experience with yag vitriolysis and how that's
incredibly frustrating from the surgeon's perspective of you know, you're
trying to visualize it, you're trying to laser it while
you see it, and there's a lot of moving parts
and the efficacy is questionable, let alone the risks. How
(24:40):
much of this is automated where kind of the patient
is at the platform, and it's not necessarily the surgeon
even making those decisions in real time. It's more just
an automated decision based upon when the technology detects the
virtuous opacity.
Speaker 2 (24:58):
Yeah, so we I think it's going to be one
of that the surgeon approves the decision. So it's going
to be you're able to see the surgeon's going to
be able to see the floaters like in in three
D space, and it'll the computer will have identified which
ones are going to be targeted, and you'll press a
button and then all those that are have being targeted
(25:20):
will be taken care of. And and so it'll be
it will not be the surgeon will not be chasing anything,
which you know from a surgical standpoint, it'll be more
you're kind of the overseer of safety and eventually I
would imagine, you know, probably not soon, but eventually it'll
be just all the floaters are taken care of, and
(25:41):
it'll be able to track eye movement and track floaters,
and so the floaters will be moving around, but it'll
just take care of them. I do feel that that
is possible. I just don't know the speed at which
that's going to be possible, but in the future that
will be the way it's done.
Speaker 1 (25:54):
Yeah. Sure. Well, when I think of Lasik with the
Ximber laser when it's doing it's part, I mean, so
times the patient's moving around, but you don't want them
to move around. It's a similar thing in that the
machine is recognizing the cornea, perhaps based on the underlying
Irish structures, and I mean thousands of pulses of laser
are being put onto this cornea in a very very
(26:16):
quick amount of time and basically the surgeon's just pressing
a foot pedal mm. So different technologies, but similarity of
automation to an extent, where the surgeon's role is more
of the the observer moderator.
Speaker 2 (26:32):
Yeah, and we we foresee I think that a similar
model in terms of probably some I don't know if
the system will be in a separate office, will it
be at the office of you know, where's it going
to be and how's it going to work. I'm not
sure if we know all the the nuances of the
business model and how patients will be taken care of.
(26:57):
You know, one one option is, you know, do you
do it as part of a cataract surgery procedure or
do you do it after the fact for those people
who have visually significant floaters? Is it a premium product?
All these things? I don't I'm not really from a
business stamdpoint. I don't have any expertise in that. And
it'll be I guess what the market, you know points
(27:17):
us in what direction?
Speaker 1 (27:19):
Matthew, Are there any other exciting developments on the floater
frontier that sounds very weird to say exciting developments on
the floater frontier? Other technologies or kind of techniques that
we haven't spoken about that are kind of mainstream already
that we're we're missing here or is that pretty much
kind of summarize where we're at right now and that
(27:40):
the market really is waiting for a product to emerge
to treat this.
Speaker 2 (27:45):
Yeah, I would say that, you know, every day we'll
have patients who come in with bothersome floaters and because
of the current roadblock in terms of technology of the
tractomy technology, you know, it is dissatisfying both for the
patient and for the clinician. And I guess I just
one thing would I would say that, you know, floaters
(28:06):
are for patients. They're actually very very bothersome for many patients.
And the tough thing from a surgeon standpoint is, you know,
you'd like to take care of the problem, but the
difficulties with the current side effects and complications of the tectomy,
you know, just make it not the greatest of procedures.
And it would be wonderful if there was a way
we could figure out a way to take care of
(28:27):
floaters in a safe fashion that didn't have the high
risk of the tectomy. I do wonder like truckt MEET
technology is always improving, and you know, twenty seven gauge
access or better fluidics, you know, it is possible that
teckt ME technology will also catch up. But you know,
I was involved in a in a study which just
(28:49):
was recently done with twenty five gauge the tracted ME systems,
and the risk was still very high for floaters, and
so we're not there yet from the up to me standpoint.
So I don't know of any other specific technology on
the horizon apart from laser that could fix the problem
in an efficacious way.
Speaker 1 (29:11):
Well, Matthew, thank you so much for joining me. Really
really interesting conversation, A nice blend of some kind of
diagnostic better diagnostic understanding of floaters and also some potential
well some therapeutic modalities that exist right now, such as
attract ME and some stuff that's on the horizon which
isn't being used yet, as you said, but is certainly
(29:31):
exciting for the future for a very prevalent problem that,
like you said, it can be easy to dismiss because
we see it so frequently and we don't have such
a great thing to do for it, as many of
us can also attest to, is obviously something that's quite
frustrating for patients. Can we learn more about Pulsemedica for
those who are interested to learn more about the technology
and more about the company.
Speaker 2 (29:52):
Yeah, so I guess just reach out to Pulse Medica
near who's the CEO is probably the best person but
to reach out to just to discuss the technol and
where they are and what the plans are for the future.
Speaker 1 (30:04):
It is.
Speaker 2 (30:04):
It seems to have a lot of excellent people on
the board as well as the company itself. Seems to
be pretty motivated group of people. And I've worked with
a variety of startups and I would say this is
by far the most successful in terms of making things
happen and moving forward, and so it's being exciting to
be part of the team.
Speaker 1 (30:20):
Well. I will put the link to Paul Smedica in
the in the podcast notes and talk to Matthew Tennant
from the University of Alberta. Thank you so much for
joining me.
Speaker 2 (30:30):
Yeah, thank you and thanks for your time.
Speaker 1 (30:31):
Uh and thank you everybody for listening to another episode
of blind Spot. Have a great day and
Hey everybody, I'm XAEO Mednik and welcome to another episode
of Blindspot. This episode is sponsored by THEA Pharma Canada.
THEA Pharma Canada is the Canadian subsidiary of THEA, Europe's
leading pioneering and innovative eye health brand. Founded in nineteen
ninety four by Henri Chibre. With five generations of history,
the Chibret family has been dedicated to I care for
(00:30):
more than one hundred and fifty years. Their commitment to
improving lives is born of their pioneering spirit. They continue
to lead the worldwide preservative free movement in eye care.
They've created innovative delivery systems. They've focused on making products
accessible and cost effective for patients. They live this mission
every day because everyone should have the same opportunities to
see the world through healthy eyes. So thank you THEO
(00:53):
Pharmer Canada for supporting Blindspot. Floaters are one of the
most common presenting symptoms that patients complain of in the
with theomology or optometry clinic. Yet despite that, there's not
much we can do for patients who present with this symptom.
Of attractomy is fairly dangerous and aside from that there
isn't really much that's efficacious in order to treat this symptom.
(01:14):
So what exactly are floaters, how risky are vitrectomies, and
what's on the horizon for potential treatment plans. I'm joined
today by retina specialist doctor Matthew Tennant. Doctor Tennant is
a clinical professor at the University of Alberta Department of Ophthalmology.
He's past president of the Retina Society of Alberta and
past Vice president of the Canadian Retina Society. He chaired
(01:34):
the Royal College of Physicians and Surgeons of Canada working
group to develop the first Retina specific area of focused competency.
He did his fellowship training at Will's Hospital and currently
works at the University of Alberta. He works with the
startup company Pulse Medica, which we'll speak about in today's podcast,
which is developing a platform to potentially treat floaters. All right,
doctor Matthew Tenant, welcome to the podcast. Thank you so
(01:57):
much for joining me.
Speaker 2 (01:58):
Yeah, thanks for having me on.
Speaker 1 (02:00):
So we're talking about floaters today, and we're talking about
something that fits as I try to make most episode
fits within the confines of blind Spot kind of something
where we think we know what we are offering to
patients and we have a paradigm, but maybe there's a
shift in that paradigm that needs to be reconsidered. So
before we talk about the treatment of floaters, which is
(02:21):
a challenging issue, you just describe, I mean most of
them all just an optometrists listening to this know what
floaters are, but maybe they don't know exactly what it
is path of Physiologically, Well, we'll tell patients there's a
change to the vitreous to the jelly of your eye.
Sometimes we'll actually look in the eye we'll see a
vitreous capacity that we can say, oh, yeah, you've got
a big floater. But a lot of the times we'll
(02:43):
be seeing patients and they'll be talking about floaters and
we'll look at the back of their eye. We might
not necessarily see anything specific. So how would you describe
physiologically a floater before we start getting into how we
would tackle it with a treatment.
Speaker 2 (02:56):
Sure, So the most common cause for floaters is it
what's going to post your vitrious attachment When protein is
pulled off of the retina from the vitreous, the vitreous
then separates and leaves most commonly a weis ring, so
a ring of protein in the central part of the vision.
I'd say that's the most common thing, but of course
(03:17):
there's a variety of other causes for floaters, inflammation, hemorrhage.
These are the other less common causes. I would say
that the most likely trouble for the patient is there's
an optical change and so for whatever reason, the focus
of the eye separates, or the focus of the eye
creates a an itis of protein within the visual axis,
(03:40):
and so it's not always possible for the physician to
see that properly because you're focus when you're looking in.
If you're not lining up perfectly with what the patient's seeing,
you're going to miss it. And so it's easy for
us to see a weis ring, but often just the
density of the floater is mob for us, but for
(04:01):
the patient it's severe. I would say, often we're left
somewhat in the in the dark in terms of when
we look in, we don't see too much, and yet
for the patient it's it's very very significant. Of Course,
the obvious weiss ring is easy to see, and you
can talk to the patient about that. But I would
say many times a patient is not sure. You know,
(04:21):
they're they're looking at looking out, they're seeing significant changes.
You're looking in, You're not seeing too much change. And
so that can be difficult from a clinician standpoint because
it's obviously very bothersome to the patient, but perhaps not
so obvious when you look in clinically.
Speaker 1 (04:36):
Yeah, and that's one of the problems, I mean a
lot of things with op thealmology. One of the reasons
we go into it is we can say that patients
will tell us an issue, we can see it, we
can treat it. And this is one of those things
where they'll kind of say, this is really really bothering me.
And it's not that we don't believe them, but we
can't always see it. And the way you explain that
makes sense because when we're doing and I'm not a
RETTA specialist in mccorney specialist, but I still obviously do
(04:59):
retinal exam but we're scanning the retina three sixty, but
we're not necessarily always scanning the vitreous to that same
degree three sixty at different depths of the vitreous where
we would be able to see those opacities, and even
if we are, those opacities still might not be visible
to us in the same way that they're visible to patients.
One thing that I was taught in residency, and I
don't know if this is true. Maybe it's just based
(05:21):
on one study that was easy to communicate relate to
patients was that when a patient would come in with
a PVD a posterior vitorous detachment, we'd say, you know,
I know, the floaters are frustrating right now. A third
of people they'll kind of go away or the brain
will fully adjust, a third of people they'll kind of
stay there, but they won't be overly bothersome, and a
third of people they're going to be a pretty big nuisance.
(05:42):
From your experience as a retina specialist, then, granted you
might be seeing some of the more or not might
be you are seeing some of the more extreme scenarios.
Do you think that statistic holds up?
Speaker 2 (05:53):
Yeah, So outside personality plays a large role in in
floaters as well, in terms of you know, if you're
if you're a perfectionist with regards to vision, then if
you get an if you get a change, you've you've
developed p v D and optically the vision is not
the same. That's a that is a significant problem. I
(06:18):
tell patients, you know, over time, your brain will adjust.
I'd say that's probably the most important part. And that's
where personality comes in and your your outlook on life
In terms of if you're able to put up with
UH slightly reduced vision as a result of the vitreous change,
I don't, I don't know.
Speaker 1 (06:40):
I don't know.
Speaker 2 (06:40):
If they actually all ever really go away completely, Like
if you compare it to the other eye, you always
have a change. And and so it's it's tough because
for those people where it's visually disabling, you know, what
what do you do about that? That that, to me,
I would say, is the most important thing. And then
we'll be talking talking about this, But then what are
(07:01):
the risks of doing something that perhaps is the most
important part? You know, are you able to put up
with floaters knowing that it'll likely improve just because you'll
get used to it, or is it significant enough that
you should do something about it?
Speaker 1 (07:14):
Yeah, And that segues really nicely into what can we
do for it? And we're going to talk about pulse medica,
which is kind of a newer treatment that you're involved with.
It's a company that involves a new treatment, you're involved
with the treatment floaters. But before that, I want to
talk about the traditional paradigm, which does carry a lot
of risk to it. And I mean if a trectomy
has been in the past, even the presence a way
(07:36):
that a lot of people will say, Listen from the
general ophalmologists or from my standpoint, when I see a
patient and they're saying, my floaters are bothering me, my
message will be and I'm curious what your message is
when they're actually sent to the retina specialist, is my
message will be, you know what there is of atractomy
that could be done for it if it's really really
bothering you. I really don't recommend it because it's a
pretty big procedure. It's not like, I mean, every surgery
(07:57):
has its risks, but it's certainly more risk laden than
cataract surgery is. And I would only recommend that if
this is a significant hindrance on your life. And like
you said, that's personality based, that's symptom based, And what
though would you tell a patient are the actual risks
of the tractomy for floaters, because it's easy for us
(08:18):
to kind of say, listen, it's a riskier procedure, and
it's easier for patients to say, yeah, I get it's
a risky procedure, but I'm really bothered by it. I
want to take that chance. You do a lot of
attract to mees as a retina surgeon. What are the
actual risks that patients and perhaps sophomologists don't even fully
understand when you're undergoing that procedure because it sounds like
(08:38):
a good idea when you're desperate and you just want
to get rid of those floaters.
Speaker 2 (08:41):
Yeah, there's two parts of it, I guess, you know.
I think of when I compare let's say, cataract surgery
to attract me for floaters. So cataracts tend to worsen
like they will worsen with time, whereas floaters, you know,
unless you have uvi iitis or some other cause for
worsening floaters, most of the time, they they don't worsen
like they happen they're bad, your brain adjusts then they
(09:03):
stay able the same, so they're not harmful apart from
the problem with your vision. Uh, and so that's the
first step. They're a relatively stable phenomenon to risk of surgery,
and so we know it's it's high. It's it's actually
surprisingly high considering you know, everyone gets a PVD, So
what's the difference with the tracting that the risk is
(09:24):
two to two point five percent risk of rental detachment
with floatoectomy with the tractomy, So that's very high, you know,
one and forty and and so you know, if I
tell what I tell patients is you have a problem
which is likely not going to get worse, will probably
improve with time, but it's never going to go away completely.
(09:45):
And if you have surgery and you get a rental detachment,
I promise you your rental detachment is going to be far
worse than just having these floaters. And then and then
from there then usually what I do is I get
them to think about it, because you know, it's hard
to make it a same quickly in the office, and
you know they have all these you know, well should
I get it done? Should I not? And then are
(10:05):
they able to put up with it? So usually I
give them three to six months to think about it,
and then the people who and then I actually get
them to call me back, so I don't book an appointment.
They'll call me back. If they decide they want to proceed,
then I'll have one more meeting with them. So I
do make it somewhat difficult because I want to really
make sure that the people who are having have attract
me really are bothered by it and really decide that
(10:28):
this is intolerable. It means to be done well.
Speaker 1 (10:30):
As you say, one in forty risk is not small.
And then you're also taking into account they're the risk benefit, right.
The benefit when you're doing the tractomy for retinal detachment
is obvious, right, like you need that to be done
or else you're going to lose your vision, whereas if
the benefit for for flow directomy is I mean, you
haven't lost your vision, it's just the quality of the
(10:51):
vision's down. So there's that whole kind of calculus we're
doing always maybe calculus is a fancy word for just
saying risk benefit that we're doing whenever we're just siding
whether or not we want to operate on a patient.
In terms of the mechanics or the technique of how
you do have attrectomy, will you do it a little
bit differently than if you're doing it for a retinal detachment.
And I guess what I mean is, are you a
(11:13):
little bit less intensive on how much you're releasing the
vitreous traction in the case of a float erectomy as
opposed to a retinal detachment when you've already got evidence
that that vitreous traction has led to a tear.
Speaker 2 (11:27):
Yeah, you're right, So I don't think I really because
I'm worried about rental detachment. The risk is high. I'm
really focusing on the vitreous base to make sure that
first I'm not creating any terrors when I'm removing the
vitreous and two that if there's any abermalities whatsoever, I
would treat them. So if there's lattice, if there's any
areas of traction tups, I would treat those with laser,
(11:49):
hoping that that would reduce my risk for a subsequent
tear formation and detachment. But agreed that I will also
perhaps be a little bit less of restive with removal
of vitreous So I'll remove like the white ring, I'll
move central floaters, but I'm not spending quite as much
time with with peripheral shaving. If if I don't think
(12:13):
that that's going to be visually significant. You know that
being said, patients are pretty observant. So if you leave
too much of a skirt of vitreous, then they'll they'll
see that, you know, there'll be no vitreous in the center,
and then there'll be some vitreous in the periphery. So
it is a balance. And these are cases that it's
funny because I'm perhaps the most nervous about because I
(12:34):
know that right now, the retin's great. You know, they're
they're not having a problem at the moment apart from
the vitreous condensations, and I have a one in forty
chance of creating a retinald detachment.
Speaker 1 (12:46):
Moving to things that are maybe a little bit less
concerning treatments, I mean, there's a lot of stuff that's
probably I don't want to call it voodoo, but stuff
that's unproven in the literature, and then there's some stuff
that is maybe proven to an extent. The first thing
that comes to my mind, and maybe I have some
other ones you want to talk about, is yag vitriolysis.
And I know that some studies have shown that using
the YAG laser to target maybe a weis ring or
(13:07):
target some of the vitrious capacities that can be effective
in reducing floaters. I've seen some studies that have said
shown positive results, but it doesn't seem like it's something
that's really taken off. So what's kind of the general consensus,
Not that I'm putting you to the task of speaking
for all retina specialists, but what's the general consensus on
(13:27):
YAG vitriolysis for symptomatic treatment of floaters.
Speaker 2 (13:31):
So I'd say the general consensus is, if you have
a very obvious waste ring, and you have a lot
of time in your hands as a specialist, you could
potentially break up that weis ring with YAG, thereby reducing
the size and the prominence of that within the visual axis.
And so it is possible to do. It doesn't eliminate floaters,
(13:51):
but it does make prominent floaters less obvious. There are
risks in terms of location. Within the literature, there are
known harm that can occur in terms of if you
happen to laser the retina or too close to the
ret and you can damage the ret and you can
cause hemorrhage, breaking blood vessels and such. But I'd say
the main problem is it's not particularly effective, and it's
(14:14):
very time consuming in terms of both for the patient
and for the clinician. As we talked about, it's not
always possible to identify exactly what the patient is seeing
compared to what the clinician can see. And also it's
in a three dimensional space and an object which is moving,
and so you know, lining up all that with your
YAG can be frustrating. I've done it once, had a
(14:37):
very very i would say, educated patient who spent a
lot of time thinking about the various risks and benefits.
And I had gone to California to spend money to
get treatment in one eye, and then ask if I
could help with his other eye, and I don't know,
he couldn't look back to California. And so you got
me motivated to see if actually the treatment would work.
(14:57):
And there's a special lens you can get in a
personal lens. I read the book. There's there's a specific
book an expert on flutoectomy with the egg fits your lysis.
And I did all that work and then I worked
on his eye and it was incredibly frustrating, incredibly frustrating
because it's somewhat hard to aim a yegg deep within
(15:20):
the vitreous cavity, and because of the lining up of
what you're seeing, you're never sure, am I too close
to the retina? It's like it's it's a it's a
stressful and not very effective treatment. And then you know,
if you have an ability to do with attract me,
which I do, then you'd be like, why am I
Why am I wasting the patient's time? Why am I
(15:41):
wasting my time doing this? And so the combination of
those two things makes it not very effective for anyone,
for the clinician and for the patient. But if you
if you don't have the ability to do of atractomy,
then you know it's and you have a very prominent wispring,
then it is something that could be tried to break
(16:03):
it up into smaller bits. But it hasn't. It hasn't
really taken off because of those two difficulties.
Speaker 1 (16:10):
Yeah, I was gonna say, could be tried, but doesn't
sound like something you're you're overly endorsing or enthusiastical.
Speaker 2 (16:16):
I don't know, like maybe someone else has better expertise
and I'm sure they do, but just to me, I
was like, what this is so useless.
Speaker 1 (16:25):
Which brings us, which brings us to pulas Medica. And
I actually reached out to puls Medica because I was curious.
I came across this new technology and it's the website
of Polsmdica says it's developing a platform that's intended to
be the first safe, effective, and non invasive system to
screen and treat victrio retinal disease starting with symptomatic vitorios opacities,
so eye floaters. I'm really really curious, because you're involved
(16:47):
with this company, to tell me a little bit about
this technology, first of all, how it works, and then
we'll maybe get into some of the efficacy and where
you think it's going. And the reason I thought this
was a good topic was one because everything you've just
said is really important for general up them all just
an optometrists to know. But also because it could be
exciting that there might be a more effective, perhaps less
dangerous option to treat this extremely common symptom that we're
(17:10):
so hesitant to take on. So what is Paulsmedica?
Speaker 2 (17:14):
Yeah, So puls Medica is an Edmonton startup from the
University of Alberta, and so Near who's the CEO of
the company, as a PhD person from the University of Alberta,
and I met him years ago when he was still
a PhD candidate and he was working with themtal laser
(17:35):
technology and so we were doing exploring different ophthalmology related
opportunities with them TOAL laser, and then he graduated in
him and his mentor I started up Pulse Medica, and
so this company is a technology focused company. And to
be truthful, my beginning interest actually was treatment of vitrimact
(17:55):
attraction and so I thought it would be wonderful if
you could treat traumatic attraction laser as opposed to surgery,
just cut the strands of vitreous that were attached to
folia and break that apart. And and so I'm still
hoping that that will be eventually used with this company.
But from a business standpoint, bituomatic attraction is relatively rare,
(18:16):
floaters are very common, and so the company from a
business standpoint realized that this technology could potentially be used
for floaters and so there I would say their their
expertise is multi factorial in terms of first moving floaters,
So can you track moving floaters? And with SLO and
(18:39):
oct technology, is it possible to track them in real time?
And then second, can you then integrate a laser system
to do the same tracking and then apply laser within
that focused area? And then and then three what kind
of laser technology is most amenable to taking care of floaters?
(19:05):
And so we've talked about YAG laser. So YAG laser
is disruptive in terms of a little explosion, but the
speed at which you can put in laser is relatively
slow in terms of I think you can do ten
bursts in a second or something like that Venttal laser
you can do one hundred thousand bursts like one hundred
(19:27):
thousand laser spots within a second. And so the ultimate
goal is to identify a moving floater, track it, figure
out exactly what the three D shape is, and then
mulsify it get rid of it completely with Vental laser
by applying multiple spots in a safe fashion. And so
we're not there yet, but it is pretty amazing like
(19:49):
within a relatively short period of time what Pulse Metic
has been able to do in terms of develop the
technology for tracking. So they're able to do that attract floaters,
like visualize them and then track them. And then they've
been working on safety in terms of making sure that
it doesn't damage tishoot and and so once that, once
(20:09):
that is done in terms of making sure that there's
they know what distance they can apply the laser to
the vitreous without damaging the retina, then you're able to
create a situation where you can apply the laser at
a distance from the retina, which is automatically safe because
the system is tracking where the retina is, where the
(20:30):
floater is, and then and then with the Femto laser
get rid of them completely.
Speaker 1 (20:35):
It's really it's really crazy. So, I mean most of
us when we think of the femto laser, we're probably
thinking about the lasik because femtos to create lasi flaps.
But with the femto there, I guess what you're saying.
The main difference from the yet there's many differences from
the yags, wavelengths and a lot of fun stuff that's
probably too physics for the audience, But it sounds like
the rapidity of that scanning technology allows for both easier
(20:56):
detection of these moving floaters and then once you've detected it,
you may only have a certain amount of time before
that floater is moving around. So the rapidity of the
actual laser in addition to the detection aspect of it,
can lead to dissolution of that floater really quickly.
Speaker 2 (21:14):
Other part is the safety part in terms of because
it's multiple bursts, you can you can titrate the power generating.
So if you with the same level of power, if
you if you put in a bunch of spots, that
will create more energy and more disruption of the floater.
But it's it's very tight tradable, so you you can
(21:34):
figure out exactly how much is needed to get rid
of the floater without causing any damage or that that's
our goal in terms of you can up it by
such a minute amount each time multiple spots and tell
tell there's there's there's no floater, and yet no extra
energy is applied. So think of it like poster caps
(21:55):
lotting me with the egg. So you could do it
at a very low energy level on multiple spots, or
you could increase the power and do like a few
or whatever. But that but that ability to tight trate
is like one like for YAGG for us it's like
one two, one two point five or whatever. So so
the energy, the energy titration is relatively you know, it's big,
(22:20):
like your options are limited or is this the limit?
There is no limit to the amount of titration you
can do. And so the hope is with with an
automated system, you can you can figure out exactly how
much energy is needed and use no extra energy, so
zero extra energy, but also solve the problem in terms
(22:41):
of got murder your floaters, whereas for YAG, like YAGG floaterectomy,
you can't really do that because you only have certain
power levels you're able to do and you can only
do ten a second, and so by then the floater
is moved or whatever. And so the Fentral laser is
is a is a we feel a better technology for
(23:02):
this particular problem. And and by chance the U of
A team originally that's their expertise is Fenttal laser, so
they have a lot of expertise in working with femto.
And then what they're developing now is this octslo scanning
tracking mechanism, and so it is it is like the future,
and the question is you know the timing of that future,
like in the end it'll be possible. But it's just
(23:23):
a question of you know, are we the company that
does that, is some other company does that? But in
the end, that'll be a better solution than the tectomy
if we're successful in getting rid of visually significant floaters.
Speaker 1 (23:36):
Has this been tried on patients by any company that's
using this similar type of technology.
Speaker 2 (23:41):
No, I don't even know right now. I don't think
there's any fenttal laser companies out there working for floaters,
and so no, and so I don't know if it's
too optimistic, But the hope is that by next year
sometime we'll be working in the first in human trial
and probably starting off like I've been working with them
terms of like despite the fact that we do have
(24:02):
we're creating the safety data. You know, what's the best
patient for this sort of problem, So probably would be
a pseudofak patient with a prominent floater right behind the lens,
like it's far away from the retin as possible, and
then you know, gradually become more comfortable to technology and
then go from there.
Speaker 1 (24:20):
It's really interesting how would the platform kind of look
like in terms of I mean, I'm guessing as you
were describing your experience with yag vitriolysis and how that's
incredibly frustrating from the surgeon's perspective of you know, you're
trying to visualize it, you're trying to laser it while
you see it, and there's a lot of moving parts
and the efficacy is questionable, let alone the risks. How
(24:40):
much of this is automated where kind of the patient
is at the platform, and it's not necessarily the surgeon
even making those decisions in real time. It's more just
an automated decision based upon when the technology detects the
virtuous opacity.
Speaker 2 (24:58):
Yeah, so we I think it's going to be one
of that the surgeon approves the decision. So it's going
to be you're able to see the surgeon's going to
be able to see the floaters like in in three
D space, and it'll the computer will have identified which
ones are going to be targeted, and you'll press a
button and then all those that are have being targeted
(25:20):
will be taken care of. And and so it'll be
it will not be the surgeon will not be chasing anything,
which you know from a surgical standpoint, it'll be more
you're kind of the overseer of safety and eventually I
would imagine, you know, probably not soon, but eventually it'll
be just all the floaters are taken care of, and
(25:41):
it'll be able to track eye movement and track floaters,
and so the floaters will be moving around, but it'll
just take care of them. I do feel that that
is possible. I just don't know the speed at which
that's going to be possible, but in the future that
will be the way it's done.
Speaker 1 (25:54):
Yeah. Sure. Well, when I think of Lasik with the
Ximber laser when it's doing it's part, I mean, so
times the patient's moving around, but you don't want them
to move around. It's a similar thing in that the
machine is recognizing the cornea, perhaps based on the underlying
Irish structures, and I mean thousands of pulses of laser
are being put onto this cornea in a very very
(26:16):
quick amount of time and basically the surgeon's just pressing
a foot pedal mm. So different technologies, but similarity of
automation to an extent, where the surgeon's role is more
of the the observer moderator.
Speaker 2 (26:32):
Yeah, and we we foresee I think that a similar
model in terms of probably some I don't know if
the system will be in a separate office, will it
be at the office of you know, where's it going
to be and how's it going to work. I'm not
sure if we know all the the nuances of the
business model and how patients will be taken care of.
(26:57):
You know, one one option is, you know, do you
do it as part of a cataract surgery procedure or
do you do it after the fact for those people
who have visually significant floaters? Is it a premium product?
All these things? I don't I'm not really from a
business stamdpoint. I don't have any expertise in that. And
it'll be I guess what the market, you know points
(27:17):
us in what direction?
Speaker 1 (27:19):
Matthew, Are there any other exciting developments on the floater
frontier that sounds very weird to say exciting developments on
the floater frontier? Other technologies or kind of techniques that
we haven't spoken about that are kind of mainstream already
that we're we're missing here or is that pretty much
kind of summarize where we're at right now and that
(27:40):
the market really is waiting for a product to emerge
to treat this.
Speaker 2 (27:45):
Yeah, I would say that, you know, every day we'll
have patients who come in with bothersome floaters and because
of the current roadblock in terms of technology of the
tractomy technology, you know, it is dissatisfying both for the
patient and for the clinician. And I guess I just
one thing would I would say that, you know, floaters
(28:06):
are for patients. They're actually very very bothersome for many patients.
And the tough thing from a surgeon standpoint is, you know,
you'd like to take care of the problem, but the
difficulties with the current side effects and complications of the tectomy,
you know, just make it not the greatest of procedures.
And it would be wonderful if there was a way
we could figure out a way to take care of
(28:27):
floaters in a safe fashion that didn't have the high
risk of the tectomy. I do wonder like truckt MEET
technology is always improving, and you know, twenty seven gauge
access or better fluidics, you know, it is possible that
teckt ME technology will also catch up. But you know,
I was involved in a in a study which just
(28:49):
was recently done with twenty five gauge the tracted ME systems,
and the risk was still very high for floaters, and
so we're not there yet from the up to me standpoint.
So I don't know of any other specific technology on
the horizon apart from laser that could fix the problem
in an efficacious way.
Speaker 1 (29:11):
Well, Matthew, thank you so much for joining me. Really
really interesting conversation, A nice blend of some kind of
diagnostic better diagnostic understanding of floaters and also some potential
well some therapeutic modalities that exist right now, such as
attract ME and some stuff that's on the horizon which
isn't being used yet, as you said, but is certainly
(29:31):
exciting for the future for a very prevalent problem that,
like you said, it can be easy to dismiss because
we see it so frequently and we don't have such
a great thing to do for it, as many of
us can also attest to, is obviously something that's quite
frustrating for patients. Can we learn more about Pulsemedica for
those who are interested to learn more about the technology
and more about the company.
Speaker 2 (29:52):
Yeah, so I guess just reach out to Pulse Medica
near who's the CEO is probably the best person but
to reach out to just to discuss the technol and
where they are and what the plans are for the future.
Speaker 1 (30:04):
It is.
Speaker 2 (30:04):
It seems to have a lot of excellent people on
the board as well as the company itself. Seems to
be pretty motivated group of people. And I've worked with
a variety of startups and I would say this is
by far the most successful in terms of making things
happen and moving forward, and so it's being exciting to
be part of the team.
Speaker 1 (30:20):
Well. I will put the link to Paul Smedica in
the in the podcast notes and talk to Matthew Tennant
from the University of Alberta. Thank you so much for
joining me.
Speaker 2 (30:30):
Yeah, thank you and thanks for your time.
Speaker 1 (30:31):
Uh and thank you everybody for listening to another episode
of blind Spot. Have a great day and
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