Does what it says

It is a great tool, I don’t think there is really an alternative. You do have to be super careful as it constantly reminds you. This is a big deal removing tons of images. Take your time. Think for a moment before every button click. Take the time to examine your website really really well before emptying the Media Cleaner trash.
Do that and you will be fine and I saved gigabytes of space in my woocommerce store due to unused image sizes, we had changed the product image size and just WP made unused sizes.