Diode Laser

What is a DIODE LASER for glaucoma treatment? How does it work?

A diode laser lowers the eye pressure by essentially turning off some of the fluid-producing cells of the eye. This “turns the taps down” so that there is less fluid produced in the eye, therefore, less fluid to drain. The build-up of fluid decreases, and so does the build-up of pressure.

When is a DIODE laser used?

This type of laser is reserved for cases when high eye pressure has already damaged vision, and is now causing a lot of eye pain. This laser is used mainly to control pain, however it is sometimes used to save vision in patients with high eye pressure who are too high risk for surgery because of advanced disease or numerous medical problems.

How is a DIODE laser performed?

A diode laser is done as an outpatient procedure in the hospital. First, freezing is applied with a needle (retrobulbar block). This will cause some pressure around the eye and some brief discomfort. The freezing will spread (a mixture of lidocaine 2% and Marcaine 0.5%) behind and around the eye, so that there is no pain during the procedure. A freezing gel (Xylocaine 2% gel) is also used to numb the surface of the eye. The freezing takes about 15 to 20 minutes to work. After this, the non-treatment eye is covered to protect it, while the eye to be treated is lasered. A clip is inserted to hold the lids back and the laser is applied with a pen-like “probe” to the surface of the eye. Usually, you cannot feel anything while this is done, because of the heavy freezing around the eye. Occasionally, however, there is a bit of discomfort. If there is a lot of discomfort, the procedure would be discontinued and either rebooked or paused for more freezing to be applied.

How long does the DIODE laser take?

This entire procedure takes about 20-30 minutes, including the time it takes to freeze the eye (15-25 mins), and the time it takes to perform the laser and patch the eye before going home (5 minutes).

What can I expect after the laser is done?

After the laser, the protective covering over your non-treated eye will be removed. Your lasered eye will be rinsed and patched with several different kinds of drops and ointment (to lower eye pressure, decrease inflammation and prevent infection). This patch needs to stay on your eye for 4-6 hours. It can be removed after this time, and the ointment prescribed, along with any other routine glaucoma drops, can be used the same evening.

Will I have pain after the DIODE laser?

The freezing usually lasts about 4-6 hours, sometimes longer, therefore most people only have some mild discomfort that improves with Tylenol ®. It is not recommended to take ibuprofen or aspirin products right after this laser, since they may promote bleeding. If you were having a lot of pain prior to the laser, and think you will need more than plain Tylenol ®, please let your doctor know.

What are the instructions after a DIODE laser?

Your lasered eye will be patched with various eye drops and ointment to lower the pressure, risk of infection, and lower inflammation. This patch can be removed 4 to 6 hours after the laser. If you have any discomfort, you can use ice packs on top of the patch or around it. You can use plain or extra strength Tylenol ®, however you should avoid ibuprofen or aspirin products. If you think you might need something stronger than Tylenol ® (which is not typical), let your doctor know.

At GEM Clinic, you will be given a prescription of a combined steroid and antibiotic ointment (eg. Maxitrol ® or Tobradex ®) that you need to use after any regular drops, once in the morning and one at night in the lasered eye for 3 weeks. Continue all your regular glaucoma drops.

You will need to follow-up with your doctor in one month (unless otherwise specified) to check your eye pressure and see how you are doing. If you have excessive pain or decreased vision in either eye, contact your doctor immediately, or go to the emergency department on evenings and weekends. You can also call the Misericordia Health Centre switchboard at 204-774-6581 and ask to speak to the on call Ophthalmologist.

What possible problems should I look out for after a DIODE laser?

Usually, there is some discomfort in the lasered eye after this laser, which improves within a few days with Tylenol ® (with or without codeine) and the eye ointment. If there was poor vision prior to the laser, this may be a bit worse right after the laser, or may be the same. However, excessive pain (worse than before the laser), tearing and marked decreased vision in either eye are unusual and rare problems that should be checked as soon as possible. Contact your doctor or go to the nearest emergency department on evenings and weekends. You can also call Misericordia Health Centre switchboard at 204-774-6581 and ask to speak to the on call Ophthalmologist.

What are the possible complications of the needle anaesthetic (retrobulbar block)?

The needle anaesthetic can cause some bleeding and bruising around the eye, which usually disappears within 10 days to 2 weeks. However, rarely, there can be a large amount of bleeding behind the eye that causes pressure behind the eye. If the bleeding is excessive, the pressure may have to be released by cutting the outer corner of the lids. It is important to note that this is rare. The needle is directed under and to the side of the eyeball, but can sometimes puncture the eyeball or the optic nerve, especially in people with large eyes. Such a needle puncture is usually very tiny and does not need any stitching, but it can potentially cause bleeding, retinal tearing, retinal scarring or even infection. In cases where the optic nerve is punctured, some of the anaesthetic may travel to the brain and cause general anaesthesia. These complications can be treated and are extremely rare, but may potentially cause further vision loss or other medical problems.

Despite these risks, it is important to use a needle anaesthetic (retrobulbar block) since the diode laser can be very uncomfortable if the area is not properly frozen.

What are the possible complications of DIODE laser?

The diode laser can cause a lot of inflammation (which is decreased with post laser steroid ointment). Sometimes the inflammation can actually “spread” to the good eye. This may cause pain and irritation of the good (non-lasered) eye. If this happens, it can be treated, but it is very important to see your doctor as soon as possible, or go to the nearest emergency department if it occurs on weekends or during holidays.

A diode laser may need to be repeated, if the effect was not strong enough to lower the eye pressure. In this case, over time, especially with repeat treatments, the eyeball that is being treated may shrink in size. It is also very possible to lose further vision over time, with repeated diode lasers, therefore this laser is usually only used in cases where pain control is the main concern. In situations where the treatment is being given to lower eye pressure to preserve vision, it is used sparingly and only when other procedures, like surgery, are even a higher risk for vision loss

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