YAG Peripheral Iridotomy

What does it mean when people have “narrow angles” or “Acute or Chronic Angle Closure Glaucoma”?

The eye has a watery fluid that is made inside the front of the eye, which is important for keeping the eye healthy and nutrified. This fluid circulates inside the eye: it gets made in one area and then drained in another. This is a different fluid from the tears that moisturize the outside of our eyes. When the drainage area inside our eyes is too small or narrow because some eyes are smaller than average, the fluid can build up and cause the pressure inside the eye to increase. The drainage area is called the anterior chamber “angle”. People who have narrow angles are at risk for developing either acute or chronic “angle closure glaucoma”. This means that when the pressure in the eye gets higher, it can cause damage to the optic or eye nerve and eventual loss of vision. When this happens suddenly, we call it “acute angle closure glaucoma” (AACG). People who get this condition have a really severe headache, blurred vision, nausea and vomiting. People can also get “chronic angle closure glaucoma” (CACG) which is not necessarily painful, but can cause blurred vision when the pressure spikes every so often causing slow, insidious vision loss that a person may not notice until it is very advanced. Both of these types of glaucoma are very dangerous, and can be prevented by screening for this problem with regular check-ups with your Optometrist, and then by having YAG laser Peripheral Iridotomies with your Ophthalmologist.

What are the symptoms of angle-closure glaucoma?

Typical symptoms of an acute angle-closure glaucoma attack are:

  • Headache or eye pain
  • Blurred vision
  • Haloes around lights
  • Red eye
  • Nausea and vomiting

This is an eye emergency. The eye pressure should be relieved within hours, otherwise there may be permanent vision loss.

Not everyone with angle-closure glaucoma will experience an attack. Sometimes the disease develops slowly, and there are no obvious symptoms. Through examination, your doctor may recognize your risk for angle-closure glaucoma before you experience any symptoms.

Are there any over the counter medications that can trigger an attack of angle closure glaucoma?

Medications that can partially dilate the pupil, such as over-the-counter cold medications and antihistamines, can trigger an angle closure attack and should be avoided until after the laser procedure is performed.

What is a Laser Peripheral Iridotomy?

This laser is used to prevent “angle closure glaucoma”. Using this laser, a tiny hole is made in the iris or coloured part of each eye to allow the drainage angle to open up. This improves the drainage of fluid in the front of the eye and prevents build up of fluid that can lead to high eye pressure and angle closure glaucoma.

What should I expect with this procedure? Is it painful?

This procedure takes a few minutes per eye. You need to have some preparatory drops to make sure your eye pressure does not increase from the temporary inflammation caused by the laser.

After the technician takes some initial measurements and applies the preparatory drops to your eyes, you will wait for a few minutes while the drops work. Sometimes the drops may give you a slight brow-ache and make you feel slightly nauseous; this feeling will pass. You will then be called into the laser room for the laser, which will be performed by your Ophthalmologist. The actual treatment will take about 5 minutes or so. A lens with a layer of lubricating gel will be placed on your eye to hold your eyelids back and direct the laser. This will feel strange but does not cause pain. You may feel the lens moving slightly as the doctor directs the laser. Some people feel a slight pain or prickly feeling when the laser is applied. This lasts a few seconds at most. Occasionally, there is a bit of bleeding with the laser. This is usually minor and clears up quickly (rarely, especially with people on a few blood thinners, bleeding can take longer to stop). It is common to experience blurry vision after the procedure. This should clear up within a few minutes to hours.

Occasionally, especially if you are quite anxious about the laser, you may feel light-headed and feel like fainting. If this happens, we may have to postpone the procedure and allow you to recuperate by lying down in an adjacent room. Fainting with laser procedures is not that common, but happens to some people.

What should I expect after the laser?

After the laser, our assistants at the front reception will give you a prescription for prednisolone 1% eye drops to be used 4 times per day for 4 days to be used in the lasered eye(s). This is an anti-inflammatory drop that decreases the inflammation after the laser procedure. You should discard the bottle after completing the 4-day course. Prednisolone 1% is a topical eye steroid, which can cause high eye pressures if it is used for a long time. It is important not to use it for longer than the prescribed period.

Our assistants will tell you when your eye pressure will be taken, approximately one hour after the laser. It is important to check that your eye pressure is at an acceptable level prior to discharging you for the day. You do not have to wait in the office for an hour. Many people choose to have a coffee downstairs in the mall, or do some other errands, and then return in an hour.

What are the possible complications after this laser?

You will notice blurred vision right after this procedure, and you may feel light-headed. The blurry vision is temporary and usually clears up within a few hours. This occurs because there is some “pigment dust” released by the laser, and sometimes a small amount of bleeding. This is usually a minor issue and clear up within hours.

Sometimes, the iris is too thick to penetrate with one treatment, therefore another touch-up laser may be necessary to enlarge or complete the hole. Occasionally after the laser, there is extra light that comes through this extra hole into the eye, causing a “prismatic” light effect. Usually, this is not an issue in most people, however if there is persistent glare, there are options for treating this issue.

Sometimes, despite the iridotomy treatment, eye pressure can be persistently high after the procedure, and require extra medications (drops or sometimes pills) and even surgery to lower the pressure. It is very important to be monitored after this procedure in order to maintain good eye health.

What is the standard follow-up procedure after the laser is done?

For most patients who have normal pressures post-laser, a one week and one month follow-up will be arranged either with your own Optometrist or at GEM Clinic (if you do not have your own Optometrist). A letter will be forwarded to your Optometrist to update your file. If you have an ongoing glaucoma issue, or need to be checked by the treating Ophthalmologist again, this appointment will be made before you leave or in response to your Optometrist’s update (depending on your post-laser outcome).

What happens if my eye pressure is higher after the laser procedure?

Occasionally, your eye pressure may be higher after the laser procedure. It may be necessary to give you some extra eye drops or oral medications temporarily to lower the pressure. Your Ophthalmologist may wish to check you again the next day if the pressure is very high after laser, which is not common but can happen. Rarely, if the pressure elevation is not controlled by medication alone, surgery may have to be considered to lower it. This is a rare circumstance that can happen especially in people with severe glaucoma.

What symptoms should I expect after the laser is done?

After the laser, if you did not have any symptoms before the laser, you will likely not notice anything different. However, if you experienced some spikes in your eye pressure causing haloes around lights and slightly achy eyes or headache from the narrow drainage canals, you should notice relief of these symptoms. Reading will be easier and glare will decrease.

Occasionally, light gets through the new lasered hole in the iris and causes a sparkly light effect. This is not common, but can happen. Usually, the laser hole is placed in an area that is hidden under your eyelid, so that light cannot shine through it. If this happens, it is usually a minor problem, and can be addressed if very bothersome.

Most people do not have many issues at all after this type of laser. It is a relatively easy procedure to have, and is very important for preventing sight-threatening ANGLE CLOSURE GLAUCOMA.

Can I expect that my glaucoma will be cured after this laser?

You will still need to be monitored for glaucoma after the laser, either by your own Optometrist or Ophthalmologist. Occasionally, the eye pressure may still be elevated and you might need eye drops on a regular basis to control the eye pressures and prevent damage to your eye nerves that may lead to vision loss. After laser, it will be safe to dilate your pupils without causing an angle closure attack. Also, over-the-counter drugs advising “do not take if you have glaucoma” (because they may cause pupil dilation) should be safe to take after successful laser iridotomies have been performed.

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