YAG Laser Iridotomy Complications

Hello -- I just had a Yag laser iridotomy done in my right eye about 3.5 weeks ago. The reason is because I have narrow angles and my ophthalmologist said that there was a rapid change in the angles over a four month period -- so much so that he has never had a patient progress so rapidly. Anyway -- I did not find the laser procedure itself to be painful. It felt like a little pinch in the eye and I believe it took about 5 "hits". Unfortunately, my physician didn't really warn me about what the after effects could be. You will likely be given a drug called pilocarpine which causes your pupil to constrict. It apparently also helps with thinning out the iris so that a good spot can be found to place the iridotomy. But it constricts the pupil for about 12-16 hours (or at least that is how long it lasted for me). I experienced very hazy vision for that same length of time also. Felt like I was looking through a brownish wedding veil or through a haze. About an hour after the procedure, I detected a light aberration -- which appeared as a horizontal line of light across my field of vision. Over the next few days, that progressed to more of a blob of light or a crescent of light in the mid to lower visual field. It does not bother me all the time but is worse in bright light and I notice it he most when I drive.

The placement of my iridotomy was in the superior position which is somewhere between 11 and 1 o'clock position. I felt good about that position because my eyelid would cover the iridotomy hole. However, that is not a guarantee that you will not experience dysphotopsia (glares, haloes, crescents, etc) following the procedure. In fact, there is some literature that indicates that some patients still experience this phenomenon even when the eyelid fully covers the iridotomy hole. It is especially worsened if your eyelid only partially covers the hole (and I think that may be my situation).

I spoke on the phone with my doctor the following week. I let him know that I had done some online research and found that there was quite a bit of information regarding the horizontal approach -- at the 3 or 9 o'clock position -- and that the indication was that there was less problems with light aberration at this position. He said that the trend is to do it at the 3 or 9 o'clock position but that he prefers to do it at the superior position based on a study that came out about 10 years ago indicating that 9 percent of people will notice some light aberration in a fully covered iridotomy, 18 percent experience the same with a completely exposed iridotomy site and 27 percent with a partially covered. So he says that the risk of experiencing this doubles with a fully exposed iridotomy. HOWEVER, there is a lot of literature that indicates that the patients who get the 3 or 9'oclock position (referred to as either on the horizontal meridian or temporal position) have far less difficulty with dysphotopsias.

I am scheduled to have my left eye done on October 26th. My physician said he is happy to place the iridotomy in the temporal position, if this is what I prefer. Well, I don't like the weight of the decision on me -- because I'm not a doctor. So I wrote up an email describing my situation and sent it to about a dozen professors specializing in Glaucoma and several of the leading medical school ophthalmology programs. I have received answers back from about 5 physicians. Four of those recommend the horizontal approach. Two of them sent me a reference to a study and if you would like that forwarded to you, you can let me know your email.

It has been frustrating because prior to the procedure -- my vision was perfectly fine. Now, I have to deal with this problem. So I want to do everything in my power to understand and be educated on what the best approach for my left eye. I know that though my vision was perfectly fine and now it is messed up --- that I am a ticking bomb waiting to go off -- and could easily develop acute angle closure glaucoma and be in an eye emergency in short order.

Hope this information is helpful somehow.

Sharon

After having Lase Iridotomy in my left eye for narrow angle preventive , I have floaters! I am so upset, as I had perfect vision before this. I do not need glasses. Only now I cannot read as these floaters are distracting. I am fearful of having the other eye done.
Help.
Leslie

Because I have narrow angles.

I'm scheduled for an iridotomy in May, no elevated eye pressures ever. Went to get eyeglasses in Dec '22 and was diagnosed with narrow angles, was told to see an opthamologist in one month. I've been full of anxiety about going blind since then.

I went to see an opthalmologist one month later and only had the gonioscopy done, pressures were normal. MD diagnosed me with Chronic closed narrow angle glaucoma. I asked him why the diagnosis, and he told me to read the glaucoma pamphlet. Asked him why he didn't check my optic nerve or visual fields, do an OCT scan? He said my eyes needed to be dilated for these tests, but I had researched this and eyes do not need to be dilated for a comprehensive exam to rule out glaucoma. While I was in the office, he scheduled me for an iridotomy in 2 weeks?

I was suspicious about the diagnosis and why I didn't have a comprehensive exam with him, I let him know via phone, he then referred me to a glaucoma specialist. I went one month later, (hard to get an appointment). All tests were done, optic nerve was perfect, peripheral vision was normal, OCT scan normal. My narrow angles measured about the same (mild, according to one chart I found )? The glaucoma specialist changed my diagnosis to narrow angles. Said I did not have glaucoma and was confused about the diagnosis. She gave me 2 to 3 months to schedule the LPI, but said the majority of people with my anatomical narrow angles, no glaucoma never have acute attacks, but suggested I have the iridotomy at the 9 o'clock position on the left eye. My eyes are light brown! Will it be noticeable? She said she read a lot of research about less side effects post with the 9 o'clock position. I have a call in for her to return to find out how many patients she's done the laser on at the 9 o'clock position, side effects, and about my daily stress headaches for 23 years, also other things that I didn't mention.

My vision has not decreased, been wearing glasses since a child only inside. I've had a bad astigmatism in left eye since I was 7 years old. Of course I'm nearsighted and the farsighted came with age.

I'm planning on getting a third opinion, have not chosen an opthalmologist specialist yet, since I don't need a glaucoma specialist anymore, hopefully it will be soon.

I'm so nervous about this whole thing, I can't live with side effects from the iridotomy due to my stress level. I work from home every day. I want my life to be normal. I know the devastating effects of angle closure and DO NOT want to go blind or be miserable the rest of my life.

These posts, mostly from 2016 have been mostly helpful, but got progressively more disheartening as they went on due to side effects post LPI. I don't think I have a choice 🙁

Any newer experiences with post laser iridotomies, positioning of the laser shots, especially the 9 o'clock position, and side effects would be greatly appreciated.

I just saw this post. I have very similar situation to you- except I have a wonderful Neuro Ophthalmologist that I trust implicitly. In fact, I just went for my 6 month checkup last week. She dilated my eyes because we had not done that in 2 years. Everything looks great, and my angles are narrow, but mildly and have not changed a bit since my last appointment. Her recommendation is, and always has been, that she will not do the iridotomy until I am at least 50% angle. She also reassured me that just knowing that I have this enough for now because I know the signs to look for in acute angle closure, which she said in normal pressure eyes with mildly narrow angles, acute closure is rare. When we discussed what will happen when we get to that point, she mentioned that the 9'oclock position is what she would do.

I just saw this post. I have very similar situation to you- except I have a wonderful Neuro Ophthalmologist that I trust implicitly. In fact, I just went for my 6 month checkup last week. She dilated my eyes because we had not done that in 2 years. Everything looks great, and my angles are narrow, but mildly and have not changed a bit since my last appointment. Her recommendation is, and always has been, that she will not do the iridotomy until I am at least 50% angle. She also reassured me that just knowing that I have this enough for now because I know the signs to look for in acute angle closure, which she said in normal pressure eyes with mildly narrow angles, acute closure is rare. When we discussed what will happen when we get to that point, she mentioned that the 9'oclock position is what she would do.

Why would she dilate your eyes? Just curious. It can cause an acute narrow angle closure. Why is dilation so important especially if you have mild narrow angles? Thanks

She only does it every 2 years, because she said its important to check the retina. I agree, especially because my mother had 2 retinal detachments. She checks my angles and my pressures before she does it. She also said if it sent me into an acute attack, she has all of the instruments she needs in the office to stop it. Regardless, my eyes were dilated and I had no problems whatsoever. And I know that my retina is healthy. She's young but she's conservative, and I like that. She said no reason to rush into iridotomy if not necessary because that can come with its own set of problems.