YAG Laser Iridotomy Complications

What was the answer, Can I also know? thank you

After a lot of research and back and forth emailing with Ian Connor MD -- I decided to request a temporal iridotomy on my left eye. My doctor, Dr. Edwards was very fine with that. He had just been to an ophthalmology conference in Chicago and said it is still very much a controversial topic. There are definitely two camps. Anyway, he did do the temporal position. I did not experience any immediate dysphotopsia this time and got on top of the inflammation quicker with additional use of the steroid drops. Next day -- I started noticing that I did have some extra light coming into that eye -- more like a vertical "hunk" or "chunk" of light -- especially noticeable with bright light coming from the left side. It has been a week and this has bothered me less. I am hoping that it improves completely. I still have the more horizontal dysphotopsia on the right side which waxes and wanes, depending on the lighting. So there you have it -- I have an iridotomy, one each of the two positions -- and have some issue with both. I certainly could have worse vision and more problems than I do from the procedures-- so I am thankful. I am also just relieved to stop researching, thinking and spending so much time thinking about what to do about the iridotomy. All done! I will return in two weeks for a dilated exam. Thanks for asking about me.

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

Hello -- I'm glad that my posts helped someone -- you! I do still see the crescent of light near the bottom of my field of vision for my right eye which had the iridotomy at about the 12 o'clock position. I don't think I notice it as much anymore. And I only notice it under certain lighting conditions. Bright sunlight is the worst -- and especially when driving. I find that wearing sunglasses helps immensely. I was never one to wear sunglasses much but I sure do now. My left eye was the temporal position. I have very little difficulty with any light abberration in that eye. Once in a great while, if the light is very bright and at an odd angle, I will see a little bit on the lateral side of my vision which is vertical. I wish that I had done extensive homework before I had my right eye done --- but I didn't anticipate trouble, nor did my ophthalmologist. Had I known that I would get a dysphotopsia -- I would definitely have requested the temporal position for both eyes. I hope that with some time -- maybe up to even a couple of years --- that this light streak in your visual field will lessen.

@wantingtoknow I'm guessing the reason that he wants to do the iridotomy is because your angles are becoming more narrow? I do know have glaucoma but I do have narrow angles. Two years ago, mine suddenly got worse over a 4 month period and so he strongly suggested peripheral iridotomy. It is my understanding that if you have complete closure of the angles, you have a very short window of time to get treatment before you face the risk of losing your vision. Because I live 2 hours away from the ophthalmologist, I opted to go ahead with the procedure, one eye at a time. If you decide to pursue this, my one caution would be to do your homework on the position of the iridotomy. My first one was at the 12 o'clock position and it left me with a dysphotopsia. The second was done at a temporal position. See my above posts for more detailed info about that.

Had mine lasered at the 9 and 3 position and I’m left with Permanent and bothersome scatted light that overlaps images. 😡

Since it's been a few years since your Laser Iridotomy have you had any issues with cataracts? I read that the Laser Iridotomy procedure can lead to the need for lens extraction a few years out (ie cataract surgery).

Thanks. I am following up and awaiting a phone call from my doctor. n the meantime, I have done some research and have found several studies and mentions that the superior placement (between 11 and 1 o'clock) tend to have more problems with halos, crescents, light problems through that new whole. The main thought is that the tear meniscus at the edge of the upper lid creates a base-up prism effect when overlapping the position of the LPI. One article suggested lifting the eyelid to see if the light resolves -- mine does. Well, I can't sit around lifting my eyelid all the time. BUT, I will not have a superior placement in my left eye. The suggestion is 3 or 9 o'clock position. I never would have imagined that if the LPI was covered with the upper eyelid that there would be a problem. But apparently EVEN in cases where the hole is completely covered with the eyelid -- this problem can occur. Interesting, huh? No fun messing with eyes. Especially eyes that were seeing just fine and now aren't. Blah.