YAG Laser Iridotomy Complications

In my case, I feel like the risk of the procedure is less than the risk of having an eye emergency with acute angle closure glaucoma -- especially in light of the fact that I have had such a rapid change in the closure over a four month period. It isn't an easy decision though because likely right now (like me) your vision is fine. It is disheartening to have "perfect" vision before the procedure and then this problem with the dysphotopsia after. [I live two hours away from my ophthalmologist -- so scary to think of experiencing acute angle closure glaucoma -- with only a short time to save my vision.]

Did your doctor give you a time frame in which you should have the iridotomy done? Mine said within 6 to 9 weeks. He was really surprised in September when he checked me with gonioscopy. He said that in May, he thought to himself that I wouldn't need any intervention for maybe up to two years. So I don't know why my eyes changed suddenly, but they did.

Thank you this whole procedure is a nightmare to me! just thinking about it!!!!!!!

Thank you Sharon for sharing your experience, it was very enlighten, Although I am scheduled in less than a week to have the procedure done I still have not fully made up my mind to go forward. Although it was comforting to here that there was minimal pain I am mostly concerned about the complications after the procedure you mentioned as well as further surgeries. I do know if I do not have the procedure I will be facing problems as well. Stuck on not knowing what to do. Thanks again

Because I have narrow angles.

I forgot to mention that in addition to the pilocarpine drops to constrict the pupil, another drop was given to reduce inflammation and also numbing drops are given. A special lens is placed on the eye that has gel in it -- I worried about my blinking but with this lens in place, if you do blink, it just hits the lens.

There is a photo of this lens in this article: http://emedicine.medscape.com/article/1844179-overview

Also, if you would like to see someone getting an iridotomy, here is a video clip: http://www.rootatlas.com/wordpress/video/645/how-to-perform-a-laser-iridotomy-video/

Also, I didn't mention that following the procedure, I had a fair amount of pain. I took Tylenol (but not ibuprofen or aspirin) before the procedure which was recommended. The pilocarpine is known to give some folks a brow ache. Indeed, it did. My whole eye ached (but I have pretty sensitive eyes, I think -- sometimes they hurt for a few days after getting poked at at the ophthalmologist's office). I needed more Extra Strength Tylenol 3 hours after the procedure and then was concerned when I needed again at just 2 hours. I called the doc on-call and she assured me that since the pain did respond somewhat to Tylenol that it was not pain due to my IOP rising. She advised switching to Advil. I was also concerned because of the haziness of my vision. She said both the pain and the haziness were due to inflammation and to increase the prednisolone drops to get as much on board that night to reduce inflammation.

Brilliant Sharon. Thank you.
How frustrating that you lost your first reply. Thanks for persisting and post this valuable information. Here is the link to the study abstract http://www.ajo.com/article/S0002-9394(14)00073-7/abstract, but as you point out to get the full article you have to pay for it.

Bah humbug -- I had a beautifully written up reply and it just poofed. My computer has been acting strangely.

So I don't have a link to the article because Dr. Conner cut and pasted it into my email. If you google the title -- most of the sites you have to pay for the article. So here it is pasted.

Am J Ophthalmol. 2014 May;157(5):929-35. doi: 10.1016/j.ajo.2014.02.010. Epub
2014 Feb 14.

Dysphotopsia after temporal versus superior laser peripheral iridotomy: a
prospective randomized paired eye trial.

Vera V(1), Naqi A(1), Belovay GW(1), Varma DK(2), Ahmed II(3).

Author information:
(1)University of Toronto, Department of Ophthalmology and Vision Sciences,
Toronto, Ontario, Canada. (2)University of Toronto, Department of Ophthalmology
and Vision Sciences, Toronto, Ontario, Canada; Trillium Health Partners,
Mississauga, Ontario, Canada; Credit Valley EyeCare, Mississauga, Ontario,
Canada. (3)University of Toronto, Department of Ophthalmology and Vision
Sciences, Toronto, Ontario, Canada; Trillium Health Partners, Mississauga,
Ontario, Canada; Credit Valley EyeCare, Mississauga, Ontario, Canada. Electronic
address: ike.ahmed@utoronto.ca.

Comment in
Am J Ophthalmol. 2014 Oct;158(4):849-50.
Am J Ophthalmol. 2014 Oct;158(4):850.

PURPOSE: To determine if the location of neodymium:yttrium-aluminum-garnet laser
peripheral iridotomy (LPI) is related to the occurrence of postoperative visual
dysphotopsia.
DESIGN: Randomized, prospective, single-masked, paired-eye comparative clinical
trial.
METHODS: setting: Private subspecialty clinic in Mississauga, Canada. study
population: Patients with primary angle closure or primary angle-closure suspects
were recruited and randomized to receive LPI temporally in one eye and superiorly
in the other. Patients were masked to the location of treatment in each eye.
intervention: Temporal or superior LPI. main outcome measures: Occurrence of
new-onset linear dysphotopsia. Other visual disturbances also were assessed using
a questionnaire before and 1 month after intervention. Secondary outcome measures
included eyelid position, laser parameters, and any intraoperative complications.
RESULTS: A total of 208 patients were recruited to the study, of which 169 (84%)
completed it. New-onset linear dysphotopsia was reported in 18 (10.7%) eyes with
superior LPI versus 4 (2.4%) eyes with temporal LPI (P = .002). Eleven eyes
(6.5%) with superior LPI reported linear dysphotopsia despite complete eyelid
coverage of the iridotomy. No significant differences were found with other
visual disturbances between them. There was more pain experienced by the temporal
LPI (2.8 ± 2.2 vs 2.1 ± 2.0; P = .001), despite no difference in laser energy or
number of shots. Intraoperative rates of hemorrhage were similar (8.9% vs 10.1%;
P = .71).
CONCLUSIONS: Temporal placement of LPI is safe and was found to be less likely to
result in linear dysphotopsia as compared with superior placement. Temporal iris
therefore may be considered a preferred location for LPI.

Copyright © 2014 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ajo.2014.02.010
PMID: 24531024 [PubMed - indexed for MEDLINE]

Also Glaucoma Research Foundation recommended this article: http://www.glaucoma.org/treatment/laser-iridotomy-10-commonly-asked-questions.php

Thank you Sharon for this incredible information, not only from your experience, but also sharing the research you did for yourself. I commend your thoroughness and your advocating for your health.
Could you post the name and author of the study so that others can look it up? Alternatively, you should be able to upload the PDF file here on Connect. Here's how:

1. Click VIEW & REPLY in the email notice, which will take you to the Connect website and exact discussion thread.
2. Click REPLY.
3. Click "Add media" above the message window.
4. Choose file.
5. Write you message.
6. Click POST REPLY.

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

Welcome to Connect, @jennyone. I moved your message to this existing discussion so that you can meet @jigglejaws94 who has had YAG Laser Iridotomy. Jiggle or @jinngee, can you share what you have learned with Jenny?

Jenny, why has this option been recommend to you at this time?