YAG Laser Iridotomy Complications

Because I have narrow angles.

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

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

My understanding is that it may not prevent a gradual increase in pressures but it is supposed to prevent a sudden spike in pressures from happening which would lead to possible loss of your vision.

I was under the same impression as you seem to be -- that if I got the iridotomies done, then my pressures would remain low. But as they have been rising in last two years I questioned how this could be so and was told that it just prevents the sudden spike in pressure that can cause damage.

I am mostly glad I had it done as I live 2 hours from my provider and loss of vision damage can happen within an hour. I did develop a dysphotopsia in the lower field of vision on my right eye after the LPI. You can read about it above.

For a couple of years, I was monitored once a year. Now I am monitored every six months. If things continue to look okay on exam but pressures are edging upward -- only monitoring is recommended. I see my provider again near the end of October so will find out if any significant changes.

@hsantos435 I did get a second opinion and that doctor confirmed I have grade 2 angles and said I would “probably” be OK to wait but told me that if I got a stabbing pain in my eye, I needed to go to the emergency room immediately and that I could go blind in 1-2 hours. Because I travel a lot, it seemed too risky to wait and I knew I would always be worried about it when traveling so I decided to have it done. It seems like most doctors do one eye at at time, so I would ask your doctor why he wants to do both at the same time. I hope that helps!

Good morning. I just wanted to share my experience with the group. I had a laser iridotomy procedure done to both my eyes. My right eye was done last week and my left eye was done yesterday. I first went to my optometrist about 6 months ago due to the fact that I had a weird feeling in my right eye - a feeling like there was fluid building up in my eye and had headaches. The dr said it looked like I had narrow angles and sent me to an Opthamologist. At that appt she said that I do have narrow angles and scheduled me in for a laser iridotomy the following month. I think I was in shock at the appointment and didnt ask all the questions I had. I ended up spending a lot of time online connecting with people who had the procedure and reading so many posts and horror stories about the actual procedure and the possible side effects. There were some positive experiences as well. I was so freaked out that I almost cancelled my appt even though I was still experiencing symptoms. Going online can be scary. I was so scared that entire month before my appt. I did go ahead with the procedure on both eyes. The right eye last week and my left eye yesterday. I would like to let you know my experience. I understand that everyone is different and will experience different things and in no way am I trying to downplay the experiences of others but only want to share my experience to try to help others. Before my appt I did take 2 tylenol as I heard that some people get awful headaches from the drops they use to constrict the pupils. At both appts I did not experience any headaches or pain from the drops. Right before the laser I had the numbing drops put in. Next is the lense thing they put on your eye that has gel on it. It didnt hurt just felt a bit weird. I was told a specific area to look at. All I could see was the gel....no lights or anything. The sound of the laser wasnt loud at all...just a clicking sound. Didnt startle me at all. The right eye took about 8 times and I could feel something only with the last 2 lasers. Wasn't painful at all!!! Felt like I got something in my eye. My experience with the left eye was almost the same except that eye was only lasered 4 times but my eye pressure went up afterwards which I got drops for that I will use for a week and will use the anti inflammatory drops for 4 days. Fortunately I haven't had any side effects really. My eyes are/were sensitive to lights and screens for a few days after and I haven't noticed anything else except that I dont have the headaches anymore and that feeling of fluid build up has gone away. I hope this might help someone. I was so scared going in I was actually surprised that I did. I go in a month for a follow up appt to make sure everything looks good.

@shasta2292 Thank you for your response. Did you get a second opinion before deciding on doing the procedure? My doctor is doing both eyes at the same time. Should I be concern?

@hsantos435 I had the laser iridotomy on 10/18 and my doctor placed it at 9:00 position. It wasn’t as bad as I thought. The pressure in my eye dropped from 24 to 16 at my 2 week checkup so I’m happy about that. I don’t have any vision issues but my pupil is a little bigger now. My doctor isn’t concerned about my pupil size but I am waiting another month to see if my pupil goes back to normal before having my other eye done.