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

I have been advised by my ophthalmologist to have a YAG Laser Iridotomy, I am having concerns about this procedure, basically the after effects and or the pain during the procedure, If anyone out there have had this procedure done will you kindly share your experience and after affects. Thank you in advance.

Thank you so much Colleen. Nothing is being done to help improve my vision. Before the LPI, I only needed reading glasses for reading, etc. Now, both my near and far vision are worse off, and I’m suffering from miserable side effects. My eyes may eventually adjust to the bilateral white lines, but the spotty vision in my left eye and the extreme eye fatigue and light sensitivity along with bilateral eye pain are hard to deal with. I’m considering the use of tinted contacts to see if they will help ‘mask’ the linear dysphotopsia, and as a last resort, I’m researching the possibility of getting the holes sutured. I just wish I could talk to someone who has had their iridotomies closed up. Is there a way I can post a question to other folks who have had LPIs and have or are experiencing the same symptoms as I have…the way @jigglesaw94 did on 9/25/16? Thanks so much for reading this long winded reply.
Sung Ae (@babyholder).

Babyholder, I'm sorry to hear that the laser surgery worsened your vision and caused additional symptoms.

What is being done to help improve your vision? What type of glaucoma do you have?

Yes had bilateral LPIs month ago and I’m absolutely miserable. My eyes were perfectly fine before the procedure, but now I have white lines in both eyes (especially in bright settings or when I’m looking at the computer etc.) the left being much worse. In addition, I have ‘spotty, blotchy vision’ in my left eye. I’ve been experiencing some pain in both eyes and headaches too. By 1pm, my eyes are extremely fatigued and eyes are super sensitive to bright lights. Wish I could turn back time and decline the procedure.

I consider it a good thing that I had it done. Knowing that I have a "relief valve" so to speak, is comforting. I live 2 hours away from my ophthalmologist and that was one of the considerations. He said that if the pressure spikes suddenly that if you do not receive treatment within an hour, you may lose vision in that eye. So worth it then, to me.

Just saw this reply. Good to know!!
Are you overall happy you did the iridotomy?

Right eye was 12 o'clock. Left eye was 9 o'clock. I did not have any complications with the 9 o'clock. The dysphotopsia is in the right eye and is just an ellipse of light near the midline of field of vision at lower edge. I have grown used to it and don't always notice it. If the sun is very bright, I will notice it. I dropped my glasses on asphalt last year and got two little scratches on the lower portion of the lens. Seems like it magnifies the dysphotopsia problem at times this past summer.

Glad to hear things went well for you. I still notice the dysphotopsia in right eye at times but it is not very bothersome.