Why do I need this procedure when I'm not having any symptoms?
Laser peripheral iridotomy is a preventative procedure used to treat patients with narrow angles that are at risk for an angle-closure attack. Although there are some criteria that ophthalmologists use to determine whether a patient with narrow angles is at high enough risk to warrant this procedure, there is no way to predict whether any given individual will actually go on to have an angle-closure if left untreated.
What is the angle and what is closed-angle glaucoma?
Closed Angle Glaucoma
The angle is the space between the clear part of the eye (cornea) and the colored part (iris), close to their meeting point near the edge of the iris. It contains the trabecular meshwork, which is the main structure that directs fluid out of the eye. In closed-angle glaucoma, the angle is closed in many or most areas, causing increased eye pressure, which leads to optic nerve damage and possible vision loss. The rise in eye pressure may occur suddenly (an acute attack of angle closure) or gradually. There are also precursor forms of the disease in which the angle is narrow but the eye pressure is not high and the optic nerve is not affected yet.
What happens during an iridotomy?
Before the procedure your eye will be anesthetized with the same eye drops used for measuring your eye pressure. After you are set up in front of the laser, a lens is temporarily placed on the surface of eye. The laser beam is aimed and multiple laser "shots" are applied to the iris. Laser surgery can be slightly uncomfortable and you may feel a "pop" in the eye or an occasional pinprick type sensation. After the procedure is over, the contact lens will be removed. Another eye drop may then be given. After the laser treatment, you may notice some blurry vision, mild discomfort, or a foreign body sensation in your eyes. These symptoms are usually gone within a few hours to a few days. You may also be given some anti-inflammatory medication to use for a few days to a week to prevent any significant inflammation. Some patients will still require eye drops or additional laser treatment even after a successful laser iridotomy.
What are the risks of this procedure?
Common complications include a little bleeding from the iris, mild light sensitivity and a scratchy feeling on the surface of the eye for 24-72 hours after the procedure. Approximately 3% of patients may experience and extra "ghost image" through the tiny opening in the iris. This may be annoying for a while but nearly all patients who develop this complication eventually get accustomed to it. Lastly, it is not uncommon to have a mild eye pressure elevation after the hole through the iris is made since iris pigment is released during the procedure. Due to this, your eye pressure will be checked in the next 1-2 days.
Narrow Angle
What causes narrow angles?
You may have narrow angles because of certain anatomical conditions, such as having a shorter eye than the average person, being hyperopic (far-sighted), or having a growing cataract that gradually narrows the angle over time. You may also have a closed angle because of inflammatory conditions, such as uveitis, or vascular conditions - such as diabetes - that gradually cause what is termed "secondary angle-closure" over time.
How is the procedure done?
This procedure is performed in our office by your ophthalmologist. A tiny, microscopic hole is typically placed in the iris at the 3 or 9-o'clock position to allow the iris to fall away from the drainage area inside the eye. You can think of it as an escape valve, so that the pressure in the front of the eye equalizes the pressure in the back of the eye.
Do I still need to take my glaucoma medication?
Yes. Laser iridotomy is not a substitute for glaucoma eye drops. In most cases, if the patient is already on medication prior to the procedure they will continue with their medication.