Laser for after cataract (YAG laser capsulotomy)
A YAG laser capsulotomy is a special laser treatment used to improve vision after cataract surgery. It is a simple, commonly performed procedure which is very safe. During your cataract operation, the natural lens inside the eye that had become cloudy is removed and a new lens is inserted. In a small number of patients the lens capsule can thicken and become slightly cloudy and can affect light entering the eye. This means that vision can become blurred and you can experience glare from lights. This process can happen in the months following your surgery but most commonly occurs around two years following surgery.
What does the procedure involve?
When you have YAG laser capsulotomy the laser is directed at the capsule to create a hole which then enables light to enter through the lens. The procedure takes approximately 20 minutes to perform. You will have some drops put into your eye to make the pupil bigger along with anaesthetic eye drops to numb the surface of the eye. The procedure is painless and causes minimal discomfort.
What are the benefits/risks?
After the treatment most patients find that their vision is blurred for a number of hours from the dilating drops. You can also be sensitive to light so it is advisable to bring sunglasses to wear, and you can also not drive for the day following the procedure.
Complications are very uncommon. Occasionally the pressure inside the eye rises immediately after the laser treatment. If this occurs, you may need extra treatment before you can go home. Occasionally the opening made by the laser beam is incomplete, or not big enough. This will be discovered either after your treatment, or on your follow-up visit. If this is the case, it may be necessary to repeat the treatment at a later date.
Selective laser trabeculoplasty for open-angle glaucoma)
SLT is a laser procedure designed to lower the pressure in the eye in patients with glaucoma or ocular hypertension.
Who is suitable for SLT?
Patients who have ocular hypertension, primary or secondary open angle glaucoma and need to lower their intraocular pressure (IOP) may be suitable for the procedure.
How does the SLT technique work?
SLT works by using pulses of laser applied to particular cells in the eye. This triggers a process in the eye which will improve drainage and therefore lower the IOP.
How is SLT performed and will it hurt?
SLT is an outpatient procedure and only takes about 15 minutes. Your eye will be numbed using anaesthetic drops so the procedure will be painless.
How long does it take for the treatment to take effect and how long will it last?
This may be as quickly as a couple of hours after the procedure up to a couple of months. You will be monitored to check how you have responded.
Will I still need eye drops for glaucoma following SLT?
Everyone is different, so this will be dependent on the individual. A recent study has shown that 75% of new patients can be free from drops over a 36 month period following treatment with SLT.
What are the risks and side effects of SLT?
There are very few side effects of SLT. There may be some inflammation of the eye following the procedure, this can be treated with eye drops and usually resolves within a couple of days. Typically the effects of SLT will last several years, however sometimes it may be necessary to have this repeated.
What is the recovery time following selective laser trabeculoplasty?
Little recovery time is needed and you should be able to resume normal daily activities immediately following treatment.
What is the evidence for the effectiveness of SLT?
The results of a pioneering clinical study conducted by Moorfields Hospital called LIGHT (Laser in Glaucoma and Ocular Hypertension Trial) and published in March 2019 indicated that laser-based treatment in newly diagnosed cases is more successful than the traditional intraocular pressure lowering eye drops.
This landmark study showed that for 80 per cent of new patients the laser can deliver ‘drop-free’ intraocular pressure control over 36 months with very few if any side-effects. This is achieved by the laser stimulating the body’s own healing response. In effect, the laser is absorbed by pigmented cells in the eye which improves the flow of fluid leading to a reduction in the pressure on the eye.
Laser iridotomy for narrow angle glaucoma
Patients who are found to have narrow angles and are at risk of developing angle closure glaucoma can be treated with a procedure called YAG laser iridotomy. In this procedure laser is used to make a small hole in the edge of iris near the trabecular meshwork so that aqueous can flow directly into the anterior chamber angle without needing to flow around the iris through the pupil. Acute angle closure is usually treated in hospital with a combination of medicines and eye drops to bring down the pressure, followed by a laser iridotomy.