Laser Iridotomy for Glaucoma
A laser iridotomy is a laser treatment used to create a microscopic hole in the iris, thus redirecting fluid flow within the eye. The goal of the procedure is to open or widen the drainage angle of the eye, and it may relieve intraocular pressure preventing damage to the optic nerve.
This procedure can be performed in-office at DMEI in our laser rooms.
Who Is a Good Candidate for Laser Iridotomy?
Laser iridotomy procedures can be performed on those with anatomically narrow angles (or primary angle-closure suspects), primary angle-closure without glaucoma, and angle-closure glaucoma.
Those with anatomically narrow angles have a blocked or occludable internal drainage system within the eye but no elevation in eye pressure, scarring of the drainage angle, or optic nerve damage.
Primary angle closure without glaucoma, as its name implies, is characterized by no optic nerve damage related to glaucoma; however, there has been high pressure in the eye and/or scarring of the drainage angle.
Angle-closure glaucoma is a form of glaucoma in which the drainage angle between the iris (the colored part of your eye) and the cornea (the clear front window of your eye), called the trabecular meshwork, is too small/narrow. This narrow/closed angle restricts proper drainage of fluid from the eye, and optic nerve damage is present.
A laser iridotomy procedure may be performed following an acute angle-closure attack or as a preventive measure for those with anatomically narrow angles, primary angle closure without glaucoma, or chronic angle-closure glaucoma. Your doctor will determine if you are a good candidate for the procedure based on your intraocular pressure, the extent of optic nerve damage, and the progression of your angle-closure glaucoma.
Before the Procedure
Because laser iridotomy is a non-incisional procedure, you may eat and drink as you like before the treatment. You should also continue to take all prescribed glaucoma medications as well as any other medications you take regularly. However, inform your doctor if you take any blood thinners, as you may need to stop taking these (with permission from your cardiologist) several days in advance of the procedure to prevent excess bleeding.
When you arrive for the procedure, your vision and eye pressure will be checked and eye drops will be administered to constrict the pupil (the black center of your eye) prior to the treatment. This gives the surgeon better access to the periphery of the iris where the laser will be administered.
You will be seated at the laser instrument and a drop of anesthetic will be placed in the eye to numb the area. A special lens designed to direct the laser beam to focus on the iris will then be placed on the eye, along with gel to enhance the view of the iris.
One or two different types of laser technology will be used to create a small opening in your iris to allow fluid to more freely flow to the trabecular meshwork. Depending on your eye and the type of laser used, several to more than a hundred laser spots will be applied until the opening in the iris is wide enough.
You may feel slight tingling, popping, or stinging during the treatment and you will see bright flashes of light. Overall, the procedure is usually completed within 10 to 20 minutes.
Following the Procedure
The special lens will be removed, the eye rinsed, and additional eye drops administered to keep eye pressure down. You will be asked to sit in the waiting area for 30 minutes to an hour, at which time your eye pressure will be checked. If your doctor deems your eye pressure is satisfactory, you may be driven home by a friend or family member. If your eye pressure has increased, you may need to stay in the office for additional treatment and pressure measurements until the pressure comes down.
Are There Risks Associated with Laser Iridotomy?
Your eye may be slightly irritated and your vision slightly blurry following the procedure, but these effects should be temporary. Typically, any increase in intraocular pressure following the procedure is also temporary and can be treated with medication. Rarely, the pressure increase can persist and require urgent glaucoma surgery.
Other complications can include temporary inflammation of the eye, a scratch or irritation on the eye’s surface, damage to the inner surface of the cornea from the laser, or mild bleeding at the site of the treatment. Some patients may be aware of a small, unbothersome amount of light or glare through the new opening in the iris. This complication is rare but can cause vision problems.
Even if the treatment is successful, you may experience residual angle-closure glaucoma requiring continued or additional treatment to open the drainage angle and/or control intraocular pressure on a long-term basis.
You will not be required to wear an eye patch, and you may continue your usual activities the same day of the procedure. Your doctor will instruct you to administer anti-inflammatory eye drops in the treated eyed in the days following the procedure. You may also be instructed to begin or continue other glaucoma medications.
Follow-Up Laser Treatments
Your first postoperative visit will be approximately one week following the procedure to assess the treatment’s effectiveness. The opening created during laser iridotomy is usually permanent, but follow-up laser treatments may be required.