Laser Treatments

YAG Capsulotomy

You have had cataract surgery to replace your cloudy lenses. In time after this surgery, your vision may have become cloudy again. This is sometimes called an "after-cataract," but it isn't a new cataract. Instead, the posterior capsule, which holds the new lens in place, has become cloudy. A laser treatment called YAG capsulotomy can be used to help restore clear vision.

Your Eye After Cataract Surgery
During cataract surgery, your eye's lens was replaced with a synthetic intraocular lens, or IOL. This new lens was placed where the old lens was, in the posterior capsule. The IOL allows light to once again reach the retina on the back of your eye which helps restore clear vision. 

How do You Know if You Need a YAG Capsulotomy Procedure?
Some common indicators that you may need a YAG capsulotomy procedure are:
  • Blurred vision (gradual - over months/years)
  • Gradual "fog" or "film"
  • Glare and/or halos around lights at night
  • Difficulty reading road signs while driving
  • Struggling to focus while reading

If the Capsule Becomes Cloudy
The posterior capsule is a thin, clear film, much like a piece of cellophane. In months to years after cataract surgery, the posterior capsule can become cloudy. This blocks light from reaching the retina. Your vision may then become blurry again, much like when you had cataracts.

YAG Laser Treatment
Our eye surgeon does the capsulotomy using a YAG laser. The YAG laser delivers tiny, rapid bursts of energy. A special contact lens may be used to help focus the laser on the treatment spot. The laser passes through the front of the eye and the IOL without harming them. When the laser reaches the posterior capsule, it make a tiny slit that allows light to pass through. Enough of the posterior capsule is left to hold the IOL in place.

YAG capsulotomy is done in outpatient surgery center and you can go home the same day. The treatment is quick and painless. There are no needles, no stitches, and no risk of infection. You vision will most likely be fully restored soon after treatment. Once the posterior capsule has been opened, it will not cloud your vision again. The procedure is very safe. Very rarely complications do occur and they will be discussed with your surgeon before undergoing the procedure.
Laser Peripheral Iridotomy (LPI)

LPI is a treatment used to prevent or treat narrow angle glaucoma. When LPI is used in patients with narrow angles, it is considered to be a prophylactic procedure that prevents these patients from developing acute angle closure glaucoma, which they are at higher risk of developing. This is significant in that an acute attack of angle closure glaucoma usually presents with high eye pressures, pain, and loss of vision. When LPI is used in the treatment of patients who already have acute angle closure glaucoma, it is used to help lower the pressure as well as to prevent another attack of angle closure glaucoma.

What is LPI?
LPI attempts to "open" a "narrow" angle. Since the angle is the part of the eye that drains fluid from the eye, narrowing of the angle can put the eye at risk for an acute attack of angle closure glaucoma. During the LPI, a laser is used to make a small opening in the peripheral iris (the colored part of the eye). This changes the fluid dynamics in the eye and "opens" the angle. If a patient already has acute angle closure glaucoma, the small opening that is made in the peripheral iris allows fluid to drain more normally and also lowers the eye pressure.

Laser Peripheral Iridotomy Treatment
The procedure is an outpatient procedure that usually only takes a few minutes. After some eye drops are put in the eye in order to numb the eye, a lens will be placed on your eye. This will prevent you from blinking and will also minimize your eye movements. The lens also helps to direct the laser light into your eye. The laser, which is attached to the slit lamp equipment, is then directed into the eye. Most people experience minimal discomfort during the procedure. After the laser, you may experience some irritation in the eye and some blurry vision, but this is largely resolved after a day or two. You will usually have your eye pressure checked one hour after the laser procedure. You are then usually seen the day after the laser procedure and/or the following week. The number and frequency of visits after the laser may vary and depend on the condition of your eye. 

In general, the LPI will help to lower your eye pressure which may then lead to improvement of your vision. The amount of eye pressure lowering and the degree to which your vision will improve depends on the severity and duration of your acute attack of angle closure glaucoma. Sometimes, other medications or even glaucoma filtration surgery may be needed to ultimately control the eye pressure.
Vitreolysis

Types of Eye Floaters
Eye floaters are small pieces of debris that float in the eye's vitreous humor. This debris casts shadows onto the retina. If you have eye floaters, it is these shadows that you see "floating" across your field of vision.
  • Fibrous Strand Floater
    • Most common in young people, this thin, dense floater can appear as multiple dots and/or string-like cobwebs and is a result of clumping of collagen fibers of the vitreous. Depending on size, and where it is located, it may be treatable with vitreolysis.
  • Diffuse Floater
    • This cloud-like floater is cause by the natural aging process. Whilst this type of floater can sometimes be treated with vitreolysis, it often requires more overall treatment in order to obtain satisfactory results.
  • Weiss Ring Floater
    • The ring-shaped Weiss Ring floater is a large, fibrous floater that is usually located safely away from the crystalline lens and the retina. Because of this, it can be treated safely and effectively with vitreolysis.
What is Vitreolysis?
Also known as floater laser treatment, vitreolysis is a non-invasive, pain-free procedure that can eliminate the visual disturbance caused by floaters. The goal of vitreolysis is to achieve a "functional improvement". That is, to allow you to return to "normal" day-to-day activities without the endurance of floaters.

How Does Vitreolysis Work?
Vitreolysis involves the application of nanosecond pulses of laser light to evaporate the vitreous opacities and to sever the vitreous strands. During this process, the floater's collagen and hyaluronic molecules are converted into a gas. The end result is that the floater is removed and/or reduced to a size that no longer impedes vision.

Vitreolysis Treatment
Vitreolysis is performed as an outpatient procedure; you do not have to stay overnight in a hospital. Immediately prior to treatment, your ophthalmologist will administer eye drops to provide mild anesthesia. A contact lens will then be placed on your eye, with the laser light delivered through a specially designed microscope. 

During treatment, you will likely observe small, dark specks/shadows - signaling that the floaters are being evaporated into small gas bubbles. These gas bubbles quickly dissolve and reabsorb into the vitreous. The treatment session usually takes 20-60 minutes to perform and most patients will need to undergo two treatment sessions, sometimes three, in order to achieve a satisfactory result.

What is Degenerative Vitreous Syndrome?
The vitreous humor is the clear, jelly-like substance in the main chamber of the eye, located between the lens and the retina.

At a young age, the vitreous is perfectly transparent. Over time as the eye ages, this vitreous humor can degenerate, losing its form and liquefying. Without the stable vitreous humor, the collagen fibers collapse and bind together to form clumps and knots. It is these fibers, which cast shadows on the retina and appear as spots, strings, or cobwebs that are commonly referred to as "eye floaters." 

In many cases as the eye ages further, the vitreous humor can peel away from the retina entirely. This is known as Posterior Vitreous Detachment (PVD). PVD is often associated with a sudden increase in the number of floaters.

It is necessary to undergo an ophthalmic examination to determine your eligibility for vitreolysis treatment. Clinical studies have shown that vitreolysis to be a safe, effective treatment in the majority of patients. If floaters persist, however, your ophthalmologist may recommend surgery.
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