Getting My Eyes Laser-Zapped (a.k.a. My Iridotomy Experience)
Friday, April 8, 2011 at 8:41AM 
As some of you already know, I had a detached retina years back in 2004, so am not new to laser surgery. This time, the laser surgery was an iridotomy, which is a preventative surgery for narrow angle (also known as "angle-closure") glaucoma.
To be clear: I didn't have glaucoma, but was at high risk for it. Since glaucoma is the kind of optic nastiness whose symptoms don't tend to show up until it's too late to fix, my eye doctor and the specialist at Sunnybrook Hospital recommended that I opt (HA! AN OPTHAMOLOGY PUN!) for preventative surgery.
I immediately went online and starting researching, of course. I came across lots of helpful info but also a lot of questionable info... and the horror stories, of course. One of the reasons I'm writing this post is to offer a personal perspective on the whole procedure as well as some of the online info I found useful. Please note, however, that this post is definitely not meant to replace informed medical advice.
As registered nurse Tamara points out in her Flying Kitten blog, you should do your own research before deciding whether an iridotomy is right for you.
(Above: photo I snapped with my iPhone while waiting for my pressure to be checked post-surgery.)
What exactly IS narrow angle glaucoma?
Out of all the explanations online, I found this explanation of narrow angle glaucoma the most helpful. My layman's summary: Narrow angle glaucoma has to do with sudden increases in eye pressure because of a blockage or partial blockage of the tiny drainage system in your eye that usually helps maintains a constant level of pressure. More common in Asians than other races, apparently. My father had the same procedure for glaucoma, so it runs in the family.
What is preventative laser iridotomy?
Basically, the doctor uses a laser to create a small hole in the rim of your iris to let the aqueous fluid drain from your eye, which helps restore the pressure balance between fluid entering and leaving your eye.
My own experience
I had two surgical appointments, one for each eye, and a week apart. My second was yesterday. Each had a follow-up appointment the next day. Here's what happened at the surgical appointment:
Shortly after arriving at Sunnybrook Hospital and checking in with the receptionist, someone comes out to where I'm sitting in the waiting room and gives me an eye drop in the eye that's to be lasered, and a tissue in case I need it.
I'm led to a smaller waiting room where about half a dozen others are already waiting, each with a tissue.
Some of us make brief nervous chit chat (chatted with a woman about my new iPad yesterday) until the headaches hit. We were warned about the headaches in our list of instructions; apparently it's a common side effect of the muscle-constricting eye drops, and we're allowed to take Tylenol. I bring regular strength Tylenol for the first eye but smarten up and bring extra strength the next time. The Tylenol helps a little but the headache is still pretty strong, though nothing compared to a migraine.
We're called in one at a time, with each person coming out after a short time (5 minutes? 10?).
When it's my turn, I go in and sit in the examination chair. What surprised me the first time: that the whole set-up seemed very much like a typical eye exam. Lean forward, put your chin on the chin rest, forehead on the forehead rest.
The first time, the doctor's assistant held my head -- I assume this was to keep me from jerking away. The second time, no one holds my head and the doctor's assistant did the procedure, not the doctor herself, so I figure that the assistant is a resident (is that the right term?). The doctor watched the entire time, checking partway through the zaps to make sure everything was going well.
In both cases, the was also a third person in the room who was just observing...a student? Intern?...while the doctor was explaining things to them during the procedure. I didn't mind, and found the running explanation interesting. I used to watch Gray's Anatomy, and it reminded me a lot of that learning environment. Of course, I tried very hard not think about the episodes where things went horribly wrong. :-)
But back to the procedure...
After I'm seated, I get another eye drop, and then they put in some kind of lens with a clear gel beneath. This is one of the bits I was really nervous about, mainly because I don't like having my eyes touched - I tried contact lenses for two years but then gave up on them because I could never get used to touching the surface of my eyes (ick). BUT the whole lens thing went very smoothly, probably because of the numbing eye drop, and it was nothing like That Scene in Clockwork Orange (you know the one).
The lens itself is removed, leaving a thick clear gel behind. My vision in that eye is fuzzy at that point but it doesn't matter, because things happen very quickly after that. I'm told to keep my other eye focused on a small green light that's at the end of a flexible wire attached to the machine.
Another of my big fears was that I'd accidentally move my eyes during the laser treatment. The instructions we're given are clear: KEEP YOUR EYES AS STILL AS POSSIBLE DURING THE PROCEDURE. Eek, as soon as I read that I couldn't help but think, "But what if I DO move my eyes?"
Iit wasn't nearly as difficult as I thought, thankfully. Probably because the procedure is so short (first one was about 15 seconds with a few zaps, second was about 30 seconds with about 10 zaps), and it's also easy to focus on a particular spot.
I was also worried about blinking, but found that the gel (or maybe it was the drops) made it easier not to blink, plus the doctor seemed to be able to time the zaps between my blinks.
The zaps themselves were very short. I was warned that I'd feel a "pinching sensation," and that term is pretty accurate. Though not pleasant, they weren't painful. I'd compare the sensation to the first split second of realizing you have a speck of grit caught under your eyelid. May be different for other people, though.
After the procedure
After it's over, the zapped eye feels very odd but not painful. The first time, it was as if a thin black gauze was held over my eye for at least 10 hours -- not surprising, considering that the eye drops had made my eye muscles constrict so less light was getting through.
I was given a prescription for eye drops - a steroid to help with inflammation - and was told to take them four times a day in the affected eye, for five days.
I had been warned that one of the possible side effects would be glare. I've always been pretty sensitive to glare (in terms of a halo of light around light sources) all my life, and I can't tell if this is worse or not.
One side effect that I hadn't been warned about: a thin horizontal hazy-white line across my lower vision that moves up and down as I open and close my eyelids. For the right eye, the line is very faint and I can only see it in sunlight. For the left eye (the one that was done yesterday), I see it almost all the time, especially when looking at any light source...including my computer screen. It's a bit fainter today than it was yesterday, though, so hopefully it'll fade with time.
Even if it doesn't, however, I'm still glad I had the procedure done, and I'm grateful that technology exists to make it possible. It's possible that I may never have gotten glaucoma ... but if I had, I would have deeply regretted NOT having had the iridotomy when it was possible.
As for the thin white line: it's distracting if I focus on it, but it doesn't interfere with my illustrating (yay!) and I forget about it if I'm concentrating on something else. SO ... I'm going to opt for the "stop fretting about it, move on with your life" strategy, and be grateful for what I have.
Some useful related posts:
Lasers Burned A Hole In My Eye - Iridotomy (personal account: excellent, with lots of useful info)
Treatment for Glaucoma with Laswer Iridotomy (Video) - South Bay Opthamology
Laser Iridotomy (Encyclopedia Of Surgery)
Debbie Ohi
Since so many people have asked since my April 2011 post:
No, the white line has not faded at all, nor has my brain gradually adjusted to the line and blanked it out.
However, I've gotten used to the line and purposely don't let it irritate me anymore. It took a real mental effort in the beginning since initially that white line drove me crazy, and I even had an appointment scheduled with a specialist to discuss the possibility of a procedure in which a tattoo on my eye would supposedly get rid of the line.
But as the day of the apopintment approached I thought, "What if something else goes wrong? Will I spend the rest of my life regretting not leaving things as they are?"
Once I made that decision, I decided to try ignoring the line as much as possible from that point forward. Not to talk about it, not to focus on it, to move on with my life.
Reader Comments (37)
Thanks for the detail and explanation. It's good to have a sensible person explain medical procedures step by step and calmly.
I really shouldn't have read this, I'm /very/ squeamish about eyes (there is no way short of a general anaesthetic I'd get contact lenses within a foot of my eyes!). But glad it worked for you, anyway.
The white line I'd treat the same as the one on my VDU at work, marginally annoying but as long as it isn't obscuring anything important is can be ignored. Which may be what's happening, your brain is filtering it out as a constant.
Thanks for sharing this, Debbie. My sister has had issues over the years, and this may be something for her to know about at the very least. And so glad you'll still be illustrating!! I hope that little line goes away... The brain can do amazing things with irritating little buggers like that. :-)
Oh wow, I didn't know they could prevent narrow-angle glaucoma. I'll have to ask my eye doctor about this. My family is riddled with both open-angle and closed-angle glaucoma - I have an aunt and an uncle who are both legally blind due to narrow-angle glaucoma. I think you are wise to have done this to protect your eyes, especially as an illustrator!
Quinn: Thank you for saying that. I kept coming across such HORRIFYING accounts online ("don't get this! it's sooo painful and dangerous!") that I thought I should speak up as someone who went through the experience and was fine with it.
Chris: At my follow-up today, the doctor says that the line may fade after a few months, if not sooner. If it doesn't, and it really bothers me, she says there is a tattoo process than can help. She doesn't do the procedure herself but would recommend me to someone who does.
M.A. Scott: I'm counting on that as well (the little line disappearing). Hope everything works out with your sister!
Brooke: So sad to hear about your aunt and uncle losing their sight because of narrow-angle glaucoma. :-( Definitely ask your eye doctor about this, and find a good surgeon. I was lucky to have Dr. Birt at the Sunnybrook Hospital, who is one of the top specialists in glaucoma-related treatment.
Thanks for writing all that, Debbie. If I read a few more pieces like this, I may be able to tolerate whatever eye surgery is in my future.
Hi Debbie,
I saw some views on my site that came from your site so I decided to come over and say hi. I hope your eyes are feeling good and the line is going away.
Your procedure sounded a lot more uncomfortable than mine did. I did not get a headache and my vision was not blurred. I guess i was lucky even on the repeat iridotomy in my right eye.
It's funny something that I did not even think about as a side effect for me was the white line. I did not get it right after and it only happens on rare occasion. Mine seems almost like as I blink it moves and fades away until I blink again. It seems to happen when my eyes are dry and irritated. Especially after a lot of computer work. Not very bothersome. Usually lubricating drops seem to help. My doc did tell me about the procedure.
I love your drawing too!
Tamara
Hi Debbie, Loved the info. Have the same annoying white line, but feel better about dealing with it. The only thing I wonder about is when I called the doctor and told him about it, they had me come in like it was some emergency situation. Then they acted like they never heard of this side effect. Makes me think I should find another Dr. I did read that your brain eventually filters it out as insignificant info. and it goes away. Hope thats true! Thanks! Toni
hi debbie, i had mine done 5 days ago... while i was reading your post it was like if i was reliving my whole experience.. thanks for sharing .. and yes, i too see the white line (and also the one on the left side is bigger than the other one) if i blink or if i see out the window... i hate it and i was already getting upset but now i see that i'm not the only one .. has your line faded away? please teel me the TRUTH!!!!!! thanks again.
Lyzette: I've posted an update at the end of my post -- no, the line never went away. Like you, I was upset at first but now I've gotten used to it.
Had my first eye done today. Had a great experience. Happy I had it done. Hope the next one goes as well! The headache was no biggie, didn't really have much blurriness, and all in all, good experience.
I recently had an emergency iriditromy in both eyes because I had a "narrow angle glaucom attack" that was devestating and very painful. I too have the light bars in both eiyes that were and are very annoying. I read up on this procedure and found that the laser hole should have been made under the eye lid and the problem would not exist. Does anybody have any information on this matter? If so I would appreciate hearing from you at dickpritch@yahoo.com
Thanks for anything you send
Hi Debbie, I just had my left eye done yesterday. It took a bit longer than yours did...the Dr told me I had a very thick Iris. He started zapping on one machine and said he just couldn't get this one spot, so he had me move to a different (and presumably stronger) machine. I only got a slight headache - like you said, nothing like a migraine. My eye was throbbing and sensitive to light for a few hours after the local anesthetic drops wore off. The 1st couple hours was a bit blurry, but I assumed it was the gel they put in. My only worry is that darned white line you spoke of. At first I thought I had something caught in my eyelash (like a piece of lint or hair), but when I woke up this morning, it was still there. I was hoping to read that yours faded, so I'm a bit disappointed that it didn't. I am scheduled to have my right eye done in about 3 weeks. I sure hope I don't have the white line in that eye, too. Does the white line cause more night vision problems for you? Oncoming traffic is bad enough without seeing what looks like a reflection. I also ride a motorcycle, so I'm a little worried that it might make my night vision worse. Any thoughts? Thanks again for your post..it made me feel lots better knowing I'm not alone!
Hi Debbie, Thanks so much for your your post. I am having an iridotomy on both eyes (a week apart) in about six weeks and your story has helped to calm my nerves somewhat. I have been reading online about different ideas about the location of the iridotomy, especially with respect to the glare that results afterwards. May I ask in what location your iridotomy was done? My Dr. has recommended a 3 or 9 o'clock position, which seems a little counter-intuitive to the 12 o'clock which could be covered by the eyelid.
Hi debbie ,Thankyou for the post even I have undergone iridotomy but just weeks back and I'm just worried abt white line disturbing whenever look down
For those who are legally blind from glaucoma they are now able to do a new procedure/surgery where they insert a tiny telescope in one eye so you have regular vision out of that eye & then peripheral vision out of the other eye. The article said it takes some adjusting but this man in his 70's is now able to see again. I have now seen this telescope surgery advertised by an Eye Institute somewhere. The surgery I read about took place in Rapid City, SD and was done by two eye doctors there. If you Google The Rapid City Journal newspaper you may be able to read the article. I had an Iridotomy on both eyes too. I don't have any white lines. I live in Kailua Kona, HI and had the procedures done at a clinic about 1& 1/2 miles from where I live.
Thank you for the info, Debbie. My husband's doctor is suggesting this procedure and I have so many questions. Hearing your story in detail is very helpful.
Hi thanks for this I had both eyes done 3 weeks ago in london one eye was done ok but had to have a second treatment as one iris was thicker. I found it quite painful and wasn't looking forward to another session. When I went back the hole had closed up on the eye that had been successfully treated apparently that happens sometimes. But both eyes were done ok and I've had no problems so far other than itchy eyes. Am happy I've had the procedure. Mine was done at the top of the eye under the eyelid.
I had the same iridotomy done on both eyes two weeks ago. One had to be re-done a week later. I didn't have any headache and only had each eye zapped twice. The holes are at about 10 or 11 o'clock on both eyes and luckily I don't have any white lines. There was just me and the dr in the room during the procedure and I was very nervous the first time. He had to keep telling me to not move my eyes, to lean in etc. The worst part was the lens that was put on my eye prior to the lasering. I could never wear contacts as I hate anything touching my eyes at all and the funny thing was that after the first one was done, he said just that...that I would be a horrible candidate for contacts. We both laughed. When I had to go in for the re-do, it was not a problem at all and I barely felt anything. I think I knew what to expect this time, so just wasn't as nervous. The eye that had to be re-done was a little blurry after each time, but cleared up within a few hours and was not very painful at all. The first one was perfect right after, no pain, no cloudiness. The first time I was probably in the chair for about 15 minutes...the second time it was probably under 10 minutes. It's a very fast procedure for anyone wondering. I wasn't given any drops after and was never told about taking Tylenol or anything (but I did after anyway as there was a slight achy feeling, not really painful, just a tad achy)
How wonderful we live in a time when something can be fixed that used to cause blindness.
I had this procedure about 2 months ago. I was not told to expect the headache which was a killer! The procedure was as you describe it, very fast with little discomfort. My recovery has been terrible. I have the white blink smear that blurrs my vision and have suffered from headaches on the side of my head ever since. I initially attributed them to the steroid drops, which I think I may be allergic to, and while these have relented a bit over the past weeks, I still suffer from them, especially when on the computer for long periods. I am supposed to have the procedure done in the other eye, but am frankly rethinking whether I want to go ahead with it. I know for some this is a great solution, but I'm not sure it was the best for me.
I had this done 3 days ago. I had no problems. I did have a headache afterwards which Ibuprofen handled just fine. I had the sensation that there was a hair across my eye - is this the white line you speak of? but that went away after 2 days. I'm still taking the drops. They sting slightly. I'm slated for my 2nd eye in 2 weeks. The whole procedure took less than 5 minutes. I had it done through Wills Eye Hospital. My doctor handled the entire experience. A+++ I'm ignorant as to where they placed the hole. I will need to inquire on that.
FWIW, I am nearsighted and am just presenting with narrow angle. I had this procedure done as preventative.
Dear Debbie,
Thank you so much for posting this explanation of your procedure. It helped me enormously to face the scary prospect of eye surgery. I'm very squeamish when it comes to my eyes. I had my surgery last week; both eyes at once at a famous clinic in downtown Toronto that does mostly cosmetic eye surgery but still takes OHIP patients. Right eye, the expected 5 zaps. Left eye, off the scale with around 50 zaps to get the job done. I was beyond the end of my rope. The doctor explained that some areas of the iris are thicker than others and you can't tell until you begin. Dear God. It was very, very hard to sit still through 50 zaps. Anyway, I asked about the white lines and he said that a study, recently ended, has concluded that the best place to zap the hole is in the temporal margin of the iris. That is, on the outside edge. This seems to cause the fewest "white lines" incidents. My eyes ached for several days afterward but are fine now. Thanks again, for your detailed explantion on this blog.
i am 36 years male my family doctor reffed me to eye specialist. eye specialist inform me narrow angels in my eyes need to make small hole in iris where as my eye pressure was under 21 eye sight was very good, i was so much upset to know about laser surgery . Yesterday old doctor 75 years eye specialist put eye drop in my eye and after half hour i was called laser room where doctor again put drop in my eye after that he tried to put lens in my eye after that when doctor fired laser when it was hitting in my eye i fell cutting and pain in brain after 5 short i fall down and faint after few mints i saw doctor was siting over me and punting water over my face then i was in shocked and my body was look so weak i have very bad experience LPI TREATMENT if any one have experience please info me why doctor inform he could not complete procedure
Muhammad Saleem Canada
I'm really glad that I came across this, I had my treatment 7 days ago (on both eyes) and have been using steroid drops 6 times a day plus my usual drops, then I drop down to 4 per day from next week. My main problem is the constant blurriness each day when I start to put in the drops and the slight headaches, all being well this will go next week,
This post has been really useful, Thanks.
Darwin Hunnington UK
Has anyone else noticed, that when you raise your eyelids, the iridotomy glare is greatly lessened or eliminated for the moment? Thanks for sharing your experience.