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)
I had the YAG laser iridotomy surgery on 2/22 in preparation for Visian ICL (which is scheduled for this coming Friday 3/21). I started noticing the white line a few hours afterwards. That's when I found this post. It was the exact same issue and I was not told that this could be a possible side effect either. It isn't as noticeable as it was but I still see it @ least a few times a day. I'm hoping my brain learns to absorb or "tune" it out like I've been told. Fingers crossed the ICL procedure goes well w/no side effects!!
I had LPI about three weeks ago. I was nervous admittedly, because I'm both a nurse and an artist. I was given steroid drops, to be taken 6 times a day for the first week and then down to 4 times a week for the second week. I started to notice problems in the second week, by detail through my right eye was bad, with detail down by 75%, not vision loss exactly, but inability to see detail, so looking at say, a number plate, the white background would have cobwebs of black around the edge while the numbers would just be a black blur. I also noted some swelling of the eyeball. I got an emergency appointment and was told that the steroid drops had increased the pressure in my operated eyes from 18 to 38. The drops were stopped immediately and more drops to reduce the pressure in that eye. I went in for a check up yesterday and the pressure in my right eye had dropped to 20, which was good, however I am still experiencing acuity loss, though it seems a little better and something I term as 'ghosting', This is like the effect you get if you stare at a TV screen, or maybe lights, then look away and the coloured flashes of light follow your vision. This concerns me but the doctor told me to relax.
The thing that continues to annoys me, is that I've seen three doctors so far, and none of them will actually give me a rationale for having LPI in the first place. With drops my pressure was sustained at around 17/18, but having LPI appears to have had no effect at all. When asked the doctors simply cannot give me a rationale for why I needed LPI, what improvement (if any) it will have, and why, if drops maintain my pressure, is LPI even necessary. It seems to be simply something they do. I'm a psychiatric nurse, and have to admit that certain treatments, ECT immediately comes to mind. Basically, we don't know why it works, or how it works, or even if it will work at all, its simply an option.....a sort of 'poke it see what happens' approach.
This is hardly a clear clinical rational for drilling a hole in someones eyeballs.
Don't get me wrong, the principle is sound. Too much fluid in the eyeball increases the internal pressure, in my case due to a narrow vent that doesn't get the fluid out enough. So drill a new hole to make up for the restriction of the other. However, if there is a chance that it will not work, or in fact add additional problems. And if it actually doesn't reduce pressure, why bother with it, if medication can effectively do the same?
any advise would be great, though admittedly this is an old post and possibly long forgotten.
thanks
dave
I'm scheduled for an iridotomy tomorrow. Very nervous, probably won't sleep but your posts were helpful. Thank you!
I had laser iridotomies in both eyes, one week apart and just had my follow up appointment. Everything went very well. The doctor used an argon laser first to soften my iris since they are denser if your your eyes are brown. This didn't hurt at all but felt unfamiliar. Then he used a YAG laser to do the iridotomy. I counted the zaps and if he slowed down or took a break I relaxed more. The worst part was me worrying so much. I got a bit fainty just from my own anxiety, but it was over in a few minutes. I used prednisone drops for four days and had no headache at all, just slight blurryness for 24 hours. I listened to audiobooks I downloaded from the library to give my eyes a rest. The second eye a week later took only a few zaps (way less) and I had no blurryness after a few hours. I was able to resume my normal activities, go for walks within a couple days, but felt very tired from the prednisone drops so I slept a lot. I have no white line at all, thankfully, and my vision is the same as before: 20/20 with glasses. My doctor decided to put the holes at the sides of my irises one at 9 o'clock and the other in the other eye at 3 o'clock, to cut down on the glare problem. I've been able to go back to the gym and completely back to normal without having to worry about sudden closure, thank goodness.
An excellent book that really helped me before the procedures is by Dr. Harry Quigley at Johns Hopkins. I think it's called: what every glaucoma patient should know, or Glaucoma: what every patient needs to know. He's an expert on narrow angles and has done tons of research. He writes in a simple easy to understand way that answered most of my questions. To anyone having an iridotomy, good luck and don't worry. It's all over pretty fast and you'll probably have a good outcome as I did.
I had a laser iriditomy on october 6 2014. This wad on my rt eye. I had one on the left I Sept 2013. First time all went well. Different doctors. The doc makes all the difference. The second doctor was uncaring. He let the contact lens skip right off my eye while he was shooting the laser. The lens was reinserted without any cleaning. It had hit the table and my jeans.I am concernrd about infection.
I was poo pooed about my concerns by a tech. The doctor dissapeared and I did not see him again even asking to talk with him didn't work. The tech did all the work and appeared more competent than the doc. The doc spent less than 5 minutes doing his thing. No explanations from him. He left the gel from the contact lens in my eyes and on my very long lashes and when I complained to another tech who stunk of ciggie smoke and was checking my eye pressur 45 minutes after the procedure that my eye hurt I was ignored. What was hurting was an eye lash that became stuck in the corner of my eye. I got that out with a tissue. I was not even given a mirror . When I showed him the lash he just sai
Wen I got home I used amirror and found one third of my upper lashes stuk inward in a mass of dried gel.
Before I left the docs office I was given 1ml of steriod drops and told to use them until they ran out.. Next appointment was to be in 4 months..I insisted on sooner so was given 1 month.
So except for the 45 minute pressure check no checks of pressure for one month. I know this is not best or even passing treatment. I am wondering if the doc has lost it. I am very nervous about this.
I can't complain to anyone since this is the practice in my area. Any suggestions?
If the correct spot on the upper part of iris close to the lid is chosen as the location to make the hole then the chances of having
glare as a side effect is minimal if not in fact non-existent. In addition it is unclear what the benefits versus risk ratio is concerning the extent of angle closure. 25 degrees seems to be the cut-off point and preventive laser surgery is recommended. But none of the professional ophthalmological organizations provide any statistical information in this regard. Currently technology is available that can accurately measure the exact angle of the mesh. But, even with this information at hand
the exact risk of becoming blind is never definitively stated. Always keep in mind this type of laser surgery is a cash cow for the doctor doing the procedure. For example Medicare pays about $3000 to the doctor for what amounts to a ten minute procedure.
had the lazer iridtomy procedure. It was simple, quick and painless. I read so much material beforehand and was temped to cancel it and HAPPY I DID NOT! i find that people that have had no issues and there should not be, do not take the time to write to calm others.
only thing i would recommend is to take a Tylenol before the procedure as some of the eye drops will cause a bad headache.
GET it done! went back to the doctor that did the procedure at a 3 o'clock position on my iris... no issues at all! he did say it was medically necessary and Dr. Prince in NYC was excellent. At the after exam three weeks later he said both of my eyes are now the same. The procedure actually changes the narrow angel to normal!
the procedure was a blessing.
I haven’t seen any online comments where people have said they had both eyes zapped on the same day.. they seem to be getting them done one at a time (on different days). However, my appointment is for having both eyes done at once. I had been told (by three ppl including the doctor and my regular optometrist) that I would be having only one done (I had asked them directly)
At my yearly eye exam, the test where you look at the green dots revealed that only the left dot was green; with the right eye I saw a tray dot.
Has anyone here had both eyes done at once?
My laser procedure is set for Mar 18, 2015.
Had my irridotomy three months ago. Happy to know I won't go blind. Yes white lines, but with time they fade away and just relax and enjoy what you ca see. Rarely if I concentrate on looking for a thin line at night in certain lights, I might find a hint of one. But I don't have time to create negative thoughts and I'm happy I did it. It's over. Good luck to anyone who's done this! It's frightening but we get thru it!
Hi Debbie,
I'm supposed to have laser iridotomy this week, but keep wondering if I should try to put it off. No one else in my family has glaucoma and I don't think anyone else in my family has narrow angles. (Were my siblings right--was I actually adopted?!) Your post has put me at ease, somewhat, but I'm a little worried about the white lines. Are you still experiencing that?
Thanks for your thoughts.
Susan
Three weeks ago, my ophthalmologist interrupted a routine eye exam before I could be dilated. My eye pressures were high and I was poised for an acute glaucoma attack. Damage was becoming apparent from chronic blockage and swings in pressures. As she explained the need for LPI surgery, my doctor commented that this was “not an elective procedure” for me. That got my attention--as did the unexpected diagnosis.
Returning home, I did my due diligence and prayed about it. Soon, I realized that although there might be some risks with the procedure, there was a substantially greater risk of an attack and total vision loss. Why wouldn’t I take this step to protect myself?
The two procedures went very well with the zaps at 11:00 and 1:00. Each process was similar to those outlined above. They were done a week apart, going smoothly and effectively each time. The work was handled by a team of interns, residents, and ultimately my ophthalmologist who performed each surgery at a university's optometry school.
The surgeon made the holes at 11:00 and 1:00 because her experience is that the lid covers the holes well at that placement and the potential for residual visual distractions is minimized. As she termed it, "We're creating a second pupil, effectively giving light another way to enter the eye." By placing the holes at those positions, there is less opportunity for more light to seep in, and drainage is optimized. That made a lot of sense! I now know when I see something different in my peripheral vision that it is from that, and I do not need to worry about it.
Now that all the surgery-required drops have worn off, I have had absolutely no visual distractions or artifacts. Glare has always been a problem for me, so post-surgery I still notice it and continue to manage it with sunglasses and a hat. I will need to update my corrective lenses because my acuity has changed--but that too is manageable. These are small prices to pay for the relief I feel with my eye pressures and the knowledge that the risk of a glaucoma attack is greatly reduced.
Most importantly, my eye pressures immediately dropped by 30%! One week after, my eyes are much less achy AND the eye pressures have remained 30% lower than when we started. The difference is palpable, and for the first time in years my eyes feel good.
If you'are questioning whether to have this, remember why it has been recommended: It's to drop your eye pressure when you have an anatomical form of glaucoma which cannot be treated with drops. The reduction is significant and will help save your sight. That is well worth any distractions you may have in your vision post-surgery.
Hi - glad I found this website and was able to read all these posts...I was diagnosed with narrow angles a couple of months ago and had my first iridotomy last month (second eye will be done next week). As I'm still relatively young (42) and don't have any family history of glaucoma or any other risk factors apart from being long sighted I was pretty shocked at the diagnosis. The iridotomy itself was painless and so far (on the eye that's been done) I haven't noticed any visual disturbances although I suspect my visual acuity has declined a bit in that my distance vision seems to be worse I that eye than it was before ...although there is no telling if this was because of the surgery or just a general decline. Anyway, I'm glad the procedure wasn't as awful as some of the posts on the internet have implied....however, I'm still a bit worried as to what the long term prognosis is for us narrow angle suspects? My angles improved after the treatment but they're not wide open (despite my consultant being very sure there is no plateau iris) so I suspect I am still at risk for chronic angle closure at some point in the future. Sadly I think I have read a bit too much on the internet and so I'm worrying that the iridotomy is not going to be the be of the story. Does anyone have any personal accounts of how things went for them post iridotomy?....I.e. Anyone have the lpi as a preventative measure but still go on to develop problems afterwards?.... Thanks in advance for your time... Maria