Getting My Eyes Laser-Zapped (a.k.a. My Iridotomy Experience)

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)

Update on Monday, March 26, 2012 at 7:26AM by 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.