Laser Peripheral Iriditotomy to Prevent Glaucoma Part 2

[942joey]

have been diagnosed with borderline open/closed angle glaucoma. Two weeks ago pressure was 24. Last week it was 21. My father had open angle glaucoma; my sister had both open and closed angle glaucoma. She presently has chronic closed angle glaucoma. Would I be a candidate for Iridoplasty. Can you recommend Glaucoma in the Naples/Ft Myers area ? Thanks jo

[942joey]

I have been diagnosed with borderline open/closed angle glaucoma. Two weeks ago pressure was 24. Last week it was 21. My father had open angle glaucoma; my sister had both open and closed angle glaucoma. She presently has chronic closed angle glaucoma. Would I be a candidate for Iridoplasty. Can you recommend Glaucoma in the Naples/Ft Myers area ? Thanks jo

[smithakrishnan79]

Thank you for your reply. Sure I'll do it soon.

[smithakrishnan79]

Hello Dr. Mahootchi,

I have been diagnosed with Narrow Angle Glaucoma and been told to get the Yag Laser PI done. How soon I should do this Yag Laser PI? Do I need to do this immediately?

Thanks in advance

Smitha.

[AMahootchi]

Probably the sooner the better in terms of avoiding harder to treat problems. Listen to your doctor.

[Liquidization]

Hello i have been told i have a narrow angles and an iridotomy was recommended out of all the patients that you have done this for how many of them have vision impairments such as increased light sensitivity or lines in there vision glare how many of them say that there eye sight is now ruined and how many say the treatment was a success and show no negative symptoms your respond will be highly appreciated.

[AMahootchi]

Thanks for your question. The % that say they have no negative long term symptoms is 99-100%. I don't have any patients who think their vision is "ruined". About 1% of patients will have either short term foreign body sensation, inflammation, etc. Those symptoms usually resolve in a few hours or a few days.

Also, making sure the PI is in a part of the iris that is normally covered by the upper lid helps avoid any post op stray light symptoms.

A yag laser is easier on the eye than the Argon

[quallupiluit]

I had LPI performed in my ophthalmologist's office last week. She used a YAG laser and the treatment lasted no longer than two minutes for both eyes. Don't be intimidated by it. Dr. AMahootchi's comments reflect my experience. It was easy and my vision is perfect. Thanks for the great videos!

[AMahootchi]

On what page of that BJO article does it say " the side effects of iridotomy are the second most frequent cause of blindness in Japan?

It is a study about 33 patients done with an Argon Laser. 33 patients comprise the group of the second most common cause of blindness in Japan according to you.

That is false.

[lain02]

Hi, It's been a while. It's been a month now after i had this type of operation, somehow my eye started to feel normal but I'm still in to Xalatan. however my left eye feels like there's something poking it from the inside. I'm having headaches on the FOREHEAD but NOT on the back of the head as I often feel when my IOP rises. Does it have anything to do with the surgery? Would you be so kind to give me an idea what could be a possible cause? Thank you in advance.

[AMahootchi]

You can still post as long as you provide references for your claims as stated above. You haven't done so.

People look to this channel for authoritative medical information. You make wild and unsubstaited claims as if your were a physician ( you have said you are not) and you have been asked to provide references for you claims and can't.

So either provide references for your claims in the next 24 hours our you will be blocked.

Innocent people don't deserve your mis-information.

[Henribert]

Dr. Mahootchi,

why can't I post again?

[AMahootchi]

Henribert--You haven't yet provided a reference for you Japan claims. Your comments about "most patients can't cope" with floaters simply isn't t true. Either provide a reference for your claims or stop scaring people.

Either provide the reference for you Japan claims or stop posting.

Either provide a reference for your your "can't cope" claim or stop.

Complications from this laser procedure are usually minor, self-limiting, and non-vision threatening.

[lain02]

Just had this a couple of days ago, I think my left eye is having tantrums.

My right eye recovered normal vision in more or less an hour but my left eye took about more than half a day. Right eye normal vision, left eye normal but not as clear as before the operation. I see floaters, no headaches from anti-inflammatory drops but the day after I had nausea. Eye pressure; left eye 22, right eye 16. I really hope everything the Dr. said are true that everything will soon return to normal.

[AMahootchi]

Sound like either your pressure went up the day after or your eye muscles had spasms after the procedure. 1% or so have this but the the vast majority of those will get better in a short time and completely recover.

Most floater patients get better as well. Henribert post some pretty outragous claim about floaters ( and their treatment) that even a casual look at the literature would refute.

Your floaters should become less noticable soon. Did you have floaters before your procedure?

[lain02]

Thank you for asking. I didn't notice if I have them before, but after the operation, they became more significant, like I see a fast crawling insect on my peripheral.

I don't think I would undergo another surgery unless it's really related to vision loss. It's scary.

I'm in to Xalatan before until like 3 months after the procedure plus Betaxolol Hcl for my left eye until pressure normalizes.

Can I have an idea about the span of time it will take for my eyes to be normal again?

[AMahootchi]

Odds are on your side for resolution of the symptoms.

If the other eye needs to be done I'd ask your doctor about pre-treating more or using more steroid +/- non-steroidal drops in the immediate post op period. Even a mild cycloplegic once after the surgery may help avoid spasm. You can talk with your doc about the appropriateness of that for you--i.e. you can use our experience with one eye to make the other eye's experience better.

[AMahootchi]

Your situation isn't the typical simple narrow angle. Most aren't on drops prior to this type of laser or after. It sounds like you have mixed mechanism glaucoma--(with narrow and open angle components) So your experience will be a little different than described in the video. But our symptoms are likely to resolve and with planning, if you need the other eye done in order to preserve the vision--adjustments can be made to make the post operative experience easier on you.

[Janaenae123]

i had it done today alot faster and easier than i thought i get the other one done next month..and it is so fast the longest part is waiting for the drops to take affect

[smr43609]

I had the procedure done yesterday. This video provides an accurate overview of what one can expect as most of us really don't have a clue...I had the good fortune to have it done by a specialist with, what I would consider to be, the best practice in this area. He was patient, professional, and I would encourage persons of all ages to have regularly scheduled visits with an ophthalmologist. I think this area of health care needs more advocacy. Very little proactive care in this area.

[wildflowerlu]

Thank you very much. I've been nervous about it, but your experience and the video has eased my mind. Thank you very much for answering my question!

[wildflowerlu]

How long does the procedure take? Also is the procedure painful?

[AMahootchi]

The procedure with a Yag Laser as in the video is usually less than a minute long. You can see the procedure in real time on the video. It takes a few minutes for some pre-operative drops to take a effect but usually patients are in and out in of the laser suite in 30 minutes or less. Argon laser PI's take a little longer.

The eye is easy to numb ( with drops) and most feel none or very little pain.

[kmkienitz01]

I had this performed on me earlier today in preparation for ICL. It's a bit painful at first but once the procedure is done it's not too bad. My eyes just feel like they are really tired (no surprise considering what they went through). Wasn't as painful as the Doc made it out to be.

[AMahootchi]

Thank you for posting. You show another indication for the procedure that is becoming more common. The ICL ( implantable collamer lens--formerly known as the implantable contact lens) must have a PI done before hand in order to prevent angle closure--because of the way the lens could block the usual flow of fluid inside the eye. Hopefully that clears things up a bit for those unfamiliar with ICL's.

[NBCanuck]

Many thanks for posting this. I'm having the procedure tomorrow afternoon and I'm completely calm about it. Your video made it very non-threatening.

[AMahootchi]

You are most welcome and ...thank you.

[Catchetat]

The surgical procedures look really simple! Thanks for the video!

[Henribert]

It looks simple, but it isn't.

Many things can go wrong:

- The energy of the laser beam may be too high, causing damage to the inner lining of the cornea.

- The laser beam may get out of focus, damaging other parts of the eye.

- When the anteriorposterior chamber is shallow, the laser may damage the cornea/lens.

- The iridotomy must be located at a place where it doesn't cause glare and double vision.

[KelliShaver]

So sorry to hear about all the problems you've had! :( It's been a big adjustment and I, too, can't really do the work I was doing before. I think they're probably a very safe option for a lot of people given that the alternative is blindness (as in my case), but I don't think I agree with them as a preventative for angles that may never close. Careful monitoring and educating patients would be a better alternative, I feel. The more invasive iridectomy probably caused most of my issues.

[KelliShaver]

I had the procedure done a few days ago, after an attack in which the my IOP shot up to 54! It's interesting to see the procedure from the other side of the laser. I did have some pain and I do have a little more glare and light sensitivity now, but I'm not really far enough post-op to know if that's going to be permanent. My visual acuity seems to have been unaffected, thankfully. At 20/180, it's bad enough as it is! I have ROP with monocular vision, so this was quite a frightening ordeal.

[KelliShaver]

I guess you can put me in the less than 1% for which this procedure fails. Since I first posted, I've had multiple repeat failed iridotomies and have since underwent a surgical iridectomy that seems to be doing much better but is currently partially blocked by a blood clot. This, plus Alphagan and Timoptic are working to keep IOP down for now, though.

[Henribert]

This procedure fails in more than 20%! So your are not an exceptional case.

I do not understand why your IOP has to be treated with Alphagan and Timoptic. Normally with narrow angle glaucoma, once the iridectomy is done, you do not have elevated IOP. With an iridotomy this is normal, because the cut out iris debris obstructs the trabecular meshwork.

Do you have open angle glaucoma as well?

How can the iridectomy be blocked by a blood clot? Don't ophthalmologists know how to dissolve it?

[KelliShaver]

I'm off the drops (which were probably more of a precaution than a necessity) now that the clot has gone away. The plan was just to let the clot dissolve on its own as long as the pressure was staying down, because my eye had already been through a lot of trauma, it's the only one I have, and there were other medical problems going on in the eye. I think it was just felt that this was the safest approach since the treatment plan I was on was doing well at that point.

[Henribert]

What is your vision like now? Do you still have pain, glare, light sensitivity and other visual aberrations after the iridotomy?

[KelliShaver]

My visual acuity is the same as it always was (which is, sadly, about 20/100). I do have some more light sensitivity and glare than I used to. This causes some eye strain and tiredness from time to time and I have to take more breaks when reading or working on the computer. I'm waiting on new glasses with anti-glare, polarized lenses which should hopefully help a fair bit. The polarized lenses help a lot outside.

[goopty15]

awe

[crawlerbackhoe]

AMahootchi, how do you know which narrow angles will close? do all narrow angles eventually close and if they do, do they always lead to glaucoma?

[AMahootchi]

Great question. It's a matter of degree of obstruction of the drainage mechanism. There are several rating scales. If the mechanism is occludable then we usually recommend prophylactic treatment.

At the same time, one could not predict when an occludable angle will occlude--just that it is likely or unlikely based on the rating scales.

[AMahootchi]

Are you saying that as a patient who has had the procedure or as an ophthalmologist?

[Henribert]

I am saying that as a patient who had the procedure 10 months ago, and seeing the outcome my doctor didn't do the other eye.

I had much pain during the procedure. The eye was inflamed for 2 months and still hurts occasionally because of a corneal scar. I have had glare and diplopia ever since. The glare can be minimized by wearing sunglasses, but the double vision cannot. I patch my eye, so that the double vision won't make me sick. I am no longer allowed to drive a car, and I lost my job.

[squishy66]

thank you so much for putting this on youtube!

i'm having yag pi for narrow angle glaucoma in a week and i was really nervous about the procedure. this helped alleviate some of my fears.

[seankaty]

wow, Dr.Mahootchi rocks!!!!