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Laser peripheral iridotomy (Photo)

laser iridotomy for glaucoma
This photograph shows the view your ophthalmologist has during a laser iridomy. A LPI (laser peripheral iridotomy) is a procedure where a laser is used to blast a hole through the iris. This hole allows the fluid in the eye to drain properly and can be of great help in cases of acute glaucoma, and to keep those prone to acute glaucoma from developing it.

This picture may be hard to understand out of context … basically, a lens is being held up to the eye in order to view the iris (colored part of the eye) in high magnification. The laser hole is very small, and typically is performed in the top part of the eye (under the eyelid) so that it can’t be seen. Even then, the resulting hole is so small that it’s almost impossible to see without a microscope. To get a better idea how this procedure is done, watch our laser iridotomy video from which this snapshot was captured.



5 Comments



Hi,
this video looks great, and you get the impression it is a simple, straightforward procedure that protects your eye.
But it isn’t as simple as that. After the iridotomy pressure can rise considerably. So if you haven’t had a glaucoma attack, you will often get it after the iridotomy! And then surgery is needed!
More than 80% of the patients have double vision after the iridotomy for the rest of their life, and they will see a very glaring horizontal line in their eyes. After iridotomy 90% of the patients will never ever be able to see properly.
But the IOP is lowered, and that is all the doctors are concerned about.
I had an iridotomy in my right eye, and I have regretted it ever since.
Kitty.



Comment by Kitty Haddo — November 13, 2007



Kitty,
I am sorry to hear about your experiences with your iridotomy. You bring up several points that I should address:

1. It is NOT true that 80% of people have double vision, nor 90% of people have poor vision after this procedure. The iris hole created is very small (often difficult to see using the microscope). Also, this drainage pathway is created far superiorly in the iris, up under the eyelid, such that even if this “second pupil” ends up larger than expected (a very unlikely event), the eyelid covers it and thus avoids monocular double vision.

I’ve never seen anyone complain of double vision or decreased vision after laser iridotomy, but it is possible and there are certainly many people in the online community who have experienced difficulty.

2. Now, the eye pressure CAN rise temporarily after a laser procedure. After all, we are kicking up some pigment and this tends to “clog the drain” afterwards. It’s important to check the eye-pressure about 30 minutes afterwards to ensure the IOP hasn’t gone too high.

Overall, however, a laser iridotomy is about the most innocuous glaucoma procedure that can be performed … the eye is not entered with knives and thus there is no risk of dangerous infection. The whole point of using the laser is an attempt to avoid placing people at risk with surgery.

Unfortunately, as you can attest, there are risks with any procedure, no matter how simple … in this case, one possibility is iris bleeding with resulting IOP increase.

I don’t know the circumstances behind your own iridotomy (there are many causes of glaucoma, and many ways to perform an iridotomy) but I’ve often found that ‘good things happen to good people.’ I can assure you, though, that this procedure has helped many more people than it has harmed.

Best of luck to you and your ocular health, and I thank you for sharing your own experiences on this website … your account is educational for everyone.



Comment by admin — November 13, 2007



Hi,

Thank you for your message.
My IOP must have risen considerably after the iridotomy, because I had much pain and blurred vision. When the eye was examined again 22 hours after the procedure, the IOP was down to 23, but it must have been extremely high in the meantime.

Just before the iridotomy the optic nerve had been examined by HRT and the visual field by FDT, everything was fine!!!
When a month after the iridotomy these exams were done again (I insisted on that) it was found out that my optic nerve was severely damaged and that I had lost 70% of my visual field.
This was due to the glaucoma attack I had had several hours after the iridotomy, without my (and the docto’s) knowing it.

If I don’t squint my eyes I have severe double vision and see strange flashes of light. This is such a common effect of iridotomy that special iridotomy lens are being produced by several companies. I will discuss this with my ophthamologist (of course I went to another doctor than the one who did the surgery).

Did you know that iridotomy, or, to be more precise, the keratopathy as a long term complication of iridotomy, is one of the main reasons for blindness in Japan?

Just go to the ‘Prevent Blindness America’ glaucoma Web forum and read what people write about iridotomy.

It may be that this procedure has helped more people than it has harmed. But it did and still does harm to thousands and thousands of patients, without doctors taking any notice, as they are so sure this is, as you put it, an ‘innocuous’ procedure.

An iridotomy can cause retinal detachment by the high energy of the shock waves, it can cause uveitis and severe innerocular bleeding, and in many cases it leads to poorer vision. This was found out in a US study the results of which were published in 2005. It was the first study ever done on iridotomy, and it certainly was an eye opener for doctors.

Do you monitor your patients, on whom you have performed an iridotomy, closely during the following years? Do you ask them how the procedure has affected their vision?
Please, do so.

Iridotomy may be a good thing to do in order to break a glaucoma attack, but it should never, never be done as a preventive measure.
We don’t know how many glaucoma attacks were prevented by iridotomy, perhaps none at all.
But we do know that severe harm was done to thousands of patients.

Thank you for reading this long message. I feel obliged to share my experience so that doctors become more aware of the risks this procedure entails.

Kitty



Comment by Kitty Haddo — December 9, 2007



Hi,
this video doesn’t tell the truth and gives patients a wrong impression.
Iridotomy is a painful procedure and a shocking experience.
I had an iridotomy 11 months ago.
My doctor told me there would be no pain associated with it and I would hardly feel any discomfort. So I wasn’t prepared for what it was really like.
The laser light created such an enormous glare that I had severe pain even before the first ‘shot’ came. I had the impression that somebody was literally shooting through my eye, a frightful experience.
There was great pain, hard to describe, as if extremely hot needles were injected into your eye with great force, and there was a burning sensation as if someone was pressing a hot cigarette through your eye. The pain was not only in the iris, but went right through the eye.
I got 38 shots, and the pain was so strong that I bit onto my tongue until it was bleeding. I didn’t even notice I was doing that.
I had a severe inflammation afterwards which lasted for more than 5 months, and the eye was sore and painful for about 8 weeks.
I still have blurred vision, and I lost 4 Snellen lines. Before the surgery my vision was 20/20, now it is 3/20.
My doctor only said:’You’ve still your other eye to see with.’
The iridotomy was a preventive measure. It may have prevented a glaucoma attack, but it surely destroyed my vision.

I have created a support group for people suffering from the consequences of iridotomy, and our group has already more than 200 members.
Kristine



Comment by Kristine O'Leary — December 24, 2007



Ms. O’Leary,
My first impulse was to delete your post, as despite my earlier reply to Ms. Haddo, this is not a forum for discussing the dangers of iridotomy. However, I’m leaving your post up (but shutting down further discussion on this page) because you DID spend valuable time writing your experiences and I do appreciate this.

This page (and the linked video) is meant to be an educational movie geared toward the beginning eye doctors on performing a laser iridotomy … a skill that unfortunately we have to learn on our first patient (there are no good animal models or computer simulations for this kind of thing). A video like this is useful for the new doctor, and I wish I had seen a video like this before performing my first iridotomy.

This video and website is also NOT meant to be a promotion website. We are not selling the idea that people should be getting laser iridotomies willy nilly for “preventive medicine.”

These qualifiers out of the way: I stand by my prior post. Laser iridotomy saves many more eyes than it harms. So much so, that it has become standard of care in most countries because the complication rate with a laser is so much lower than surgical iridotomy in the operating room.

Sadly, as you can attest, there are complications, and I can’t knowledgably (or legally or ethically) comment on your own circumstances. Your comments are a reminder to us that, no matter how seemingly “innocuous” a procedure is, there ARE consequences.

Another medical example of “consequence” that is brought to my mind, that might be comparable to this laser procedure, is the placement of an IV line into the arm. In the hospital, IV access is crucial for giving fluids, nutrition, medication, and monitoring, saving millions of lives every year. However, an IV line can also cause an infection, sepsis, and even lead to death. Yet, we still place IV lines all the time and don’t spend lengthy amounts of time going over these dangers … the risks are “statistically” low, and if you’re getting an IV placed, you must really need it!

A procedure like an iridotomy is similar … it saves many, many eyes from acute glaucoma, but every once in a while it makes things worse. And if this happens to your own eye, you never forget it.

There are many things we CAN do in medicine, the trick is deciding if we SHOULD do them. It is our responsibility as physicians to properly inform and educate people about the risks of doing (and not doing) any procedure so people can make their own informed decision upon their healthcare.

In summary, thank you for posting your experiences and troubles after your iridotomy. I am pleased to hear about your support group, as there needs to be a group like this. I would love to have the address for referring any of my patients to if they ever have any complications from this otherwise vision-saving procedure.



Comment by admin — December 25, 2007


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