Glaucoma can be a concerning diagnosis, especially since it can lead to blindness. While there are plenty of ways to treat it, laser surgery might feel overwhelming.
Fortunately, laser peripheral iridotomy is a quick, outpatient procedure that reduces the risk of vision loss from angle-closure due to pupillary block, though additional treatment is sometimes needed.
If you have narrow-angle glaucoma, this treatment could protect your eyesight before serious problems occur. In this article, we’ll go over everything you need to know about iridotomy to keep your mind at ease.
What Is Laser Peripheral Iridotomy?
Laser peripheral iridotomy (LPI) is a surgical procedure that restores the flow of aqueous humor for people with angle-closure glaucoma. Aqueous humor is the clear fluid in your eye that gives it shape and nutrients.
Iridotomy is a quick, safe, and less invasive method for preventing angle-closure glaucoma. The procedure itself is straightforward and takes about 10 minutes per eye.
How Does Laser Iridotomy Work?
The iridotomy procedure uses laser energy to create a small hole in the edge of the iris (colored part of the eye). This allows eye fluid to flow regularly while reducing intraocular pressure.
The procedure uses a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. While there is no cure for glaucoma, laser iridotomy is effective in:
- Lowering eye pressure
- Preventing further optic nerve damage
- Preventing vision loss and blindness
What To Do Before Your Procedure
Preparation for laser iridotomy is simple and doesn’t require fasting or sedation. Before the procedure, your doctor will examine the drainage angle with gonioscopy (the standard test); anterior-segment OCT may be used as an adjunct.
They may apply pilocarpine drops to shrink your pupil, and apraclonidine drops will prevent eye pressure spikes. Be sure to wear comfortable clothing, avoid makeup, and bring dark sunglasses to wear afterward.
Be sure to eat beforehand. Lastly, have someone to drive you home after the procedure. It’s not safe to drive after an iridotomy.
What to Expect During Treatment
You’ll sit comfortably at the slit-lamp microscope while your doctor gently stabilizes your eye with a contact lens. From there, they’ll create a small hole in the iris with a laser.
You can expect to feel a brief sensation of pressure or a small pinprick, accompanied by a flash of light. The procedure is comfortable, and most patients feel very little pain.
No stitches or bandages are required, making the experience simpler than you might expect. In just a few minutes, your risk of severe vision problems significantly decreases.
Recovery and Aftercare
About 30 minutes after the procedure, the eye doctor will recheck your intraocular pressure. After surgery, make sure to schedule a follow-up appointment for a week later to check the drainage angle.
Be sure to use the prescribed anti-inflammatory eye drops daily for 4 to 7 days. Avoid strenuous exercise or heavy lifting for a few days, but most people can return to normal daily activities within 24 hours.
During this time, you may experience blurry vision, which should clear the next day. You may also experience mild discomfort and soreness for a few days.
What Are the Benefits of Laser Iridotomy?
Angle-closure glaucoma happens rapidly and can quickly damage your optic nerve, threatening your vision. Laser iridotomy prevents this severe outcome with impressive reliability.
Other benefits include:
- High success rates
- Rapid recovery
- Quick and painless procedure
How Much Does Laser Iridotomy Cost?
Laser iridotomy is generally covered by insurance when medically necessary. Without insurance, the average cost of laser iridotomy is between $1,000 and $2,000 per eye.
There are other ways to pay for a laser iridotomy if you don’t have insurance. This includes Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and CareCredit.
What are the Side Effects of Laser Iridotomy?
Laser peripheral iridotomy is safe, and serious complications are rare. However, like every procedure, it can lead to some side effects, including:
- Mild soreness
- Blurred vision
- Halos around lights
- Eye redness or irritation
- Temporary inflammation
Although it’s rare, there are some complications you should be aware of regarding this procedure. Some of the more serious risks include elevated eye pressure, bleeding in the eye, corneal damage, and cataract formation.
Notify your ophthalmologist promptly if side effects seem severe or persist beyond a few days.
When to Call Your Doctor
Contact your doctor immediately if you experience any of the following symptoms after an iridotomy:
- Severe or worsening eye pain
- Persistent or increased halos or glare around lights
- Sudden decrease or loss of vision
- Significant redness, swelling, or discharge from the eye
Who is a Candidate for Laser Iridotomy?
Laser iridotomy procedures are for those with anatomically narrow angles (primary angle-closure). People with this feature have a narrow drainage angle that increases the risk of blockage in the eye's drainage system.
The procedure can also be performed following an acute angle-closure attack or as a preventative measure for narrow angles. Laser iridotomy is also recommended for people with:
- Acute angle-closure glaucoma
- Chronic angle-closure glaucoma
- Secondary angle-closure glaucoma
- Narrow drainage angle with normal eye pressure
Who Shouldn’t Receive Laser Iridotomy?
Laser iridotomy has some contraindications. The procedure is not for the following conditions:
- Primary open-angle glaucoma
- Secondary glaucoma (increased eye pressure not caused by a closed drainage angle)
- Ocular media opacities (such as scarring or swelling of the cornea)
- Uveitis (eye inflammation)
- Problems tolerating laser eye surgery
Alternative Treatments For Laser Iridotomy
In addition to laser iridotomy, there are other ways to treat closed-angle glaucoma, including:
- Medicated glaucoma drops to reduce intraocular pressure
- Trabeculectomy to create a small flap to open the drainage pathway
- A glaucoma drainage device, which surgically implants a tube to drain eye fluid
- Cyclophotocoagulation laser treatment that targets the “inflow” of eye fluid
- Cataract surgery, which removes the clear lens of the eye
Recent research has found that cataract surgery, a procedure that removes the eye’s lens, has been more clinically effective at lowering IOP for some people with narrow-angle glaucoma than laser peripheral iridotomy.
What’s the Outlook for Laser Iridotomy?
Laser iridotomy is remarkably successful, significantly reducing your risk of acute angle-closure glaucoma attacks. Clinical trials consistently show success rates over 90% in preventing severe eye-pressure episodes.
While laser iridotomy effectively addresses pupillary block, some patients eventually require additional treatment. For example, a cataract extraction might be necessary to address lens-related crowding.
Further glaucoma management might also be required if optic nerve damage was present before iridotomy.
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