Eye Treatments & Procedures
What is Laser Iridotomy?
Laser Iridotomy is the prophylaxis treatment for narrow angles and treatment for acute closure glaucoma.
Who is a Candidate for Laser Iridotomy
Patients with narrow angle glaucoma and acute angle glaucoma are candidates for laser iridotomy.
What are narrow angle and acute angle glaucoma?
There is an angle formed between the iris and posterior cornea. When this angle is narrow, this is referred to as narrow angle glaucoma. With narrow angle glaucoma, the iris is appositional against the trabecular meshwork (TM), which is the drainage system of the eye, usually for 180 degrees.
Patients with narrow angle glaucoma are at risk for acute angle closure glaucoma. Acute angle closure occurs when there is sudden angle closure (usually from pupillary block) and the iris is covering the trabecular meshwork (TM).
After angle closure, there is a rapid rise in eye pressure which is a medical emergency!
What are the Symptoms of Acute Angle Closure Glaucoma?
With acute angle closure glaucoma, patients experience acute/sudden
- eye pain,
- red eye,
- headaches (usually one-sided),
- nausea and/or vomiting,
- decreased vision, loss of vision, decreased vision, blurred vision, photophobia (light sensitivity), tenders (ocular).
Narrow angle patients are at risk of pupillary block and acute angle closure patients suffered pupillary block. Pupillary block occurs when your iris is stuck against the anterior lens at the pupil border in your eye. This blocks the natural pathway and drainage of aqueous humor (intraocular fluid).
Pupillary block can lead to further narrow angling and appositional closure of the iris against the Trabecular meshwork (TM) leading to extremely high eye pressures which is a medical emergency.
Laser iridotomy creates a hole in the peripheral iris, which allows an alternate route for aqueous humor therefore bypassing the pupil. When aqueous is able to enter the anterior chamber the iris move back to its natural position (not against the TM) and aqueous can drain out of the eye.
Laser iridotomy is an outpatient procedure that can be performed in the office.
Laser Trabeculoplasty (LTP) is a outpatient office procedure for patients with open angle glaucoma. It serves as a primary (first-line) therapy or adjunctive therapy (used with topical glaucoma medication, eye drops).
LTP can lower eye pressure (IOP) up to 30%. The effect of LTP is temporary (lasts month to years) and not permeant (not curative) therefore patients need to follow up with their providers for future treatment options.
LTP has the potential to last 3 to 5 years for some patients but has decreased efficiency after each passing year after initial treatment.
The laser targets the pigmented drainage system of the eye, the trabecular meshwork (TM). The laser treatment is usually performed with argon, diode, double-frequency neodymium: yttrium-aluminum-garnet (Nd:YAG).
This laser procedure is usually recommend if patients cannot tolerate some eye drops, never used topical medication, inconsistent use of topical medication, or are on maximum topical treatment for glaucoma.