YAG laser capsulotomy is a non-invasive procedure used to correct the blurring of vision which is a relatively common side-effect of cataract surgery.
So why does this happen? During cataract surgery, a replacement intraocular lens is implanted into the eye, and the patient’s own natural lens (the one with the cataract in it) is removed. However, the lens membrane (capsule) is left in place, and the new artificial lens is placed inside it. Leaving the capsule in place helps make vision more stable after the surgery and it also makes surgical complications less likely.
Unfortunately, in some cases the posterior (back) portion of the lens capsule becomes thicker and cloudy over time, causing blurring of vision – this is called a called posterior capsule opacification (pco). A YAG posterior capsulotomy is used to correct this problem by creating an opening in the cloudy capsule and restoring clarity of vision. After the procedure, vision is returned to how it was immediately after the initial cataract surgery.
You might want to consider this procedure if you are experiencing blurring of your vision, following cataract or lens replacement surgery. This vision deterioration can occur a few months after the operation, but most often happens about 2 years afterwards.
YAG laser capsulotomy typically costs around £550 for one eye, or around £825 if both eyes are to be treated.
YAG vitreolysis, a different YAG laser procedure used to treat floaters (black spots or lines which move around your field of vision) costs around £1,250 per eye.
The good news is that YAG laser treatment is carried out as an out-patient procedure, so there is no overnight stay involved. The main thing to consider in advance is that you shouldn’t drive to or from the clinic on the day of the treatment, so you will need to arrange alternative transport.
When you arrive at your clinic, you will have your eyes checked. Local anaesthetic drops will be applied to numb your eye (or eyes, if you are having both treated). This means that you won’t feel any pain when you have the treatment. You may also have drops applied to widen your pupil.
Before the treatment begins, you will have a special contact lens placed on your eye to help focus the laser, and to keep your eyelids open. This should fit comfortably, thanks to the numbing drops which will have been applied.
You’ll then be asked to place your chin on the frame of a laser machine, and you will see a bright light, which allows your surgeon to see the inside of your eye. A laser is then applied to your eye, making several small holes in your lens capsule which join up to make an opening. But don’t worry: this is painless, thanks to the numbing local anaesthetic drops.
The opening which is created in the cloudy lens capsule creates a clear pathway for light to pass through. This restores vision, removing the blurring that the cloudy capsule had been causing before the procedure.
The treatment only takes around 5 minutes, but your surgeon will want to examine your eyes again after 20 minutes. They will also check the pressure in your eyes, before letting you leave the clinic and return home.
The results of the laser surgery are almost immediate. But if you have had drops applied to widen your pupil, this can make your vision a little blurry immediately afterwards. This is one reason why you won’t be able to drive home from your appointment. The effects of drops used to widen your pupil can take around 8 hours to wear off.
You’ll be advised to rest when you get home, and perhaps get some sleep. Your vision is likely to be much clearer when you wake up, as the effects of the drops will probably have worn off by then.
Follow-up appointments will be arranged, and you should continue to have yearly check-ups to keep track of the health of your eyes.
The treatment can cause some discomfort for a short while afterwards. The bright light used during the procedure also causes dazzling, and this may affect your vision for around 5-10 minutes after the procedure. You could also see some ‘floaters’ – black spots or lines which move around in your field of vision – but these should improve over time.
YAG capsulotomy is an effective treatment, which is only unsuccessful in less than 1% of cases. It is also safe but, as with any medical procedure, there are some risks.
The most common risk is a rise in eye pressure, known as glaucoma. Your surgeon will check for this after your treatment, and if it does occur you will be given treatment. Treatment for high pressure in the eye can be eye drops, tablets or a combination of the two.
A rise in eye pressure is often transient, which means that it settles down by itself after a short while, and so the treatment will be short lived too. According to the NHS, transient rises in eye pressure happen in 7.5% of YAG capsulotomy treatments. Sometimes, a long-term rise in eye pressure occurs, but only in less than 1% of cases.
Other serious risks are of retinal detachment, swelling of part or the retina (the macula), or lens displacement. But these are unlikely, only occurring in less than 1% of cases. Rarely, an inflammation of the eye (known as uveitis) occurs and very rarely, patients can experience a reduction in their quality of vision.
YAG can be covered by health insurance, so you should check the details of your policy with your insurer. You may also wish to discuss with your preferred clinic, as they could work directly with your insurer to arrange payment for your treatment.
YAG surgery should restore your vision back to how it was at immediately after your initial cataract or lens replacement surgery. It works to remove blurring of vision which can occur after cataract surgery, if the posterior (back) of the lens capsule has become cloudy. If you had good, clear vision after your cataract surgery, but your vision has become cloudy since then, YAG surgery should restore that clarity of vision.
YAG surgery is available on the NHS, for people whose vision and lifestyle are seriously affected by clouding of the lens capsule. Criteria for approving the surgery on the NHS include vision problems affecting your work or lifestyle, glare caused by bright lights, double vision, a significant difference in vision between your two eyes, or another vision-threatening eye disease.
The effects of the surgery are almost immediate, but your vision may be blurry for a short while afterwards, especially if you had drops applied to widen your pupil before the procedure. These drops can cause blurring of your vision, with the effects taking up to 8 hours to wear off. After that though, your vision should be restored back to how it was immediately after your initial cataract surgery.
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