Laser Surgery & the Eye
Laser surgery is performed as an outpatient procedure either at the office or in the hospital setting. There are many different types of laser procedures that may be performed on the eye, including retina laser, glaucoma laser and laser after cataract surgery. Ask your doctor which procedure is relevant to your condition.
Laser panretinal photocoagulation (PRP) is a treatment that can reduce the risk of severe vision loss by 50% in patients with proliferative diabetic retinopathy, an advanced form of diabetes that affects the eye. PRP is performed over 3 to 4 sessions. Laser is applied to the retina in order to stabilize vision and decrease the risk of vision-threatening complications from occurring. There is discomfort with each treatment which can persist for a few hours to days. Tylenol can be used for headache following treatment. The vision may be blurry for several minutes to hours after each treatment.
Focal or grid macular photocoagulation is performed in the outpatient clinic. It is a light, painless, laser treatment applied to the macula, the center of the retina. This procedure helps reduce the risk of vision loss in patients with swelling of the macula (macular edema) due to a variety of causes. The vision may be blurry for several minutes to hours after each treatment. Some patients may require repeat laser treatments.
Laser retinopexy is performed on patients with retinal tears. Laser is applied to the retina surrounding the tear and acts to tightly “spot-weld” the retina around the tear. Laser treatment is usually successful in sealing the retinal tear and preventing a retinal detachment. Occasionally, additional treatment may be required, and rarely, a retinal detachment may develop despite treatment. The laser is very bright and there is some discomfort involved. Most patients have blurry vision or discomfort for several minutes to hours after the treatment. Patients usually feel back to normal by the following day. This treatment will not remove any floaters. Floaters usually dissipate or improve within weeks to months. Sometimes patients may continue to have floaters indefinitely. In patients with retinal tears, there is a 1-2% risk of scar tissue or wrinkling developing in the center of the retina called the macula (macular pucker). Laser treatment may increase this risk by 1%. This condition may result in distortion or blurring of vision over several months to years. Surgery may be required if it becomes severe.
Laser peripheral iridotomy is performed on patients with narrow angles or angle closure glaucoma. The angle is the area between the cornea (the front window of the eye) and the iris (the coloured part of the eye). This is the area where fluid drains out of the eye. If this angle becomes blocked, the pressure in the eye can rise precipitously. Patients with a sudden rise in eye pressure, called angle-closure glaucoma, can develop a red, severely painful eye associated with headache, nausea and vomiting. Furthermore, the risk of vision loss and blindness is high. When assessing the eye, the ophthalmologist can determine which patients are at risk for an attack of angle-closure glaucoma. If you are felt to be at risk, your doctor may recommend this procedure. Therefore, this laser is often performed as a preventative procedure, whereby, a small hole is lasered in the iris which cannot be seen with the naked eye. There is usually no pain associated with this laser. Risks of this procedure are minimal and include: inflammation in the eye, transient bleeding within the eye, transiently elevated eye pressure and glare. These risks are will often abate in short time with or without eye drops. This procedure usually only takes 1 session to complete.
Selective laser trabeculoplasty (SLT) is performed on certain patients with glaucoma to help control the eye pressure. In this procedure, a gentle, painless laser is applied to the angle of the eye. The angle is the area between the cornea (the front window of the eye) and the iris (the coloured part of the eye). This is the area where fluid drains out of the eye. This procedure helps lower the eye pressure in patients with glaucoma. It is generally about 80% effective in patients deemed amenable to SLT. It can be performed as primary therapy for some glaucoma patients or as adjunctive therapy to pressure-lowering eye drops. There are minimal risks to this procedure including transient inflammation in the eye nd transient elevation of eye pressure. These risks will often abate in short time with or without eye drops. This procedure usually only takes 1 session to complete per treatment although further laser may be required.
Laser Performed after Cataract Surgery
Laser posterior capsulotomy is performed on patients who develop posterior capsular opacification which can occur in a minority of patients at some point after cataract surgery. After the cataract has been removed during cataract surgery, an artificial lens implant is placed into the capsular bag, a very thin membrane sits behind the iris (the coloured part of the eye). In a minority of patients, this membrane can become hazy. This is called posterior capsular opacification. Haziness of this membrane can lead to blurring of vision. When this occurs, a gentle, painless laser can be applied to this membrane which opens it up and removes the haziness. Patients will often see better by the following day. Some patients will complain of a few floaters after laser, however, these generally disappear with time. Risks to this procedure are minimal but include a 1/200 risk of retinal tears or retinal detachment. Your doctor will assess your eye about 2 months after laser. This procedure only takes 1 session to complete.
Some General Facts Regarding Laser
On the Morning of Laser
- There are no restrictions in activity prior to most laser procedures.
- Take all your usual medications on the morning of your laser procedure.
- If you take blood pressure pills, or blood thinners (Aspirin or Coumadin), continue as usual.
- If you have diabetes, continue to take your diabetes pills or insulin on the morning of surgery.
Immediately Prior to Laser
- All patients will receive topical anesthetic drops.
- Your doctor will instill certain medical drops in the eye prior to laser. Some may be to dilate the pupil and some may be to constrict the pupil, depending on the type of laser being performed.
Instructions after Laser
- The vision is usually blurry immediately after laser.
- Some patients may see some floaters, depending on the type of laser performed.
- Some patients may have discomfort. Tylenol is usually sufficient for any pain.
- Some patients will be given a prescription for eye drops after laser, depending on the type of laser being performed. If so, your doctor will discuss what eye drops may be necessary and how long they need to be taken.
Caring for Your Eye after Laser
- There are generally no restrictions after laser.
- Sunglasses are generally recommend, although not necessary, for the first day after laser while outdoors.
- Activities: There are usually no restrictions.
- Bathing: There are usually no restrictions.
Glasses: The lasers described above will not change your need for glasses. If you wore glasses prior to laser, you will require them after. If you never wore glasses prior to laser, you will not require them after.
If you develop severe pain, redness, or decreased vision any time after laser,
notify your surgeon’s office immediately. On a weekend or after-hours, go to
Your nearest Hospital Emergency Department.