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AG laser peripheral Iridotomy

The young doctor wants to do both eyes at the same time.  

No symptoms. 52 year old female 20/20 & 20/30 vision

Eye exam Jan 2014 measured eye pressure to be 15 and 23. Feb 2014 it was 14 in both eyes. Plan to have a Yag-Pi in April. Seeking second opinion advice since such a dramatic drop in eye pressure is unusual. Am I'm being over-diagnosed with preventive operation? I'm getting really scared that I won't be able to do photography anymore. Is this is an unnecessary procedure?

I have NO SYMPTOMS and planning to get a Yag-Pi - can't I just use eye drops?

Closed angle. Should cataract surgery be the better initial procedure to deepen the chamber angle and to clear the visual axis permanently?

Since Yag-pi is likely to increase the frequency of having cataracts and since the Doctor did not discuss Exfoliation syndrome as possible cause for an elevated IOP - I am worried that this is not the right thing to do.

I do have dead cones in the eye that was at 23 in Jan2014 from ten years ago when I fell asleep with my arm laying on my eye. A previous eye doctor told me that because of the odd shape of the dead area

From what I googled, "... even if the opening was made, the iridotomy can be a complete failure if you don't have pupillary block but e. g. plateau iris. Many ophthalmologists don't know the difference, so many unnecessary iridotomies are done with the resulting severe adverse effects of glare, white lines, double vision, permanent inflammation and permanent elevated high pressure.


There are many people who have a glaucoma attack after the iridotomy, and this means the iridotomy was a failure. It happens when the cut-out iris debris obstructs the trabecular meshwork.
I Iridotomies often lead to uveitis. It's a surgery that should simply be avoided, because it has so many side effects and very seldom prevents a glaucoma attack. It more often provokes it.
5 Responses
233488 tn?1310696703
MEDICAL PROFESSIONAL
Use the search feature an archives and read about angle closure glaucoma and laser peripheral iridectomy  LPI.  

The IOP in a normal eye can vary 5-8 points in a 25 hr period. An eye with a shape to have angle closure glaucoma but not actually had it occur yet has normal or borderline IOP    Also an eye like yours can get acute angle closure, subacute angle closure or intermittent angle closure.

ACG is not treated with drops anymore.  You need a second or even third opinion with a eye MD ophthalmologist, if possible one that specializes in glaucoma   Complications are relatively unusual.  I often treat both eyes at the same time especially if the patient has transportation problems, or if they have lots of health problems or are very weak due to age/illness.

In your case and others where the person is apprehensive above normal I do one eye at a time usually a week or two apart. Plateau iris is relatively uncommon shape for the eye and still needs a LPI but later also iridiplasty

You are flat out wrong when you say LPI has 'so many side effect' and wrong on "very seldom prevents a glaucoma attack" and  it does not provoke acute angle attacks. That who paragraph is wrong you wrote.

Get your second and third opinions.  You can find eye MDs near you at www.geteyesmart.org

JCH MD
Avatar universal
Thank you so much for writing.

The "side effect' comment was from off a blog and it freaked me out.

I am going to a second doctor in Tucson - she has a Pascal.   The original doctor in Sierra Vista used a Goldman.

I noticed I was wrong it was not a 23 but a 22 when reading a copy of my records. From googling:

10 to 21 mmHg is normal range.

If that is so then I I'm thinking should just do the one eye if repeated IOP is high but not the other eye that stays at a even 14.


Again. Thank you very much for writing back.
233488 tn?1310696703
MEDICAL PROFESSIONAL
No you're still missing the point. The laser is done because the iris could push against the angle and cause the eye to have an attack. So I've done several hundred LIP. Only a few had an attack of ACG or high IOP. Think of it this way. If you look in your back yard and see a very big limb hanging out of a tree and threatening to fall on your back porch you don't wait for it to fall you call a tree service to remove the tree limb. Same deal.

This is a good website or more information:
http://www.glaucoma.org/glaucoma/types-of-glaucoma.php

The type of laser is not a big deal. We use to use hot lasers e.g. argon but now we use cold "yag nanosecond, frequency doubled lasers".  In many instances the LPI can be done in less than a minute.

JCH MD
Avatar universal
Thanks. I've decided to go ahead on 4/7 LPI. Doc called me and said that IOP doesn't have to be high and that flashing lights could trigger an acute attack. So yeah. going ahead.

Thank you for your advice. I took it. :):):):):):):):):)
233488 tn?1310696703
MEDICAL PROFESSIONAL
Generally the laser will be over before you know it.
JCH MD
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