Rest assured that all competent surgeons remove as much of the cortex and debris as possible and polish the posterior capsule. It is not possible to remove all the living cells especially in young or middle age people. The rate of clouding or wrinkling bad enough to need surgery has fallen from 95% maybe 15 years ago to about 30% now.
The one article you cite saying 75% cloud over is flat out wrong. NOTE THAT WEB SITE HAS NOT BEEN UPDATED SINCE 2003.
The New York Times has a long and distinguished record of getting things wrong or altering the facts to their way of viewing the world (my opinion) but in this case their factual article is pretty good EXCEPT the statement that the risk of RD is much higher with secondary yag capsulotomy. There are a lot of studies on this. The best indicate that there is little increase risk of RD except in high risk eyes: previous RD, family history of RD, high myopia, history of trauma to eye, vitreous loss at time of original surgery, young patient, history of previous vitreous surgery or vitreo-retinal disease.
Random reports many out there.
One study risk of retinal detachment after cataract surgery. (0.68% overall)
Second study same subject: risk (0.84%)
RD after yag capusology (1.2%)
I do over a hundred yag capsulotomies per year. I do not recall when the last retinal detachment was but it would be over 15 years ago. I do tell patients about the small increase risk of RD. If they have high risk characteristics I send them to a retinal Eye MD to carefully examine the retina, treat any holes/tears/thin areas and give and "OK" to proceed. Then after surgery I have the retina Eye MD check them 7-10 days after the laser and report immediately any dramatic increase of floaters, flashes of light or loss or peripheral vision.
My clinical experience does not indicate that the risk of RD is much higher with yag capsulology than original cataract/IOL surgery.
Hope this helped you.
Thank you very much for your expert and informative comments! The risk of RD after YAG laser should be low for my eye (healthy 61-year young. with myopia only), but dramatic increase of floaters, flashes of light and loss of peripheral vision, seems to be common complaints on this site and other studies. I'd appreciate very much some statistics based on the hundreds of YAG capsulotomies you've done. What's the percentage of your patients or other studies regarding these type of risks? How much vision improvements post YAG capsulotomies, your patients with healthy eye like mine (myopia only) normally got? Thank you so very much again!
If the eye is healthy and the vision is reduced due to cloudy posterior capsule then the visual improvement is close to 100%.
In doing several hundred of these yag capsulotomy per year I believe there has only been one RD and retinal tear that was lasered post Yag in my practice.
Remember this is a PROBLEM forum. People that are happy and pleased with their eyes or their surgery are not on the internet looking for answers to problems or sharing their happy experiences with others.
What a relief! Than you! You just took a load off my mind! Close to 100% visual improvement!!! Can't wait to get my vision back to 20/20 (or close).
Any of your patients with healthy eye had dramatic increase of floaters, flashes of light or loss of peripheral vision?
You're absolutely right! I was overjoyed for seeing 20/20, abeit it only lasted a year, I never thought about sharing my good fortune here!
Thank you for all your gracious help!
Almost everyone has increase of floaters immediately after the procedure. It comes from bits of the posterior capsule cut by the yag laser being pushed into the vitreous. So I tell everyone about this. These bits of capsule usually settle down and for the most part are gone 2-5 days post laser. Flashes are abnormal and if occurs requires a detailed dilated retina exam with view of peripheral retina.
Nothing doctors do to patients will ever be risk free, but of all the procedures ophthalmologist do this is the quickest, pain free, lowest risk (for most everyone except those high RD risk patients I've discussed) and most rewarding for the Eye MD and "happy" for the patient that we do.
If the rest of your eye is healthy and the membrane is quite cloudy the improvement and patient "joy" has been among the most rewarding things I do.
All cataract patients can never thank you enough, for all your informative well written posts, like -- "Consider ALL the Options Before Your Cataract Surgery: Working Through What’s Best For You", there should be a law to require all Eye MDs, to give a copy to all patients prior to cataract surgery, if I'd find an article like yours, with my extensive in-depth research (I reminded my doctor about the placement of the incision to correct astigmatism, after he said IOL refunds will be made at pre-op, no IOL available for my too slight astigmatism ..), I'd not to have my non-symptomatic cataract surgery done so early.
Only 19 months, my secondary cataract affected my vision ten times or more worse than original cataract, and yag laser won't prevent the openning it created to grow back, I fear the repeat of yag laser for the rest of my life.
I've sent a link of your article to my brother-in-law, who's in need of a cataract surgery in Portland OR, and wish your article can reach all cataract patients worldwide!