Is it worthwhile to have a laser to repair a tiny tear in the retinal

[taurus1203]

Dr Oyakawa,
I saw you are answering questions.
I had my cataract surgery for my LFET eye 2 months ago. It recovered quite well. Vision  of my left eye is 20/25. Light sensitivity also reduced. The eye strain reduced a bit but I still feel the strain.
I went to have a follow up visit with a retinal specialist today. He told me my left eye is doing fine.
But he found a very tiny tear in my RIGHT eye, 6 o clock position and the size is less than 1 mm. I asked him I had a few examinations in the last few months, why the other doctors didn't discover. He told me that this tear is very small and he only discovered it when exerting pressure at the edge of the lower part of the eye.

He recommends me to do a laser to fix it. His reason is that the tear is small, the number spots of laser will be small as well and this will have less impact to my vision. If I wait until the tear to get bigger, I need to have more laser spot.

I have a few questions like to ask your advice ?
- How likely this spot will get bigger or even lead to detachment ?
- How many spots do I need for such a small holes/tears ?
- How effective the laser can stop the tears be getting bigger ? I remember you mentioned the laser is not effective for some types of tears
- What is the side effect of the laser (e.g dry eye, light sensitivity I am fear of) ? How does it compare to a LASIK ?
- Can I go to work the day after the laser ?

Thanks a lot

[taurus1203]

Dr Oyakawa,
I am glad that you still remember my situation. My surgeon and I eventually chose the B&L SofPort Violet shield. He checked my aberration is +0.05 and the aberration free design of AOV should fit me the most as it also blocks some high energy light. The other reason is I am extremely concern about the possible glare and the AOV has a lower refractive index.

He found my astigmatism around -1.4D. He put one extra small incision and my astigmatism is around -0.5D. He suggested me to set the myopia to be -0.5D but I prefer to be -1.0D to match my right eye better. It turns out -0.75D.
My vision is not bad and I can read 3 to 4 letters of 20/20. My left eye can also read books without glasses. Light sensitivity also improved a lot. But the eye strain only improved a little bit. The cataract surgery should be classified as successful. The only problem is that in the dark situation (when the pupil is around 6mm or bigger), the side light at some angle hit the edge of the IOL and causes a lot of glare. It was very serious at the first 2 weeks. It gets better after a month and the surgeon explain my brain adapted to the glare and he predicts it will get even better when more cells accumulate around the edge.


Regarding my right eye, I don’t have any symptom at this moment and the retinal specialist also thinks that the tear is inferior. I forgot to ask him if it is a horseshoe or round hole
The only concern is that if it gets bigger, I may need to put more laser spots and it will cause more damage. Isn’t it true? Does the number laser spot depends on the size of the hole or tears? How many spots do you put for a tiny tear (much small than 1 mm) ?

Thanks in advance

[Ray T Oyakawa, MD]

If this is a tear (horseshoe tear) and looks new (no pigmentation around the tear), it should be treated.  If it is a round hole, I would not treat it.  The success at preventing a retinal detachment with an acute horseshoe tears is 95% with a 5% complication rate (retinal detachment and epiretinal membrane).   However, you had no symptoms in the right eye- I would follow and and treat if symptoms occur.  An inferior acute horseshoe tear has less of a chance of leading to a retinal detachment compared to a superior one.  A  laser to a retinal tear does not cause problems with dry eyes.  I would not use the eyes (prolonged reading) for about a week.  It takes about 9 to 14 days before the laser scars down the the tear.

What IOL did you finally decide on for the left eye?


Dr. O.