The Ins and Outs Concerning YAG Laser Eye Surgery

Interestingly, many eye health professionals liken cataracts to candy – and indeed, there is some validity to this. Much like an M&M, a cataract has an outer coating (known as a capsule) and an inner nucleus (akin to the chocolate in a M&M). When an eye surgeon performs cataract procedures, a circular opening in the front-facing capsule of the lens is made, and from there the inner nucleus is removed. The remaining capsular envelope supports a new artificial lens, which is typically injected into the capsule’s opening. With the passage of time, the capsule shrinks to wrap around the new lens – much like cling film or shrink wrap.

Because the capsule contains live cells, some capsules develop a layer of new cells that form a “frosting” on the back surface of the lens, referred to as posterior capsular opacification (or PCO) or “after-cataract.” Occurring in up to 10-percent of patients following lens/cataract surgery, this developed frosted layer is much like the frosting on a window, which can blur the view through the glass; in the case of our eyes, vision is blurred through the new lens. PCO can occur at any time after surgery, including a few weeks to even months later, and in some cases an adherent plaque may be present on the capsule, in response to which surgeons may prefer to leave it rather than risk tearing the capsule.

In cases such as these, early treatment to clear the frosting may be necessary, and that’s where YAG laser surgery comes into play.

The YAG laser technique is an approach used to clear the frosting from the back surface of an intraocular lens, and to this day, remains a tactic that is both painless and completed from outside the eye in a few minutes. During YAG laser eye surgery, eye health professionals may use a magnifying contact lens to aid with YAG laser aiming at the layer of the frosting. During treatment, patients normally experience flashes of light and clicking sounds, but you can rest assured knowing this is normal.

Before YAG laser treatments can be administered, the pupil needs to be dilated to allow a clear view of the lens surface, and after treatment, a doctor will prescribe a short course of anti-inflammatory and pressure drops. Most patients experience an improvement in clarity and vision within a day. YAG laser treatments typically only required once because the capsule does not regrow after it is vaporized by the procedure.

So let’s recap for a moment; YAG laser treatments are administered as a result of cataract surgery complications, the most common being clouding of the capsule that remains (known as posterior capsule opacification). If cloudiness affects vision, patients may choose to have this laser surgery known as YAG, or posterior capsulotomy, to correct the problem.

From there, the procedure consists of:

• Surgeon applying topical anesthetic (eye drops) so there’s no pain
• He or she using a laser to cut a hole in the clouded back lining of the lens capsule
• Allowing light to pass through the membrane to the retina at the back of the eye

Some Reasons Why You May Consider YAG Laser Surgery

If you have gone through cataract surgery and notice cloudiness (what experts in the field call “after-cataract”) after several months or years, and if it has actually caused as much or more vision loss as your original cataract, you are probably a good candidate for YAG surgery. The decision to have this procedure is based on the same criteria as the decision to have the original cataract surgery:

• Vision problems are affecting your work or lifestyle
• Glare caused by bright lights poses a problem
• You cannot pass a vision test required for a driver’s license
• You experience double vision
• The difference in vision between your two eyes is significant
• You have another vision-threatening eye disease

Rowan Eye Center Pro Tip: The YAG procedure is not required unless vision loss caused by clouding of the lens capsule is seriously affecting your vision and lifestyle.

Things to Think About

It is common to experience a new “floater” in the eye following a YAG procedure, and it’s not used to prevent clouding of the back lining of the lens capsule. Further, there is currently no way to know who will experience clouding in the back of the eye after cataract surgery. Certain lenses used in the surgical procedure to remove the cataract may lower this risk and the need for later laser surgery.

As with cataract surgery, it is important to balance the risks and possible benefits of laser capsulotomy before deciding to have the procedure, and that’s where Rowan Eye Center can help. Dr. Rowan performs YAG laser treatments at his own surgery center, and our patients routinely tell us about how quick and painless the whole procedure is, normally lasting less than five minutes. Most patients experience clearer vision immediately, enabling them to drive home themselves.

If you’re experiencing cloudy vision or halos after cataract surgery, contact our office to schedule an eye exam.