YAG Iridotomy

The primary benefit is preventing an acute angle-closure glaucoma attack, a medical emergency that can cause permanent blindness within hours if not treated immediately. Clinical studies show that YAG iridotomy reduces the risk of developing angle-closure disease by approximately 50 percent in at-risk patients. The treatment also helps prevent the intense eye pain, severe headache, nausea, vomiting, and sudden blurred vision that come with an acute attack, giving you lasting peace of mind.

Our ophthalmologists will recommend YAG iridotomy if they find narrow drainage angles during your comprehensive eye exam, especially if other risk factors are present. The treatment is also performed urgently if you have already had a glaucoma attack in one eye to protect your other eye, since the fellow eye has a very high risk of experiencing the same problem. Getting treated early, before symptoms develop, gives you the best chance of maintaining healthy vision for life.

In some situations, this procedure may not be the best option. This includes patients with:

• Poor corneal clarity, such as from severe swelling or scarring, or active eye inflammation that may limit laser access
• Advanced optic nerve damage from chronic angle-closure that requires more aggressive surgical intervention
• Certain iris conditions, such as severe atrophy, plateau iris configuration after iridotomy, or very thick, dark pigmented tissue that may not respond well to laser
• Mixed mechanism glaucoma where other factors beyond pupillary block are causing elevated pressure

For patients who are not suitable candidates for laser iridotomy, pilocarpine eye drops can temporarily help open the drainage angle by constricting the pupil, though this is not a permanent solution. In advanced cases or if laser treatment fails to adequately open the angle, a surgical iridectomy, where a small piece of the iris is physically removed, may be needed. In some patients, cataract surgery itself can relieve the crowding and open the drainage angle, especially when the natural lens has become thick with age.

No, the numbing drops make sure you do not feel pain during the procedure. You might notice some pressure from the contact lens on your eye or see bright flashes of light, but most people say it is much easier and more comfortable than they expected. Any mild discomfort or scratchy sensation afterward usually goes away within a few hours and can be managed with over-the-counter pain relievers if needed.

Recovery is typically swift, with most people feeling back to normal within one to two days. You should avoid heavy lifting, bending over repeatedly, and strenuous exercise for about 24 hours after the procedure. While you will feel better quickly and can resume most normal activities the next day, it takes several weeks for your eye to heal completely inside and for any inflammation to fully resolve.

If one eye has narrow angles, the other eye usually does too because of similar inherited anatomy. To prevent future problems and avoid the risk of an attack in either eye, our ophthalmologists will examine both eyes carefully using gonioscopy and will often recommend treating both eyes. We may perform the treatment on both eyes during the same visit or schedule them a few weeks apart, depending on your specific situation and comfort level.

YAG iridotomy is highly effective at preventing or treating angle-closure glaucoma caused by pupillary block, but it does not cure other forms of glaucoma, such as open-angle glaucoma, or reverse optic nerve damage that has already occurred. Think of this treatment as an important step in managing and protecting your eye health for life, not a one-time cure. You will still need regular comprehensive eye exams to monitor your overall eye health and eye pressure.

You cannot tell at home if you have narrow angles because they usually do not cause any symptoms until a serious problem happens suddenly. Our ophthalmologists can see this during a comprehensive eye exam using a special mirrored lens in a procedure called gonioscopy, which allows us to view the drainage angle directly. This is why regular eye exams are so important, especially if you have risk factors such as farsightedness, family history, or are over age 40.

No, the laser creates the opening at the very edge of your iris, in the peripheral area, where it is usually covered by your upper eyelid. The hole is also extremely small, typically less than one millimeter, and does not change how your eye looks to other people or affect your natural eye color. Even you will not be able to see it when looking in a mirror.

If you are at high risk and do not get preventive treatment, you could experience a sudden acute angle-closure glaucoma attack. This causes severe eye pain, intense headache, nausea and vomiting, dramatically blurred vision, and seeing halos around lights. Without emergency treatment within hours, you could lose your sight permanently in the affected eye. An acute attack is also extremely uncomfortable and frightening, and often requires emergency room care.

No, you should not drive yourself home. You must arrange for someone to drive you home because your vision will be blurry and your eyes will be sensitive to light from the dilating and other eye drops we use during the procedure. Most people feel comfortable driving again by the next day once their vision clears and returns to normal. Plan accordingly and ask a family member or friend to help with transportation.

Some patients can stop using daily pressure-lowering drops after a successful iridotomy if the procedure fully resolves their angle-closure risk, while others still need them for other reasons. This depends on your overall eye health, whether you have other types of glaucoma such as open-angle glaucoma, and your individual eye pressure patterns. Our ophthalmologists will monitor your eye pressure at follow-up visits and let you know what ongoing treatment, if any, is right for you.

The cost of the procedure varies depending on your specific insurance coverage and benefits. YAG iridotomy is typically covered by most insurance plans, including Medicare, when deemed medically necessary to prevent or treat angle-closure glaucoma. Our staff at ReFocus Eye Health Bloomfield (NW) can help you understand your coverage, verify your benefits, and explain any potential out-of-pocket expenses before your procedure so there are no surprises.

In most people, the tiny hole stays open for life and continues to protect against angle-closure glaucoma attacks permanently. However, in about 1 to 5 percent of cases, the opening might partially close over time due to inflammation or pigment accumulation. Our ophthalmologists will check the iridotomy opening during your regular comprehensive eye exams to make sure it remains patent, or open, and functioning properly. If needed, we can repeat the treatment quickly and easily to reopen or enlarge the hole.

Yes, YAG iridotomy does not prevent cataracts from developing as you age. In fact, many patients who need iridotomy also develop cataracts later in life. The good news is that cataract surgery can still be performed safely and successfully after you have had an iridotomy. In some cases, cataract surgery itself can further improve your drainage angle and reduce glaucoma risk by removing the thick natural lens.