What is a Yag laser capsulotomy?
A Yag capsulotomy is a special laser treatment used to improve your vision after cataract surgery. It is a simple, commonly performed procedure which is very safe. During your cataract operation, the natural lens inside your eye that had become cloudy was removed. A new plastic lens was put inside the lens membrane (called the bag or capsule) in your eye. In a small number of patients, the capsule thickens after surgery and becomes cloudy. This interferes with the light reaching the back of the eye. When this happens, your sight becomes misty, and you may get glare in bright light or from lights at night-time. Capsule thickening can happen in the months after your cataract operation, but more commonly occurs about two years after surgery. Yag laser capsulotomy is the only way to treat this. Apart from affecting your vision, the thickening does not damage the eye in any way. In a Yag laser capsulotomy the doctor uses a special lens to apply a laser beam to the capsule. This creates a small hole in the centre of the capsule, which lets light through.
What happens during a Yag laser capsulotomy?
You will need to visit the outpatient department for about half a day. The treatment will be performed in one of our laser treatment rooms as a ‘walk in – walk out’ procedure. Special preparations such as fasting or changing into operating theatre clothes are not necessary. You will have some drops put into your eye to make the pupil big, and an anaesthetic eye drop to numb the surface of the eye. You will then sit at a machine – similar to the one used to examine your eyes when you routinely visit the eye clinic – which has a special laser attached. The doctor may put a special lens on your eye before applying the laser beam. This lens allows the doctor to view the membrane clearly so he or she can apply the laser and make a small hole in it to clear the vision. The treatment is painless due to the anaesthetic drops used to numb your eye before the laser and takes approximately 20 seconds. After the procedure, you will be ready leave when ready.
What are the benefits of having a Yag laser capsulotomy?
The laser treatment is to remove the cloudy capsule thickening in your eye, which aims to restore your vision to how it was after your cataract operation.
Are there any risks associated with a Yag laser capsulotomy?
Complications after this treatment are very uncommon.
- Occasionally the pressure inside the eye rises immediately after the laser treatment. If this occurs, you may need extra treatment before you can go home. This treatment usually comes in the form of eye drops, but may come in the form of tablets. Your doctor will let you know which treatment you need and advise you of how long you need to take the treatment for. If we do treat you with eye drops, a doctor or nurse will put then in your eye before you leave hospital. You will be asked to remain in the department until your eye pressure has lowered to a satisfactory level. This should take a few hours at most.
- Occasionally the opening is incomplete, or not big enough. This will be discovered either after your treatment, or on your follow-up visit. If this is the case, it will be necessary to repeat the treatment at a later date. Extremely rarely, some patients can get a build up of fluid in the macula, the part of the eye responsible for detailed central vision. This build up of fluid is called macular oedema (swelling), which causes blurring or distortion of vision.
- Another extremely rare complication is retinal detachment, when the fine light sensitive membrane at the back of the eye can come away from the wall of the eye. The following symptoms mean that you need urgent treatment:
- excessive pain
- sudden onset of floaters (caused by small pieces of debris that float in the vitreous humour of the eye)
- loss of vision
- flashing lights
- increasing redness of the eye.
If you experience any of these symptoms, telephone your eye surgeon for advice immediately, or visit your nearest accident and emergency department.
Are there any alternatives?
Not really. An alternative to a Yag laser capsulotomy is to do nothing. The capsule may or may not continue to thicken. If it does, you may wish to consider a Yag laser capsulotomy at a later date.
What do I need to do to prepare for the laser treatment?
Since this is an outpatient treatment, you can eat and drink as normal. You must continue to take any eye medication as normal on the day of the laser treatment (unless instructed otherwise).
Asking for your consent
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. You should receive the leaflet, Helping you decide: our consent policy, which gives you more information. If you do not, please ask us for one.
What happens after the procedure?
After the treatment, most patients find that their vision is usually blurry for four hours from the drops. Bright lights can also be bothersome. Because of this, it can be helpful to have someone to go home with you, but this is not essential. You should not drive or ride a motorbike or bicycle for the rest of the day. Following the procedure, no special treatment is required, and you can go back to your normal daily activities straight away. If you have discomfort once you have returned home, we suggest that you take your usual pain reliever following the instructions on the pack. It is normal to have itchy, gritty or sticky eyes and mild discomfort for the remainder of the day after the treatment. You will be asked to come to the outpatient department a few weeks after the laser treatment to make sure your eye has settled down properly. This appointment will be given to you before you leave the hospital.
What do I need to do after I go home?
Anti-inflammatory drops may be prescribed after the laser treatment. These help to minimise inflammation (not infection) within the eye. People normally have to take these only for a few days or a week at most – your doctor will tell you how long you need to use them for. You do not need antibiotics, as there is no open wound on your eye. You may need to take an eye pressure lowering drops if necessary for prophylaxis.
Floaters are small shapes that some people see floating in their field of vision. They can be different shapes and sizes and may look like:
- tiny black dots
- small, shadowy dots
- larger cloud-like spots
- long, narrow strands
You may have many small floaters in your field of vision or just one or two larger ones. Most floaters are small and quickly move out of your field of vision. They are often most noticeable when you’re looking at a light-coloured background, such as a white wall or clear sky.
Do floaters affect vision?
Floaters sometimes occur without a person noticing them. This is because the brain constantly adapts to changes in vision and learns to ignore floaters so they don’t affect vision.
Floaters are usually harmless and don’t significantly affect your vision. However, it’s important you have your eyes checked by an optician regularly (at least once every two years).
Larger floaters can be distracting and may make activities involving high levels of concentration, such as reading or driving, difficult.
What causes floaters?
Floaters are small pieces of debris that float in the eye’s vitreous humour. Vitreous humour is a clear, jelly-like substance that fills the space in the middle of the eyeball. The debris casts shadows on to the retina (the light-sensitive tissue lining the back of the eye). If you have floaters, it’s these shadows you’ll see.
Floaters can occur as your eyes change with age. In most cases, they don’t cause significant problems and don’t require treatment. In rare cases, floaters may be a sign of a retinal tear or retinal detachment (where the retina starts to pull away from the blood vessels that supply it with oxygen and nutrients).
Floaters can’t be prevented because they’re part of the natural ageing process.
When to seek medical help?
Visit your optician immediately if you notice an increase or sudden change in your floaters, particularly if you notice white flashes and some loss of vision. Your optician may refer you to an ophthalmologist (a specialist in diagnosing and treating eye conditions) who can check your retina for tears or retinal detachment.
Even though floaters are usually harmless and don’t significantly affect your vision, it’s important you have your eyes checked regularly by an optician (at least once every two years).
In most cases, floaters don’t cause major problems and don’t require treatment. Eye drops or similar types of medication won’t make floaters disappear. After a while, your brain learns to ignore floaters and you may not notice them.
If your floaters don’t improve over time, or if they significantly affect your vision, a vitrectomy may be recommended. This is a surgical operation to remove the vitreous humour in your eye along with any floating debris and replace it with a saline (salty) solution.
If your retina has become detached, surgery is the only way to re-attach it. Without surgery, a total loss of vision is almost certain. In 90% of cases, only one operation is needed to re-attach the retina.