Laser Iridotomy : An effective treatment for narrow drainage angles
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Glaucoma Brochures in English and Mandarin:
Laser iridotomy is a laser procedure used to treat or prevent angle-closure glaucoma in people who are at risk due to narrow drainage angles.
The drainage angle is the space between the coloured part of the eye (called the iris) and the clear window of the eye (known as the cornea).
If the drainage angle is narrow, the iris can block off the eye's natural drainage channel, leading to a dangerous build-up of eye pressure. This can occur suddenly (with a rapid rise in eye pressure causing headaches, nausea, and blurred vision) or can be gradual, either of which will result in permanent vision loss if left untreated.
Laser iridotomy significantly reduces the risk of either sudden or gradual build-up of eye pressure.
What is Glaucoma?
Glaucoma is a disease that damages the nerve at the back of your eye, called the optic nerve. The optic nerve sends the signals to the brain that enables you to see. Glaucoma is associated with increased sensitivity to pressure within the eye. The eye’s aqueous fluid is constantly produced and drained at a balanced rate and forms the intraocular pressure within the eye (IOP). When this drainage is reduced, or if there is too much fluid production, IOP increases and leads to damage of the optic nerve.
Image of the optic nerve showing loss of nerve cells in patients with glaucoma.
Glaucoma typically has no symptoms. Most patients do not experience any issues until they visit their eyecare provider. Untreated glaucoma can cause a gradual loss of vision, usually starting in the periphery which may go unnoticed for long periods of time.
Image showing the effect of loss of sight in patients with glaucoma.
Our Process :
Assessment
Your appointment will take between 30 to 60 mins. Please continue any of your usual glaucoma drops until the laser.
Our technician will check your vision and pressure and provide you with any additional information.
Meet your surgeon
Dr Perumal is a fellowship trained glaucoma surgeon with over 10 years of experience in performing laser peripheral iridotomy.
During the procedure, a specialised contact lens is placed on the eye which will help keep the eye still.
Then, gentle pulses of light are delivered through a specially designed microscope. A small hole is created in the coloured part of the eye (called the iris) to create a pathway to prevent fluid accumulation behind the iris, and deepens the drainage angle.
The entire process takes just a few minutes and is usually well tolerated.
We will advice you on any post procedure drops and if you should continue your current glaucoma drops.
Recovery
There are no restrictions on your activities after laser treatment and most patients return to work the same or following day.
You may find your vision blurry for a couple of hours after the laser. You may also have mild discomfort, redness and blurred vision for a few days following the procedure, generally subsiding in 5-7 days. Topical anti inflammatory drops will be prescribed to reduce discomfort.
Follow up
We will typically see you again 4-6 weeks following laser to assess the effectiveness of the laser.
5 most common reasons patients have LASIK eye surgery :
Improved Vision :
LASIK can significantly improve high definition vision, allowing people to see clearly without relying on glasses or contact lenses. This is a huge benefit for people who’ve been struggling with poor vision for years.
Convenience :
For those always on the go or have an active outdoor lifestyle, a life not limited by glasses or contacts is a huge lift.
Cost Savings :
Over time, the cost of glasses and/or contact lenses, all add up. LASIK is a very cost-effective solution to reduce long-term expenses related to vision correction.
Safety :
With advances in laser technology, the small risks associated with LASIK have become increasingly minimal. Risks are minimised by choosing an experienced specialist laser surgeon who uses the latest laser technology.
Improved Self-Confidence :
For many, wearing glasses or contact lenses can be a source of self-consciousness. LASIK helps to improve self-confidence and allow people to feel more comfortable in their own skin.
Saving money
The hidden costs: what could you save?
What could that money have done?
The $40,000 you'd potentially spend on glasses and contact lenses over the next 30 years could have given you 15 luxurious holidays.
Est - 15 Holidays
Average holiday cost: $2600
Calculation: 40,000 / $2600 = 15
Saving time
The hidden cost of wearing glasses or contact lenses.
Did you know?
The time you'd spend handling glasses and contact lenses over the next 30 years is enough to have could have taken you around our planet over 30 times!
Est- 526 hours
Cleaning: 3 minutes/day
Finding misplaced glasses: 2 minutes/day
Repair, shopping: 2 hours/year
Total: 526 hours (over 30 years)
Est- 526 hours
Inserting and Removing: 3 minutes/day
Cleaning: 2 minutes/day
Renewing & Check-ups: 2 hours/year
Total: 1,012 hours (over 30 years)
Saving planet
Reducing our carbon footprint
The environmental perspective
Over 30 years, using glasses and contact lenses contributes to 876lb of CO2 emissions. Opt for vision correction and take a stand for our planet!
Est- 876.6 CO2 emissions
Combined plastic waste:
0.525 kg (glasses)+65.7 kg (contact lenses)=66.225 kilograms over three decades.
Total: 66.225 kilograms of plastic×6=397.35 kilograms = 876Lb of CO2 emissions(over 30 years)
Invested in Your Glaucoma Care
Effective
Laser iridotomy can benefit people with narrow angles
Fast
It only takes 5 minutes to conduct this painless procedure
Rapid recovery
Most patients return to normal activity following the laser.
Safe
Laser iridotomy helps prevent a dangerous build up of pressure in the eye and reduce your risk of glaucoma
Comfortable
Most patients tolerate this procedure well.
Personalised Surgical Care
Some patients are not suitable for drops or laser therapy and require either cataract surgery, minimally invasive glaucoma surgery or complex glaucoma surgery.
Minimally invasive Glaucoma surgery (MIGS) marks a milestone in the advancement of glaucoma patient care. MIGS are a form of glaucoma surgery which is associated with minimal incisions, and are generally associated with lower risks in restoring normal eye pressure.
Prior to MIGS, treatment options were limited to medications, laser and major glaucoma tube and filtration surgery. Now, with MIGS, our team at Re:Vision have more treatment options which benefits a patient with faster recovery , less surgical risks and less dependence on medications following surgery.
Our surgeon is a leader in MIGS surgery in NZ, with a wealth of experience with iStent -W, Kahook Dual Blade, Hydrus, XEN, Preserflo, micropulse and cyclodiode laser.
MIGS management include:
1) Various treatment options and benefits which are patient centric and individualised
2) Evidence based therapy and
3) Promising outcomes for glaucoma patients.
MIGS can be performed as a standalone procedure or in conjunction with cataract surgery. There are different surgical approaches under the MIGS umbrella, but they generally are designed to allow more fluid to drain out of the eye and hence, reduce intraocular pressure.
a) iStent
The iStent is the smallest medical device ever implanted into humans. The iStent decreases eye pressure by creating a pathway into the eye’s drainage system. The iStent was the first trabecular micro-bypass device approved by the FDA and is the most thoroughly-studied glaucoma device on the market.
Click here to watch video on iStent
b) Kahook Dual Blade
The Kahook Dual Blade goniotomy procedure involves removing a section of the trabecular meshwork (the part which is associated with the greatest resistance in fluid outlflow) and hence increasing drainage out of the eye.
Click here for information on KDB
c) Micropulse Laser Treatment
This procedure decreases the amount of fluid produced by the eye and increases fluid outflow. A probe is placed on the surface of the eye and the surgeon applies laser energy to part of the eye which controls the production of fluid in the eye.
d) Preserflo Stent
The Preserflo drainage shunt is type of microshunt implant used to reduced intraocular pressure by creating a controlled pathway for the drainage of fluid out of the eye. It is made from a specialised biocompatible material called SIBS, which is known for its stability, flexibility and compatibility with the human body, hence minimising tissue inflammation.
Click here for information on Preserflo
Trabeculectomy surgery has been done for more than 50 years, and involves making a separate channel for fluid to filter out of the eye.
A drainage tube is a device inserted into the eye, which acts as straw where fluid can access to drain out of the eye onto the outer coat of the eye. There are several drainage tubes available in NZ which include Molteno drainage tube, Paul drainage tube and Baerveldt drainage tube.
Generally, these surgeries are done once all others have been exhausted and have failed to stop the progression of glaucoma.
Glaucoma is optic nerve damage due to increased pressure sensitivity within the eye while a cataract is a clouding of your natural lens within your eye.
In some patients, the hardening and change in the shape of the lens with the development of cataract, can potentiate the effects of glaucoma, such as angle closure glaucoma. In this situation, we may suggest having cataract surgery as a way to treat your glaucoma.
Some patients can combine glaucoma and cataract surgery (includes patients with open angle glaucoma). MIGS procedures in particular can be performed through the same incision as cataract surgery, providing an efficient way to address two problems at once.
World class gentle effective laser
SLT Machine for LPI
The Ellex Tango Reflex Neo YAG laser is a medical device designed for various ophthalmic procedures. It is used in the field of ophthalmology to treat certain eye conditions through precise laser applications.
In conditions like narrow-angle glaucoma or certain types of secondary glaucoma, an iridotomy can be performed using the YAG laser. This involves creating a small hole in the iris to improve the flow of aqueous humor within the eye, reducing intraocular pressure.
The Ellex Tango Reflex Neo YAG laser system is praised for its precision, allowing ophthalmologists to perform these procedures with accuracy while minimsing damage to surrounding tissues. The laser technology enables controlled and focused energy delivery, which is crucial for these delicate eye treatments.
Who would benefit for Laser iridotomy?
- Patients diagnosed with primary and secondary angle closure.
- Patients diagnosed as primary angle closure suspect.
- Patients with narrow angles on medications which can potentially dilate the pupil including antidepressants and antinausea treatment.
- Patients with symptoms of angle closure (headaches, transient blurry vision)
- Patients with narrow angles requiring regular dilated eye examinations (diabetics, macular degeneration)
- Patients with a family history of angle closure glaucoma.
Glaucoma Research at Re:Vision
Dr Perumal values the importance of research initiatives and technology in glaucoma. We may invite you to participate in the Save Sight Registry run by the Save Sight Institute, in collaboration with the University of Sydney and Sydney Eye Hospital to fight glaucoma blindness.
The Save Sight Registries is one of the most advanced ophthalmic registries in the world, and is a unique platform for tracking eye disease, interventions and patient outcomes. Its sophisticated design delivers real-world evidence on the risks and benefits of current and new treatments for ocular conditions. This information helps clinicians provide safe, cost-effective and evidence-based solutions for vision impairment and avoidable blindness.
The Save Sight Registries also promotes international scientific research aimed at developing strategies for reducing the incidence of blindness throughout the world.
Frequently Asked Questions:
What are the risks?
This procedure is generally very safe. Serious problems after laser iridotomy are rare. There is a small risk of raised eye pressure immediately after the procedure. Your eye pressure will be measured after the procedure and if necessary, you will be given eye pressure lowering medication to take home.
Minor complications include bleeding and inflammation, which usually resolve on their own but can be treated if required.
Occasionally, patients can experience visual symptoms from light entering through the laser iridotomy, which usually improves with time.
Do I need to have both eyes treated?
Laser will only be offered for managing narrow angles. However, narrow angles usually affects both eyes. Therefore, both eyes typically receive treatment on the same day.
Do I need to have the procedure repeated?
The procedure does not normally need to be repeated however, occasionally, the hole created by the first procedure may be need to be enlarged.
Costs
At Re:Vision, all types of laser vision correction (LASIK or PRK) cost : $3,599/eye
Glaucoma laser costs are usually covered by most insurance companies.
A detailed quote for your consultation will be provided prior to your consultation.
We will not charge you for any procedure unless discussed and your consent is obtained.
By the time I turn 45, I will have spent on contact lenses/glasses :
At Re:Vision, all types of laser vision correction
(LASIK or PRK) cost : $3,599/eye
Get Started
Still have questions?
Get in touch with us and a friendly member of our team will assist.
We can also schedule your glaucoma consultation.
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