YAG laser capsulotomy

What is YAG laser capsulotomy?

YAG laser capsulotomy is the treatment for secondary cataract – a condition that can develop after an initial cataract surgery. Secondary cataract is also sometimes known as posterior capsule opacification (PCO).

This laser treatment is fast, effective and painless, and can be performed as an outpatient, meaning you can go home the same day.

What is posterior capsule opacification (PCO)?

Posterior capsule opacification is a common complication of cataract surgery, with studies estimating that it affects more than 25% of previous surgery participants.

During cataract surgery, the natural lens of your eye – which has become cloudy – is removed and replaced with an artificial alternative called an intraocular lens or IOL. In posterior capsule opacification, the thin membrane that holds this IOL in place, called the lens capsule, becomes cloudy.

It happens because over time, cells that are left behind in the initial surgery start to multiply and move towards the back of the capsule, clumping together and causing clouding that prevents light from reaching your retina.

Symptoms of posterior capsule opacification

There are a variety of symptoms of PCO, including:

• Cloudy or hazy vision, as though you are looking through frosted glass
• Glare and/or haloes around bright lights, such as streetlamps
• Sensitivity to light
• Colours appearing faded or washed out
• Finding it hard to see fine detail, such as small text.

If you’ve previously had cataract surgery and you’re experiencing any of these symptoms, speak to your optician or eye doctor.

How long after cataract surgery can PCO develop?

Rates of PCO developing after cataract surgery can vary from a few months to a few years.

How is PCO diagnosed?

Posterior capsular opacification can be diagnosed just using a simple eye exam, during which your optician or ophthalmologist will ask about your symptoms, evaluate the clarity of your vision and check the health of the lens capsule. Sometimes this will involve using dilating eye drops, which widen your pupil so that they can see the retina at the back of your eye more clearly.

Can posterior capsular opacification be prevented?

Cataract surgery techniques have continued to be refined over the years to try and reduce the incidence of complications such as posterior capsular opacification, but it can’t be entirely prevented.

How do I know if I need YAG laser capsulotomy?

Before you can have YAG laser capsulotomy, you’ll need to have a consultation to confirm a diagnosis of posterior capsular opacification, and to check that you are a good candidate for the treatment.

Who is suitable for YAG laser capsulotomy?

You may be a suitable candidate for YAG laser capsulotomy if you have been diagnosed with PCO and it is having a significant impact on your daily life, such as by making it harder to drive at night, work or spend time in bright lights.

Who is not suitable for YAG laser capsulotomy?

You may not be a good candidate for YAG laser capsulotomy if you have:

• An active eye infection
• An uncontrolled eye disease, such as glaucoma
• Other eye health concerns, for example issues with your cornea
• Your current IOL is unstable.

What are the alternatives to YAG laser capsulotomy?

While other non-invasive options such as different prescription glasses may offer some relief from your symptoms, there aren’t currently any effective alternatives to YAG laser capsulotomy.

How should I prepare for YAG laser capsulotomy?

Your consultant will help you to prepare for your YAG laser capsulotomy by giving you some specific steps to follow. These will help to minimise your risk of complications, accelerate your recovery and ensure you get the best possible outcome from your procedure.

They could include:

• Taking or temporarily stopping any of your regular medications if required
• Limiting alcohol in the days before your surgery, as this can make your eyes dry and irritated and increase your risk of complications
• Stopping smoking, as this is proven to enhance the likelihood of complications and delay recovery after any type of surgery
• Arranging for someone to drive you home after your appointment, as you won’t be able to take yourself
• Arriving on the day without any cosmetics on your face.

You should ensure that you follow all pre-operative instructions provided by your Nuffield Health medical team.

What should I bring on the day of my procedure?

You should bring your usual prescription glasses on the day of your YAG laser capsulotomy. You’ll also be advised to bring sunglasses, as dilating drops will be used during your appointment and these will make your eyes particularly sensitive to light.

Will I need someone to accompany me to my YAG laser capsulotomy appointment?

While you won’t be able to have someone with you during the procedure itself, you will need someone to drive you home after your appointment. You won’t meet the legal standard for driving, so you won’t be able to safely get yourself home.

How is YAG laser capsulotomy performed?

YAG laser capsulotomy is a super-fast procedure that usually takes around 5 minutes per eye. It can be broken down into three stages – before, during and after the laser element of the treatment.

Before
You’ll be given eye drops to both numb your eyes and dilate your pupils. These will ensure you don’t feel any discomfort and will open your pupils wide for the procedure.

During
A special contact lens will be placed into your eye to hold it open and to focus the laser in the correct place. The laser will then make tiny pulses on the cloudy membrane behind your lens implant. You’ll see flashes of light and hear clicking, but you won’t feel any pain. The laser will create a small clear opening in the centre of the lens so that light can pass through it again.

After
The contact lens is removed, and your procedure is complete. There’s no need for stitches or bandages, and you’ll be able to go home. You’ll be given anti-inflammatory eyedrops to start using right away, and you should take these as prescribed.

Will I be awake during YAG laser capsulotomy?

Yes. You don’t need a general anaesthetic for YAG laser capsulotomy, so you will be awake for the duration of the procedure – which takes just a handful of minutes per eye.

Is YAG laser capsulotomy painful?

No, you’ll be given anaesthetic eye drops to ensure you don’t feel any discomfort during your YAG laser capsulotomy.

How long does it take to recover from YAG laser capsulotomy?

There’s virtually no downtime after a YAG laser capsulotomy, with most people being able to resume normal activities within 24 hours of their surgery.

You may notice an improvement in your vision right away, but it can take up to 24 hours to be completely clear from the effects of posterior capsule opacification. You may also see some floaters for several weeks, but these usually clear quickly, with any remaining effects dissipating around two months after surgery.

When can I drive after YAG laser capsulotomy?

You should be able to drive as soon as the dilating eyedrops have worn off, and you can see clearly again. Please note that you must meet the minimum visual standard for driving.

When can I return to work after YAG laser capsulotomy?

You may be able to go back to work the same day as your procedure, although many people like to wait until the following day instead.

What activities should be avoided after YAG laser capsulotomy?

There are a few activities on your daily restrictions that you’ll need to consider after YAG laser capsulotomy. These are only temporary, but it’s important to avoid certain activities for a prescribed time to lower your risk of infection and ensure you get the best possible outcome from your treatment.

Things to avoid will include:

• Driving, until your pupils are no longer dilated and your vision is no longer blurry
• Strenuous exercise or heavy lifting, for at least 24 hours to prevent a temporary rise in intraocular pressure
• Rubbing or touching your eye
• Swimming, hot tubs and saunas for at least a week
• Wearing eye make-up for at least a few days, to reduce your risk of infection
• Bending down for long periods, as again this can cause a temporary rise in intraocular pressure.

Always follow the guidance and advice of your medical team.

What are the risks and complications of YAG laser capsulotomy?

Although YAG laser capsulotomy is considered to be a very safe procedure, as with any surgery, there are some risks and complications to be aware of. These include, but are not limited to:

• Floaters, which are white or grey clouds that pass across your field of vision
• Raise intraocular pressure
• Inflammation, redness and irritation
• Sensitivity to light
• Blurred vision
• Swelling of your retina
• Retinal tear/detachment
• Temporary clouding of your cornea
• Macular hole.

Some complications/side effects are more common than others. Your consultant ophthalmologist will explain all the potential risks associated with your surgery before you agree to go ahead with the procedure.

What happens if I leave my posterior capsule opacification untreated?

If you decide to leave your PCO untreated, your vision will get progressively worse until you find it hard to do your usual daily activities. This will include reading, watching television and driving. You may not be able to go to work, and your quality of life will be significantly impaired.

How much does YAG laser capsulotomy cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed, all-inclusive price for the treatment following your initial consultation.