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YAG Laser Capsulotomy

YAG Laser Capsulotomy

Please read this leaflet.  If you need help, please ask the eye clinic nurse.

What happened at my cataract surgery?

The lens of the eye lies behind the iris (the coloured part of the eye).  The lens has a transparent skin, called the capsule.  In the usual type of surgery for cataract, the surgeon makes an opening in the front of the capsule.  The surgeon then softens and removes the lens through this opening.  The capsule is left behind in the eye as a bag.  A plastic lens implant is then placed inside this bag.  At the end of surgery, it is normal for a few cells of the lens to be left behind in the bag.  

What is PCO?

Although the remaining lens cells may not cause any problem, they sometimes cause the back of the bag to become cloudy.  This is Posterior Capsule Opacification (PCO).  This often develops slowly over a period of some months following cataract surgery.  PCO is very common, especially in younger patients.  It is normal for PCO to develop after cataract surgery. 

What are the effects of PCO?

Very slight PCO is normal and may not affect vision.  When PCO is significant, it causes the vision to be constantly blurred.

My vision has become blurred after cataract surgery – do I have PCO?

There are many causes of blurred vision after cataract surgery.  It is usually best to visit your optometrist (optician) for advice.  In general, if PCO is found, you will be referred to the hospital eye department for laser treatment.

What is the benefit of laser?

The doctor uses a laser to make a hole in the back of the capsule, so that you can see through the hole.  The treatment is called ‘YAG laser capsulotomy’.  If your vision is blurred because of PCO, we would expect you to notice improvement within a few hours of having the laser treatment.  Sometimes there are other reasons for blurred vision that will not be helped by this laser treatment.  In these cases, laser may give a partial benefit for vision.  Occasionally, the treatment may not help your vision at all, but may help doctors and optometrists to get a better view of the back of the eye.  A single laser treatment is usually sufficient.  Occasionally, the laser may also be used to enlarge the opening in the front part of the capsule. 

Are there alternatives to laser?

It is possible to leave PCO untreated, and this may be best if the PCO is mild, and you are not aware of blurred vision.  However, PCO will not get better by itself, and it may get worse.  If the PCO becomes severe, it becomes more difficult to treat.  If you have significant PCO, it may be best to treat it without too much delay. 

Do I need to prepare for the laser?

Eat and drink normally and take any medications and eye drops as you usually do.  Please bring any glasses that you normally wear for television or driving.  If the weather may be sunny, you may want to bring sunglasses with you. 

If you have been given this leaflet before the day of the laser clinic, please read it.  Please write down anything that you do not understand, and any questions you have. 

Can I drive after the laser?

Before the laser, a nurse will put drops in your eye that will make the pupil big.  These drops last about four hours.  They may make your vision blurred, and the large pupil means that you could be dazzled by the sun or by car headlights.  We advise that you plan your visit so that you do not have to drive or operate machinery during the four hours following laser treatment.

What will happen when I arrive at the eye clinic?

You will be given an identity band on your wrist.  A nurse will test your vision and put drops in the eye to make the pupil big.  The eye drops will sting.  A small mark will be put on your forehead, above the eye that will be treated. 

What is the laser treatment like?

The doctor will check that the treatment is appropriate for your eye.  It is a routine outpatient procedure that is done while you sit in front of a microscope. 

The laser is usually done with a contact lens, which will hold your eye open.  The contact lens may feel a bit strange, but you will be given anaesthetic eye drops so that it will not hurt.  There will be some jelly on the contact lens so that it does not rub your eye.  The laser itself does not hurt at all, because there are no nerves in the capsule.  You will hear a repeated clicking sound.  The treatment takes a few minutes. 

What are the side effects of the laser?

Most patients have no significant side effects.  Sometimes people get slight discomfort until the morning after the laser.  Sometimes people notice extra ‘floaters’ in the vision, but these generally settle within a few weeks. 

Occasionally, the vision gradually becomes blurred about two to four weeks following the laser.  This may be due to fluid (oedema) leaking into the retina at the back of the eye.  This is more likely to happen if you have diabetes, or if you take a certain kind of anti-glaucoma eye drops (the prostaglandin type).  This problem usually responds well to treatment. 

There is a very small risk of a serious side effect called retinal detachment.  This would cause a dark shadow to spread across your vision.  It can happen years after the laser.  (However, some people who have had retinal detachment after laser would have got it anyway, even without the laser.)  Retinal detachment is treated with surgery and the results are best when it is treated urgently.  If you notice flashes of light in your vision, or a dark shadow spreading across your vision, please telephone us (see the end of this leaflet) or, if it is a weekend or bank holiday, go to the Birmingham and Midland Eye Centre, City Hospital, Birmingham, B18 7QH.  (If you are not sure about your symptoms, an optometrist or GP may also be able to give you advice.)

Are there other side effects that are rare?

The capsule is usually close to the plastic lens implant, so it is common for the laser to cause microscopic damage to the implant.  This damage is usually very minor but in rare cases it may cause a permanent glare in the vision.  After laser treatment, the position of the plastic implant lens may change.  If this is significant it will cause blurred vision.  It is very rare that surgery is needed to replace an implant lens. 

The laser treatment may cause the pressure in the eye to rise.   In rare cases this could cause permanent loss of vision, for example, in an eye that already has advanced glaucoma. 

Inflammation inside the eye may occur (especially if this has occurred in the past).  Treatment with eye drops may be needed. 

At the time of cataract surgery, it is possible for bacteria to get stuck inside the capsule.  The laser can release them so that they cause inflammation.  This is very rare but may need treating with surgery.  

What happens after the laser?

Your vision may be blurred for four hours after the laser.  You may have a shower or go swimming the day after the laser.  If you normally use eye drops, carry on with them (unless the doctor advises you to stop them).  Sometimes the doctor will recommend a short course of new treatment with eye drops.

You should arrange to see your optometrist (optician) about four weeks after the laser.  The optometrist can check if your glasses prescription needs changing and if there is any fluid leaking into the retina.  If fluid is found, you will be referred within a few days to the hospital eye department for treatment.  Otherwise, please telephone the eye department if you have loss of vision or pain or redness of the eye following the laser.

What if I have questions?

When you see the eye doctor, please tell him or her if there is anything in this leaflet that you do not understand.  Please ask any questions that you have. 

Contact details

• Eye Department at Worcester (01905) 733569
• Eye Department at Kidderminster (01562) 512382

Other information

The following internet websites contain information that you may find useful.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day. If you are unable to understand this leaflet, please communicate with a member of staff.