8 years ago, due to a congenital defect, I had surgery on the retina of my left eye. I had an excellent surgeon, and I'm confident that he did nothing wrong. Nevertheless, as he had cautioned me might happen following such an invasive procedure, shortly after the surgery I developed a fast-growing cataract on my left eye. Within just a few months of having the surgery, which was otherwise successful, the vision in my left eye had deteriorated to the point that I was unable to read the letter "E" on the eye chart.
Accordingly, 10 months to the day after the first surgery, I had a second procedure, performed by a different surgeon, to remove the cataract and implant an IOL (intra-ocular lens). For several years after that second surgery, I had enviable distance vision in my left eye, but eventually, I developed something called PCO, or Posterior Capsular Opacification. As a result, the vision in my left eye deteriorated. I had difficulty focusing, and in the past couple of years I'd developed something called "ghosting", which occurs when you eyes see two slightly different images transposed next to each other. This meant that if I was looking at someone seated 8 to 10 feet away, instead of seeing their face I'd see 2 faces, one in front of the other, which was annoying to say the least, but also, due to this I was now finding it impossible to read road signs.
PCO is the most common complication of cataract surgery, occuring in approximately 20% of patients. It's caused by a cloudy layer of scar tissue growing behind the implanted lens. This happens because when a cataract is removed, a small amount of tissue covering the lens, or capsule, is left behind to help hold the IOL in place. A PCO forms when the eye attempts to make a new lens using the material left behind. Different types of cells can cause the opacification, including migrating epithelial cells and residual lens cortex cells, but no matter what type of cell is causing it, when PCO occurs, although it's a natural part of wound-healing in the eyes, it causes problems with vision.
In addition to everything else, I also have glaucoma in both eyes, so I see my ophthalmologist every 6 months for a thorough eye exam. He had noticed the increasing PCO over the new lens, and asked me about my vision. When I told him about the ghosting (by far the worst effect for me) he encouraged me to schedule a procedure to restore the vision in my left eye. This procedure is called YAG laser capsulotomy. YAG is short for yttrium aluminum garnet, which is the type of crystal located within the laser used for the capsulotomy. It dates back to 1982, and it's considered very safe and low risk for complications.
I considered going back to the surgeon who had removed the cataract and implanted the IOL, but when I learned that my ophthalmologist was one of the first doctors trained to do YAG laser in Texas, and has been doing this procedure weekly for almost 40 years, I decided to have him do it.
From a patient standpoint, YAG laser capsulotomy is a simple, outpatient procedure. I went to my doctor's regular office. When I arrived, drops were instilled in my left eye to lower the pressure, and also to dilate my eye. It took about 10 or 15 minutes for the drops to take effect. I then walked down the hall to a different suite, where the laser was located. It's important to remain still during this procedure, so to help immobilize my head, after being seated, my head was positioned in the chinrest of a slit lamp microscope to which the laser was attached. A slit-lamp microscope is the thing where you sit in a special chair and then lean forward to rest your chin and your forehead on the device to position your eyes so they can be examined. When you go for your annual eye exam, your optometrist almost certainly uses a slit lamp microscope to examine the back of your eyes.
An assistant instilled numbing drops in my eye. She then placed a special contact lens filled with a gel-like substance on the front of my eye. Due to the numbing drops, I didn't feel anything. My ophthalmologist then performed the capsulotomy. Focusing on the posterior capsule, he "zapped" the PCO formation with the laser, which uses a wavelength to break up the tissue, first forming a hole in the central area of the lens and then moving in a circular manner around it. The zapped tissue falls off the posterior capsule and into the vitreous. The entire procedure lasted for just a few minutes, and there was no pain involved.
Most patients experience increased intraocular pressure (IOP) as a result of this procedure, so afterward, another pressure-lowering eyedrop was instilled as a preventative. I then walked back to the inner office waiting room, where I sat for about 20 minutes before my IOP was again checked. It was at a healthy 18, so I was discharged.
Immediately after the procedure, my vision was blurred and I had some horrendous floaters, both of which are normal. It’s not unusual to see floaters for up to 3 weeks after this procedure. However, just 9 hours later, at 10 PM, although I still have some floaters, my vision is crystal clear.
General Info
You shouldn’t drive for the first 24 hours after having this done, so you need to arrange for transportation to and from the facility.
Financial Considerations
Medicare Part B covers YAG laser capsulotomy if it’s deemed medically necessary due to complications from cataracts and cataract surgery, but you’ll generally need a diagnosis of posterior capsular opacification for it to be covered.
Also, if you’re having YAG done, be sure to ask ahead of time if your surgeon charges a facility fee. Facility fees can range from modest to exorbitant, and you’re responsible for 20% of the facility fee even if Medicare covers the procedure, so be sure to ask about this ahead of time. My ophthalmologist didn’t charge a separate facility fee because he has a laser on site, but if I used the surgeon who removed the original cataract and implanted the lens, I would have had to pay a separate facility fee.
