Written by Dr. James Lehmann on 05/20/18

An adjustable lens is present in the eye, within the center of a transparent bag or capsule. The lens and the capsule undergo many changes throughout an individual’s lifetime. One of the changes that occur in the lens includes opacification or clouding of the lens due to a number of reasons. They include age, previous injuries to the eye, complications secondary to diseases like diabetes and hypertension and drugs such as the statins and steroids.

The clouding of the lens is a medically known condition, called the Cataract. It is the most common cause of blurring and dim vision in the elderly. The treatment consists of replacement of the cloudy lens with an artificial lens, known as the Intraocular Lens (IOL). The latest technology available for cataract is the laser treatment, which has been available at Focal Point Vision for the past twenty years.

The latest device available for this procedure is the LenSx Femtosecond Laser, which has been used at Focal Point Vision since 2012, immediately after its approval by the FDA. For more information about cataract treatment provided at our facilities, please visit our page Laser Cataract Surgery.

Sometimes after a cataract surgery, the capsule bag in which the new artificial lens is placed develops opacification on its posterior surface. This is because of the formation of new cells on the posterior layer of the capsule, which arises from the remaining cells of the previous lens. This clouding or opacifications is known as Posterior Capsular opacification (PCO) or a secondary cataract since the lens is not involved. This blurring of capsule occurs in 10% of the patients that undergo cataract surgery. There is no specific timeline for its occurrence and may arise within days or a few months to years after a cataract surgery.

The treatment of PCO is very simple and does not usually take longer than 10 to 20 minutes. This procedure is called Posterior Capsulotomy. In this procedure, an Nd: YAG laser is used to make a few small holes in the posterior surface of the capsule, allowing the light to pass through to the back of the eye. Before the procedure, the eyes of the patient are dilated to provide a larger field to work upon. Throughout the procedure, a magnifying glass is used to enlarge the view. Immediately after treatment, the patient might notice a difference in their vision.

The YAG laser treatment can be performed within days of the cataract surgery and as soon as the vision starts to blur. Sometimes after the cataract surgery, there is some inflammation around the newly inserted lens, which is why sometimes YAG laser treatment is postponed for a month or two, to allow the inflammation to settle. After the inflammation settles down and the lens becomes fixed into the capsular bag, then the YAG laser treatment can be performed.

The treatment is done on an outdoor patient basis. No preparation is needed for the procedure such as unconsciousness or change of clothes. The patient will be awake and aware throughout the procedure but will feel no pain. The first step of the treatment is the measurement of the eyesight and the testing of the vision. After the vision has been tested, drops will be added to the eye undergoing the procedure. One type of the drops will make the eyes dilate which will give the surgeon more area to work on and the other one will anesthetize the eye and numb the area so that the individual will not feel any pain or any other sensation.

The patient will be seated in front of a machine similar to the one seen during regular eye examinations. A special lens is placed in front of the patient’s eyes, which will allow the surgeon to view the ocular field more clearly and then the laser is applied to make a small hole in the posterior capsule of the lens which will allow the light to pass through, from the lens to the retina. The procedure will take 10 to 20 minutes at maximum and after that, the patient will be asked to wait for an hour during which his vision and the intraocular pressure of the eyes will be measured.

Immediately after the treatment, there will be a noticeable difference in the vision. Although there will be some blurring due to the use of dilators in the eyes and their effect will persist for a few hours, which is why the patient will be unable to drive and another arrangement might be needed to be made. After the treatment, rest is advised and the patient is free to go home. Depending on the patient and the previous eye conditions, medication such as the anti-inflammatory drugs will be prescribed for a few days to allow any persisting inflammation to settle. Other than that, no precaution will be needed and normal activities can be resumed soon after.

In YAG laser treatment, complications are very rare and usually unheard of, though there might be some minor side effects. The most common is the persisting effect of the dilators used. Due to the use of eye dilating drops, the patient might experience blurred vision for a few hours, until the effect of the dilators disappears. In the initial few hours to days, the patient might also experience some ‘floaters’ in the field of vision, which are tiny fragments of the posterior capsule and will soon disappear.

Sometimes, if laser treatment is done immediately after the cataract surgery, thus not allowing the previous inflammation to settle down first, then the eye might become red and painful after the procedure. Another complication that might be associated with the procedure is the raised intraocular pressure secondary to a previous history of Glaucoma, which is characterized by a persistently raised intraocular pressure. That is why the patient is only given leave after his intraocular pressure is found to be in a normal range and not before.

At Focal Point Vision, we pride ourselves on patients’ satisfactory results and feedbacks. Every aspect of the treatment, from regular visits to surgeries, postoperative care, and the cost, is modified to facilitate our patients so that they may get the best treatment that is offered with ease and comfort.