Cloudy vision is often one of the first clues that you might be developing cataracts, an ocular issue that an estimated three out of five people over the age of 60 will develop. The good news is that cataracts are easily corrected with surgery. The other news? Cataract surgery doesn’t always permanently correct the clouding and blurry vision. According to Dr. Allison P. Young, Eye Physician and Surgeon in San Antonio, Texas, approximately 20% of all patients who undergo cataract surgery will develop a film or cloudiness on the supportive capsule behind the lens implant. That’s where a YAG laser capsulotomy (aka YAG laser treatment) can help.
If you’ve ever driven a car with a dirty windshield, then you have an idea of what it’s like to try and see with a cataract. The hazy, cloudy vision occurs when there are changes to the tissue that makes up the eye’s lens. Those changes can be attributed to many factors, from eye injury to excessive sun exposure to high blood pressure, but they can also be the result of the aging process. As our eyes age, the lenses become thicker, less flexible, and less transparent. The protein and fibers can break down and clump together, creating the film-like covering that causes that “dirty windshield” sensation.
The situation may start as something that is only mildly irritating, but over time a cataract can grow to create a host of problems that make daily activities like driving or reading difficult. One of the most common ways to treat cataracts is through intraocular lens implant surgery. This outpatient procedure removes the clouded lens and replaces the empty capsule with a flexible interocular lens. Once the lens is removed, the cataract will not grow back, and the vision is restored. However, if posterior capsule opacification occurs, the blurring and cloudiness once associated with the cataract may return, requiring the use of the YAG laser to treat the problem.
How YAG Works
Unlike LASIK, which reshapes the cornea and treats near-and-far-sightedness, YAG (yttrium aluminum garnet) treats the capsule that holds a lens implant. Months and sometimes years after cataract surgery, this capsule can become opaque and thickened with the regrowth of cells. That thickness, or scar tissue, prevents light from getting to the retina, creating vision problems similar to and sometimes worse than those stemming from cataracts. Named for the crystal that is located within the laser, YAG works by making a small opening in the posterior capsule, allowing light to once again pass through to the retina. The result is clear vision and glare reduction. The painless, relatively simple process takes just a few minutes to perform and is usually done in your ophthalmologist’s office.
“For my patients, we simply perform the procedure the same day that the cloudy capsule is identified,” says Young, adding that she performs “hundreds per year.”
YAG Laser Treatment: The Procedure
Similar to the machine used for an eye exam, the YAG machine has a chinrest where you place your chin and a headrest for your forehead. The doctor numbs your eyes with a topical anesthetic (eye drops) and places a contact lens on your cornea to keep the eye still. The doctor will aim the laser at the posterior capsule to create the opening as you stare straight ahead. You will see flashes of bright light during the procedure, and you may hear a clicking sound, but you should experience no pain or discomfort. Once the process is completed, your doctor will check your eye pressure before sending you home with any additional post-care instructions or prescriptions.
Young says that the improvement in eyesight is immediate and that, while there may be a few extra “floaters” in your field of vision, they will resolve within a week or two. Other than the blurred vision that results from the dilation of the eyes for the procedure, there is no downtime from a YAG laser capsulotomy. Patients usually return to work or resume other normal activities the day following surgery.
One Final Glance
As with any procedure, there are always risks, but Young assures that they are “exceedingly rare” and may include an increase in intraocular pressure and retinal tears. And, if the lens implant is not initially securely positioned in the capsular bag, then YAG may not be the appropriate option. Your doctor will assess your situation to determine if YAG laser is suitable for you and discuss any post-care instructions, including the use of anti-inflammatory eye drops for several days following the procedure.
The cost of YAG laser treatment can range from a few hundred to upwards of $1000, but it is typically covered by all insurances if the patient has experienced significant vision impairment. Once performed, however, Young says that the results are permanent.
“Once the capsule has been opened with the laser, it will never become cloudy again.”