Post-Cataract... Anyone have PCO and YAG laser fix?

[Telly]

Thanks to one of our Admins, Alan, for mentioning "PCO" in a thread a while ago. I had never heard of it then. PCO is Posterior Capsular Opacification, something I didn't know was a relatively common after-effect of cataract surgery. It is the growth of original lens cells around the IOL, that if it happens, causes a cataract-like effect. From what I read, it can be corrected by making an opening in the rear of the capsul with a YAG laser, an outpatient procedure.

When I had my second eye's cataract operation in 2018, it was a late morning appointment, and we noticed a subset of older people coming into the waiting area, that were called up, went back to the work area, and re-appeared not long afterwards, and then left. Had no idea what they were there for at the time. Did not fit the usual routine flow of either of my cataract removals. I now suspect they were PCO patients there for YAG work.

A UK National Health eye website, which has been a good and almost only source of info for my original very odd cataract issues, states there is a relatively high percentage of people going back for PCO fix within a few years of cataract surgery and IOL placement.

The visual effect of PCO to the patient is like having a cataract "come back". So this is all new to me, because my very unusual cataracts in both eyes did not have any of the usual cataract clues, like glare/"halo" around lights, trouble seeing at night, on and on.

I go to my Ophthalmologist next month, and am expecting a PCO diagnosis and schedule for YAG work in one eye.

I am interested in hearing from those who have had PCO, and had YAG laser work to correct. About the procedure, and anything else useful. Particularly if you were fitted with a coupling-lens attachment that sat on your eyeball during the YAG work.

Pre-2010 I think it was, I had a PVD-caused retinal tear, and it was fixed by hammering me with pulses from a Argon laser to burn a series of dots through my retina around the tear to allow scar tissue to grow through and hold it. The sun was a dim bulb compared to it, and after many pulses, it was like getting punched in the eye. I am very happy that it all worked out, but getting the coupling lens onto my eyeball was a real chore. Don't know if a coupling lens is used for YAG work on PCO.

For a quick description of PCO from wiki:
https://en.wikipedia.org/wiki/Cataract_surgery#Complications
Scroll down about half-ways to "Complications", the second bullet is PCO. A one-paragraph description.

 

[braumeister]

I am interested in hearing from those who have had PCO, and had YAG laser work to correct. About the procedure, and anything else useful.

According to my eye surgeon, PCO (sometimes called "secondary cataract" is common and nothing to be concerned about. He said if it happens you only need a five minute appointment for a zap with the green laser to fix it. They do it all the time.

I haven't had it myself (my cataract operations were eight years ago) but I've heard the same from others who did.

 

[MRG]

I had cataracts in both eyes and subsequent secondary cataracts. There was no attachment to my eye during these procedures. The second was done flawlessly the first caused my retina to detach and a surgery to fix it.

Honestly the retina repair was one of the worst things in my life. As I mentioned to the new surgeon before he did the second one "I didn't know if I should stick a knife in my eye or a bullet in my brain". The pain was intense and the distortion unbearable. I still have bubbles in the eye as the surgery bubble didn't clear. After 2 years it's a distant unpleasant memor. The pain is gone now, and the distortion was improved by me wearing glasses all the time.

Your chances of having a retina detach are low but increase with long eyeballs like mine. Good luck.

 

[Peter]

Timely thread, since I'm scheduled for the YAG treatment this coming Tuesday. I am a little concerned, even though I've read all the web stuff about how the procedure is quite routine and low risk.

Don't want to convert what's now a minor problem into a major one (e.g. retinal tear). Not too keen on a new collection of 'floaters" either. But I'm going ahead anyway. Will report back.

 

[ShokWaveRider]

Yes, I needed my left eye done 3 years later, no issues. Right eye is still OK. But I have had a vitrectomy in each eye since they were put in.

no need to be concerned YAG takes about 5 mins per eye, totally painless, some floaters for a couple of weeks.

 

[Marti]

I had cataract surgery in both eyes when I was 40. I needed to have the YAG done on the left eye and it was a piece of cake. Done in minutes, no pain, no side effects.

When I was 50, the retina in my right eye detached and it took 5 different procedures (1 laser outpatient surgery, 3 laser in office treatments and finally another in office treatment where they froze it). It was a long painful ordeal, but I still have my vision! In my experience, there is absolutely no comparison between the JAG and retina procedures.

 

[eytonxav]

Very common post cataract surgery. I had the YAG laser touchup done to both my eyes and it will certainly improve your vision. Several zaps around the periphery which takes a couple of minutes. Totally painless.

 

[Telly]

I'm glad to hear that a coupling lens isn't needed during YAG correction of CPO! Getting that coupling lens onto my eyeball correctly for retina work was more of a hassle and worry than the getting punched in the eye repeatedly with the Argon laser on super-star power! I cannot wear contacts, my brain goes to great lengths to keep anything off/out of my eyes. A strong natural reflex for me. My Ophth was starting to get concerned/frustrated in inability to get it on right, and was saying that if he couldn't do it, he would have to refer me to a Retinologist. Some special coupling lens he almost never uses and had to hunt around for, and deadening eye more than usual via lots of drops finally got it on. Whew! Glad I don't have to go through that again for YAG CPO work!

Like MRG, I too have long eyeballs which are the cause of myopia. The length of the eye is measured via a laser "depth finder" prior to cataract surgery, to estimate the characteristics needed for the IOL. I have just the simple spherical lenses, that get spherical in the ballpark. My glasses lenses then do the astigmatism correction I need, and adjustment of spherical power to get it all optimized via progressives. My Ophthalmologist was not keen at all for any sort of fancy lOLs for me, if I understood correctly due to the increasing measurement error with long eyeballs (and the laser measurements are through the existing cataracts, and I had very strange ones!). So though my level of myopia is much much reduced now if I don't put my glasses on, I still have the long eyeballs that are more prone to retinal detachment for any reasons at any time.

Not a sentence, but an increased probability compared to other people, that over the years that something negative can happen. Urk!

Peter, I will be interested in hearing your experience.

 

[Peter]

Peter, I will be interested in hearing your experience.

Apparently the YAG facility is flooded and my appointment has been cancelled. There was about 6 inches of rain over the weekend, which is a lot for this area.

Hoping I get a new date soon. Will report back after that happens.

 

[Telly]

Apparently the YAG facility is flooded and my appointment has been cancelled. There was about 6 inches of rain over the weekend, which is a lot for this area.

Hoping I get a new date soon. Will report back after that happens.

Bummer, Peter!!!

 

[Telly]

Update

I will probably break this up into multiple postings, as I want to later do a good description of the YAG-fixing of PCO routine for those who may face this in the future.

Two weeks ago I had the appointment with my Ophthalmologist, hereafter referred to as "the Doc" since I have a heck of a time spelling the Ophth word correctly. My own diagnosis was confirmed... need glasses astigmatism correction for one eye, YAG work for the other. The helper, then the Doc, seemed to be concerned about the large difference in vision between my two eyes via the Snellen Chart. I didn't think it was odd, as the PCO cloud was blocking a lot of info from that eye! Maybe both eyes tend to go together for most people wrt PCO.

He also wanted to run a laser scan of both eyes retina/macula. Actually I wonder if it is really OCT, Optical Coherence Tomagraphy, which can work through a cloudy medium. Anyway, the scan gives two outputs: A line elevation graph of retina and macula, and a terrain-mapping contour map of the same, color-coded for elevation. My eye with no problems other than an astigmatism shows a nice pit for the macula/fovea, which is how it should be. My eye with bad PCO shows no pit, but a gentle hill instead. This was explained as scar tissue that pulled on my retina. The "macular pucker" in layman's terms. This is totally unrelated to PCO. The thought was after YAG work and some settling time, see if refraction could make my detail vision in that eye acceptable. If it can't, he would refer me to a retinologist (oh..., boy!). If in time that happens, I'll probably tag that effort/torture onto Kat's eye topic about Vitrectomy etc.

So YAG for PCO eye was scheduled for the next week, and YAG for the other eye the week after. On to first YAG day --->

 

[braumeister]

You're getting into some serious specialization there (never heard of a retinologist before).

Reminds me of when my mother needed some plastic surgery after cancer removal on her face. She wound up with a surgeon who operated on nothing but eyelids. I always thought that was the most specialized specialty ever.

 

[Telly]

YAG Day - The process

YAG Day, the first one on PCO-clouded eye. On the way there dark and early, DW driving as no way I could with headlights, I could see a bit of blooming in headlights in the OK (non-PCO-clouded) eye. So it made sense to have that eye YAG'd the next time.

A little physics first - "YAG" is for Yttrium Aluminum Garnet, a crystal. There are many types of YAG lasers, depending how they are doped to lase. For PCO work, it is Neodymium as the dopant into the YAG crystal structure, these are called Nd:YAG lasers. They output at 1064 nanometer wavelength, which is in the infrared spectrum, not visible by the human eye.
A co-located low-power visible laser is used as a visible pointer, so the Doc can see where the YAG is pointed, off or on. The pointer in my case was red.

The process - A helper took me into an exam room, everything described/done is only for the eye to be YAG'd, the other eye was left alone. Measured eye pressure - OK. Put in numbing and dilation drops. Went to the Dark(er) Room to wait for eye to fully dilate. Maybe 20 minutes or so later, into a PCO YAG laser room.

When Doc came in, set chin on chin rest, press forehead against bar, the usual apparatus setup. A small red light is positioned in front of my eye that is not going to be worked on. I am to keep focused on that (which keeps my to-be-YAG'd eye positioned properly). Doc fiddles with line up for my eye to get straight in. Open wide, I ask if it ok to blink once in a while, Doc says yes. DW, positioned nearby, thinks I only blinked once.

So as I watch the little red light, he uses about 1 second max pulses, and moves around a bit. DW counted 21 pulses of the laser, plus or minus one count. Occasionally I could see the pointing red laser sweep across, it's not too bright, it's fine. Only near the end did I start to lose the little red light, temporarily obscured by a white blooming, but it came back. I think from start of lasing to end of lasing, was at most 2 minutes, really think it was less. No pain, none. Not at all like the green Argon laser retina-punching work done on that same eye some years ago!

Afterwards - On the way home, wearing the darkening insert due to dilation and a bright sunup, I tried to see if I could see better. I thought a little better. Just too bright out! At home, with eye so dilated, getting internal reflections, I still thought it was better. That evening, after dilation finally wore off (it takes a long time for me), I could see much better! The next morning outside, Wow! oh I could SEE! I also could see all sorts of new floaters, some rod-like, some small bits, a new "fly-went-by" in addition to my permanent fly. But day by day, the new floaters decreased markedly, very little of them left now. I guess they just don't have the stamina of my usual floaters

Now that my vision is clear in that eye, I can see just a little curvature upwards above my aiming spot if a horizontal line is there. And I mean a very little, and I don't notice it reading, at least so far. Outside, I would never notice it at all. It takes man-made objects, long, straight, with sharply-defined edges, to see it at all. So I am hopeful that no ghastly follow-on work will be needed. Next, on to YAG the other eye, then a week or two to a refraction session, and see what it all comes down to.

 

[Peter]

Thanks for the update, Telly. I'm still waiting for my YAG procedure. First the area where they administer the drops was flooded. Then I was rescheduled and told I had to get another COVID test at their testing facility. Except said facility was closed. Can I get tested at a local pharmacy? No, it has to be at our facility!

Beginning to wonder if it's all a 'sign' ... !

 

[Katsmeow]

This was explained as scar tissue that pulled on my retina. The "macular pucker" in layman's terms. This is totally unrelated to PCO. The thought was after YAG work and some settling time, see if refraction could make my detail vision in that eye acceptable. If it can't, he would refer me to a retinologist (oh..., boy!). If in time that happens, I'll probably tag that effort/torture onto Kat's eye topic about Vitrectomy etc.

Now that my vision is clear in that eye, I can see just a little curvature upwards above my aiming spot if a horizontal line is there. And I mean a very little, and I don't notice it reading, at least so far. Outside, I would never notice it at all. It takes man-made objects, long, straight, with sharply-defined edges, to see it at all. So I am hopeful that no ghastly follow-on work will be needed. Next, on to YAG the other eye, then a week or two to a refraction session, and see what it all comes down to.

Yikes, Telly, I sure hope you don't need a peel for your macular pucker! I was interested to read about the YAG treatment. I just had both cataracts done so I will keep an eye out for that in the coming years.

One thing I did to measure visual distortion was find online a good clear Amsler grid and look at it. I found that I had some line waviness both horizontal and vertical plus everything slanted down to the right. The other odd thing is that objects seen with the affected eye look bigger. I only noticed that when I would look at something with the OK eye and then with the macular pucker eye.

At 3 1/2 months after my peel, I have gotten back most of my lost visual acuity in that eye and the waviness is mostly gone. The slanting and larger size are still there but no big deal.

The thing about macular puckers is that scar tissue can continue to form and your vision can continue to deteriorate. For some people it doesn't get bad and they can just monitor it and don't need surgery. In may case, my vision rapidly went bad. Let's put it this way. By the time your vision gets bad enough to have surgery you are willing to go through the surgery to try to get better vision. I sure hope you never get bad enough to need it. They will most likely have you seeing a retina doctor periodically to monitor it.

 

[Telly]

YAG Day #2

Thanks Kat. My affected eye also makes things slightly bigger. A round clock face is a good example. If I alternately open/close eyes, the clock will change size. The clearer clock is from the puckered eye! Probably because I need a astigmatism prescription change for the non-puckered eye. In the past, one eye could be better than 20/20 with glasses. Oddly, it is the eye that I have had problems with! As much as a whole macular peel and possible gas bubble thing gross me out, if it eventually comes down to being legally blind in that eye, I could see myself (oh, no pun intended!!!) biting the proverbial bullet, and going ahead with it.

YAG Day #2 - Pretty much the same as the first time. We had a few minutes by ourselves in the YAG laser room, the machine is a Zeiss Capsulas YAG II Plus, like this: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Ftse2.mm.bing.net%2Fth%3Fid%3DOIP.LWDdMqnrATQzN5W6yM_VWAHaJ4%26pid%3DApi&f=1 View is from the Doc side.

This time, after only 6 hits, he suddenly stopped, all done! Huh? Last time was 21 hits. I asked about the hole pattern he makes... Doc makes in effect a plus sign, holes in a vertical line, holes in a horizontal line. Then the back of the capsule folds backwards. Difference in the number of hits required is due to different toughness in the capsule back. My worrysome eye must have been a real toughy!
This time, there were very few floaters, and I think all but one tiny one have disappeared within 48 hours. Probably due to a lot less fragments, and thin ones at that.
Next visit is checkup and refraction, will see were it all stands then. After Thanksgiving.

 

[Telly]

Follow-Up

Had my checkup.
Both eyes were able to be corrected to 20/20 dialing lenses with the phoropter. So that's great! No mention from the doc about the epiretinal membrane (abbreviated as ERM in the business). He had said back in early November that after YAGing the PCO in that eye, if vision could not be dialed in with a glasses lens change, he would refer me to a Retinologist. So I'm OK right now. Will see him again in 4 months. I'm usually just once a year. So no doubt monitoring the ERM to see if anything changes. If it changes, I'm thinking I would probably notice it myself first. I didn't notice it before in vision because the PCO was so bad, it hid it.
Just tonight, I found a site that has a simple yet pretty thorough explanation of an ERM, worth reading for the minute it would take to do so:
https://www.asrs.org/patients/retinal-diseases/19/epiretinal-membranes

Additional info -- Eye Pressure.
Eye pressure is measured in mm Hg, millimeters of Mercury, same as blood pressure. I have read that "normal" eye pressure is 12 - 22 mm Hg. Over 22 mm Hg thoughts start to run to checking for Glaucoma, although there is a form of Glaucoma where the pressure isn't high. Eye pressure can sometimes be lowered down to 5 mm Hg with drugs in the treatment of Glaucoma.
After my eye pressure has been measured, I usually ask "how does it look?" The answer has always been "looks okay, looks fine, etc". But lately I have started asking WHAT the actual numbers are. My eye that was really needing the PCO YAG work, the same one discovered with the ERM, was 19 in the initial examination in early November. I vaguely remember asking a couple years ago, and they both were 14 -15 range. I asked this time, they were 12 and 13, and the person testing them said that's really great! I suspect that they move around in pressure over time.
I'm just adding this in case anybody wondered about what numbers to expect and what the units of measurement are.

I proceed from this point forward... with both fingers crossed...

 

[eytonxav]

I had a severe ERM at the time of my cataract surgery and also had a pretty significant floater that was quite bothersome. Unfortunately, that pucker led to a less than optimal lens replacement in that eye, so coupled with the floater, I had the peel surgery a few years later which has helped both my vision, plus getting rid of the floater. When I was younger, I had no idea of all the issues you can run into with ones eyes as we age. Hope your ERM stays stable and does not cause you any vision issues Telly, as the peel surgery can take quite a while to recover from as inflammation is slow to subside.

 

[Peter]

After several scheduling screwups, I finally had my PCO done this morning. I didn't count the zaps, but probably 10-15. Fuzzy vision for a few hours afterwards, but now I would say my vision is back to where it was after the cataract replacement. No floaters so far.

I'm very happy!

 

[tsdogs]

That's great! I had the same experience after the procedure. Simple procedure, noticed a difference right away.

 

[Telly]

That's Great, Peter!

I have noticed something since right after YAG. Only on the second eye done, the eye without PVDs nor torn retina nor ERM. After YAG, I noticed what some call a "starburst" effect on bright lights, on more pin-point like lights.

With some experimenting, I found it only happens when that iris is pretty wide open. If I walk closer to the light, so that total light into eye increases, the iris reduces in size and the starburst goes away. I can easily duplicate it every night with a night light at home. If I see the starburst, I can eliminate it by using a small single-LED light, like those freebie keychain lights, and aim it up at an angle into either eye, like done in an eye exam to test for iris action. That closes the iris down some, and the starburst goes away. Move LED away, and the starburst comes back after a short delay. I need to check night driving with oncoming headlights to see if it is a big problem for me or not. I do very little night driving. But never know when I need to.

I have a 3 month follow-up window with the doc, so probably will go back in January to have it looked at. I'm wondering if some of the posterior capsule in that eye did not completely fall back, and may need a couple more hits with the laser. That would be a simple fix! The starburst is not all the way around the "star", about a quarter of a turn has no starburst. If I tilt my head left or right, it tracks with head movement.

 

[eytonxav]

I continued to wear glasses after my eye surgeries and have recently noticed that my left eye is getting weaker without glasses and that the sphere measurement for my glasses changed from .5 to 1.25 post 2 years after the cataract surgery. This makes me think a secondary cataract is present. I need to get an appointment to have this checked out, although my optometrist has not said anything at my last two checkups. As for me, I have not paid attention to these Rx changes and did not really notice anything as I have my glasses on at most times. Hopefully it's just a PCO that I can have zapped.