• Reference Number: HEY-592/2022
• Departments: Ophthalmology Department
• Last Updated: 1 March 2022

Introduction

This leaflet has been produced to give you general information about laser treatment for patients who have had cataract surgery and whose vision has continued to deteriorate.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you.

What is YAG laser capsulotomy?

The natural lens of the eye is enclosed in a clear, cellophane like membrane called the lens capsule. During cataract surgery the front of the capsule is opened.  The cloudy lens inside the capsule is removed.  In most cases, the back of the capsule is left in one piece, and a plastic lens implant is put in place in front of the capsule. This capsule is normally clear like a glass window.

In a small number of patients, the capsule thickens and becomes a little opaque. This stops the light reaching the back of the eye. If this happens, you may notice a gradual decrease in vision, problems with glare, or things might look slightly hazy.  The capsule thickening does not damage the eye in any way; it merely makes the sight fuzzy.  Capsule thickening (also called “after cataract”) can happen at any time after your cataract operation from a few months to years. The aim of this laser procedure is to make a hole in the thickened lens capsule (called as laser capsulotomy).

Why do I need YAG laser capsulotomy?

You need YAG laser capsulotomy in order to restore your vision to how it was after the cataract operation.  The decision to have this procedure is based on the same criteria as the original cataract surgery:

• Vision problems affecting your work or lifestyle
• Glare caused by bright lights
• Double vision
• The difference in vision between your two eyes is significant
• Another vision threatening eye disease

The procedure is not needed unless vision loss caused by clouding of the lens capsule is seriously affecting the person’s vision and lifestyle.

Can there be any complications or risks?

The laser treatment should improve your eyesight. However, occasionally there is another cause for the poor vision, such as ageing changes of the retina (macular degeneration), which will limit the improvement in your vision.

You may experience some of the following complications or risks:

• You may notice discomfort in the eye and you will be dazzled afterwards for a short while.
• You may notice ‘floaters’ which are black spots or lines that move around in your field of vision. These are due to the membrane breaking up following the laser treatment, and usually improve with time.
• The pressure within the eye may rise and sometimes requires you to use eye drops to control the eye pressure. This is usually only for a few days until the eye settles following the procedure.
• The laser may damage the plastic implanted lens, but this very rarely affects your vision.
• There is a small chance that your vision may become more blurred due to a build up of fluid on the retina at the back of the eye, which is called cystoid macular oedema. This may require further treatment with drops and tablets.
• There is also a small risk of developing a retinal detachment, which would require further treatment and may threaten the eyesight.

Although the above complications do occur, we take every precaution to reduce the risks and aim to give the minimum treatment necessary. The laser treatment is recommended and carried out in accordance with national guidelines.

How do I prepare for the procedure?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this procedure.

Points to note:

• The procedure is carried out in the eye outpatient department
• For this procedure you should not drive to and from the appointment
• You should take all your regular medications
• You should expect to be in the eye clinic for approximately two hours

What will happen?

Where to go on arrival

You should arrive at the outpatient clinic within the Eye Hospital on our Hull Royal Infirmary site and report directly to reception.

Within the clinic setting

When you arrive at the clinic your vision will be assessed and drops will be put into your eye(s). These are to dilate the pupils which will help with the treatment.

The doctor will explain why you are having laser treatment, if you have not been told at an earlier appointment. You will be asked to sign a consent form.

The procedure

You will be taken into the laser room, where you will sit at a machine with a chin and headrest.  The doctor will put other drops to numb the front of the eye before a special contact lens is placed on it. The laser treatment will then be given. You will hear a clicking sound and see a flashing light. The treatment takes about ten minutes and is not painful. Most patients say that they feel a slight “pop” or “shock” in the eye, but that it does not hurt.

What happens afterwards?

Recovery

After the laser treatment, it is advisable for you to sit for about five to ten minutes to recover.  Your vision will be blurred for a few hours after the laser treatment due to the effect of the eye drops used to dilate the pupil to allow the laser treatment to be performed. You may be prescribed some eye drops or tablets for a short while, to protect the eye against any short term increase in pressure in the eye.

Follow-up appointment

You normally do not require a follow-up appointment following this procedure unless you are having treatment for any other eye condition you will be discharged from the Eye Clinic.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Ophthalmic Department on

(01482) 816658 or 608788 (08:30am-17:00pm Monday-Friday)

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.