Prophylatic laser iridotomy

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Barbara - 04 Jul 2006 03:43 GMT

Has anyone had this preventative treatment to avoid acute narrow angle
glaucoma and with what results, such as adverse side effects?

Tkx for input.
Barbara

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Anon E. Muss - 04 Jul 2006 06:09 GMT

>Has anyone had this preventative treatment to avoid acute narrow angle
>glaucoma and with what results, such as adverse side effects?

I haven't had a laser peripheral iridotomy (PI) myself, but I've sent
several patients to a local glaucoma sub-specialist who has performed
this procedure on them.

Properly performed laser PI appears to be relatively benign (low risk
of ghost image, increased IOP, perhaps accelerating rate of cataract),
especially considering how nasty an acute angle closure glaucoma
attack can be.

Any other questions?

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Barbara - 04 Jul 2006 15:50 GMT

Tkx very much for your import. I suppose my "other question" is - is
the risk of side effects worth taking when I have no symptoms (normal
IOP - no family history, etc.) but just the observation by a specialist
of "narrow angles"?

I find this such a difficult decision to make.

Many tkx
Barbara

>> Has anyone had this preventative treatment to avoid acute narrow angle
>> glaucoma and with what results, such as adverse side effects?
[quoted text clipped - 9 lines]
>
> Any other questions?

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Anon E. Muss - 04 Jul 2006 17:05 GMT

>Tkx very much for your import. I suppose my "other question" is - is
>the risk of side effects worth taking when I have no symptoms (normal
>IOP - no family history, etc.) but just the observation by a
>specialist of "narrow angles"?

Knowing the actual angle configuration via the Spaeth gonioscopic
grading system would be helpful.

I don't *normally* recommend surgery for patients with merely
anatomically narrow angles (confirmed by gonioscopy).

However, when *other risk factors* are present such as progressive
narrowing of the angle, increased IOP, symptoms suggesting
intermittent angle-closure, monocular patient, condition requiring
frequent dilation, inability to reliably maintain follow-ups, etc.
recommending a laser PI is a no-brainer.

>I find this such a difficult decision to make.

Get a second or third opinion, preferably from a fellowship trained
glaucoma sub-specialist.

Ask them a couple questions: 1. How narrow are your angles (i.e.,
less than 90 degrees of trabecular meshwork visible, impending closure
imminent?) and 2. Besides the presence of narrow angles, what other
risk factors or reasons do you recommend surgery?

Here's a great article written on the subject written by David
Freidman, MD, MPH, of Wilmer Eye Institute in Baltimore (arguably the
top ophthalmology residency program in the United States):

<http://bjo.bmjjournals.com/cgi/content/full/85/9/1019>

If it were *my eyes* and it was questionable (not definite either
way), I would have laser PIs performed.

Hope that helps.

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Barbara - 05 Jul 2006 17:07 GMT

Thank you for replying to my "difficult" decision.

I don't have increased IOP or symptoms suggesting intermittent
angle-closure - I don't know whether the angle is progressive
(goniosopic exam performed at 6-9 mth intervals). The specialist won't
take a chance on dilating my eyes but says he sees no reason to dilate
them at this time.

I am 64 and the specialist says the "box" is bound to get smaller as I
age; but it's very difficult to agree to a procedure when you are
feeling well and have never had any eye surgery and only wear drug store
magnifiers for small print. (No cataract at this time).

I will read the article you have reference.

Thank you so much for your time.
Barbara

>> Tkx very much for your import. I suppose my "other question" is - is
>> the risk of side effects worth taking when I have no symptoms (normal
[quoted text clipped - 33 lines]
>
> Hope that helps.

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