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YAG Laser Treatment for Secondary Cataract
Months or years after cataract surgery, the thin capsule that holds your lens implant can turn cloudy — a "secondary cataract" — and vision dims again. A YAG laser capsulotomy with Dr. Michael E. Rom at Insight Eye Center in Mentor clears it in one to two minutes, without anesthetic or incisions, and the result is permanent.
What is a secondary cataract?
A secondary cataract is not actually a cataract. During cataract surgery the thin membrane that surrounds the natural lens — the lens capsule — is left in place to hold the new implant. Months or years later that capsule can turn cloudy, a condition called posterior capsule opacification, and vision becomes hazy again much as it did before surgery.
The haze is a film produced by microscopic lens cells that remain on the capsule after surgery; it is impossible to remove every one. The cells keep making the same protein material they always did, and the film gradually migrates across the back of the capsule, behind the implant. Because the cataract itself was removed, it cannot come back — only the capsule can cloud.
Posterior capsule opacification is the most common complication after cataract surgery. It develops in a substantial share of patients at some point after surgery.
What is a YAG laser capsulotomy?
A YAG laser capsulotomy is a quick, painless office procedure that clears a clouded lens capsule. YAG stands for yttrium aluminum garnet, the crystal that generates the laser. Its focused beam passes harmlessly through the cornea and the lens implant and makes a small opening in the hazy posterior capsule, so light reaches the retina clearly again.
The YAG laser suits this task because it delivers a focused beam that affects only the tissue it is aimed at. The energy vaporizes a small central area of the cloudy capsule and leaves the cornea, the implant and the rest of the eye untouched. Vision is usually restored to the clarity you had after your cataract surgery.
Dr. Rom is very patient and takes the time to answer all your questions. He took the time to make sure I understood the procedure and that I was comfortable throughout. He has a very caring chair-side manner.Kathleen S. · patient
What happens during a YAG laser capsulotomy?
The treatment takes one to two minutes and needs no anesthetic injection, because the capsule has no nerve endings. Your eye is dilated with drops, you sit at the laser as you would at an exam, Dr. Rom tells you where to look, and the laser delivers a series of brief pulses — about 30 on average — through the cornea to the capsule.
- Dilating dropsYour pupil is widened so Dr. Rom has a clear view of the capsule behind the lens implant. No other preparation is needed — no pre-treatment medication, no fasting.
- At the laserYou sit with your chin on a rest, the same position as at the slit lamp. Dr. Rom tells you where to look. If you blink, nothing is harmed — the laser is focused on the capsule, not the lids, so no eyelid-holding device is required.
- The pulsesAbout 30 brief laser pulses, on average, open the cloudy central part of the capsule. You may hear a click and see a flash with each one. The whole treatment takes one to two minutes.
- AfterwardVision may be a little blurry for a few hours from the dilation and you may notice a few new floaters, which decrease over time. There is no pain, and you can go straight back to normal activities.
What can I expect after a YAG laser treatment?
Most patients notice clearer vision within a day or two, once the dilation wears off, and the improvement is permanent: the opening made in the capsule does not close and the haze does not return. A few new floaters are common at first and fade with time. Cataract surgery itself has a very high success rate, and a YAG capsulotomy restores that result when the capsule clouds.
In the United States over 3 million patients undergo cataract surgery each year with an overall success rate of 98 percent or higher; a clouded capsule is the most common reason vision dims again afterward, and it is the easiest to fix.
Common questions about YAG laser treatment
Short answers to the questions patients ask most often. For anything specific to your eyes, ask Dr. Rom at your visit or call the office at (440) 286-1188.
Does a YAG laser capsulotomy hurt?
No. The capsule has no nerve endings, so no anesthetic injection is needed; only dilating drops are used. You may see flashes and hear clicks during the one-to-two-minute treatment, but there is no pain during or after it.
Do I need to prepare for a YAG laser treatment?
No. There are no drops or medications to take beforehand and no fasting. Your eye is dilated at the visit, so vision is blurry for a few hours afterward — ask the office whether you should bring a driver.
What if I blink during the laser?
Nothing is harmed. The laser energy is focused on the capsule behind your lens implant, so blinking does not affect your eyelids or other structures, and no eyelid-holding device is needed.
Can the cloudiness come back after a YAG capsulotomy?
No. The opening in the capsule is permanent, so the haze does not return. Very rarely a second, larger opening is needed if the first was small.
Is a secondary cataract a real cataract?
No. The natural lens was removed at cataract surgery and cannot cloud again. A secondary cataract is the capsule that holds the implant turning cloudy — which the YAG laser clears.
How soon after cataract surgery can the capsule cloud?
It varies from months to years. Some patients never develop it. If vision that was clear after surgery becomes hazy again, a dilated exam at the Mentor office shows whether the capsule is the cause.
Has your vision clouded again?
If vision that was clear after cataract surgery has turned hazy, request an appointment with Dr. Rom in Mentor. A dilated exam shows whether the capsule is the cause, and the laser treatment is quick.
