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Yag Caps

More about cataract lenses

Introduction

Yag caps is a short laser procedure done to clear cloudy vision that may occur after cataract surgery. It stands for Yag Capsulotomy. This laser is needed in up to 50% of cataract surgery patients. It treats a condition known as posterior capsular opacification, also known as PCO, which may occur a few months to a few years after cataract surgery. It takes less than a minute, and one has to put drops for five days after the procedure.

What is Posterior Capsular Opacification?

We place a lens or an IOL in the eye when we perform cataract surgery. This IOL is placed on a thin membrane called the posterior capsule. After cataract surgery, some people notice cloudiness (sometimes called 'after cataract') after several months or years. This blurry vision is because the posterior capsule turns white. The degree of whiteness can vary, and the more opaque the capsule, the cloudier the vision. This thickening is called Posterior capsule opacification (PCO). It is a relatively common complication of cataract surgery and can occur a few months to a few years after cataract surgery. Sometimes, other eye surgeries like retina surgeries where we insert silicone oil in the eye can also hasten PCO formation.  

This thickening or whitening of the capsule causes vision to become cloudy. The capsule is removed by Yag laser capsulotomy, also called Yag CAPs.

Why does PCO (posterior capsule opacification) occur?

After we perform cataract surgery, we place a lens in the bag, resting on the posterior capsule. We have removed all the opaque material, which is the cataract. This capsule has lens epithelial cells on the surface responsible for forming the lens material. After we remove the cataract, these lens epithelial cells get to know that the eye's natural lens is no longer present, and they attempt to form this lens again. Trying to form the natural lens again leads to posterior lens capsule whitening which leads to hazy vision.

Why is Yag Capsulotomy done?

Yag capsulotomy improves vision in patients who have undergone cataract surgery but feel that their vision is blurred after a few months or years after the surgery. Patients usually say that vision was good after cataract surgery but has slowly blurred.

In case of the following symptoms, your doctor can do Yag Caps

  • Vision problems are affecting work or lifestyle.
  • Glare caused by bright lights
  • Double vision
  • The difference in vision between your two eyes is significant.
  • Sometimes you may have a retinal disease, and your doctor needs to see the retina clearly. A Neodymium-YAG laser may be advised if the PCO is obstructing the doctor's view.

How does Yag Capsulotomy work?

Lasers are beams of energy that your doctor can target very accurately. There are a few types of lasers used in ophthalmology, which provide a non-surgical treatment option for certain eye conditions. This procedure is called Nd-YAG laser capsulotomy. Nd: YAG is the type of laser used for this treatment. Nd Yag caps full form is neodymium-doped yttrium aluminium garnet laser. The Nd: YAG laser uses low power and can delicately cut the lens capsule without any risk of damage to other parts of your eye. Usually, capsular opacity can be treated quite simply using a Yag laser. A doctor can make a hole in the surface of the posterior lens capsule so that the light can once again pass directly to the retina. For the vast majority of people, this can improve vision. 

The patient enters the laser room and sits in front of the laser machine. We may require the laser in one or both eyes, and accordingly, numbing or topical anesthetic eye drops are used. The patient, while sitting, positions themself on the laser machine, making sure the chin is on the chin rest and the head is against the headband.

The doctor then focuses the laser on the posterior capsule and fires and the laser beam breaks the posterior capsule. Usually, 3-6 laser pulses are enough to open up the capsule. Patients don't feel pain or discomfort most of the time and notice an improvement in vision within days.

Once done this laser does not have to be repeated.

What are the complications of YAG caps laser?

This laser therapy is considered very safe. Though there are some risks, serious side effects are infrequent. However, for the sake of completion, here are the side effects.

  • Detachment of the nerve layer at the back of the eye (retinal detachment) - This happens when the laser disturbs the vitreous jelly, which in turn is attached to the retina causing a retinal tear.
  • Swelling of the centre of the retina (macular oedema).
  • Damage or displacement of the intraocular lens.
  • Bleeding into the front of the eye - This happens when the laser accidentally hits the iris.
  • Swelling of the clear covering of the eye (corneal edema).
  • Some patients may have greater than expected inflammation after the laser, and they are treated with steroid eye drops. Usually, eye drops are used for five days, but we may use them for longer in these patients.

How well it works?

After this laser treatment, eyesight should be restored to the level the person had following cataract surgery, provided no other problems have developed in the eye. The patient can appreciate this vision improvement in less than 24 hours.  

What are precautions to be taken after the Yag Caps Laser treatment?

One does not need to take precautions like after cataract surgery. This procedure is done in the clinic, and no operation theatre is required.   Usually, we prescribe certain eye drops, which are topical steroids or a combination of steroids and antibiotics. These drops help reduce the inflammation inside the eye, which occurs after the laser and is normal.

Sometimes, your doctor may also prescribe glaucoma eye drops. These drops help in reducing eye pressure. When the eye pressure increases, we get a condition called glaucoma. Sometimes after a YAG laser, there can be a transient increase in the pressure, and thus your cataract surgeon may prescribe glaucoma eye drops for a day or two.

Will I Experience Floaters After My YAG Laser Capsulotomy?

You may experience floaters after the YAG laser treatment. These floaters usually decrease and disappear in the following few weeks. These floaters are nothing but pieces of the posterior capsule floating in the vitreous cavity or jelly. Over time they settle down at the bottom of the eye and stop bothering your vision.

What if I don't have a YAG laser capsulotomy?

The whitening of the posterior capsule is causing blurred vision. Till the YAG laser treatment is done, vision won't improve. So, while YAG laser is not a must-do procedure, it is important to get it done so that your vision improves, and so does your quality of life. 

If an early PCO is not treated, the whitening continues to increase. This whitening is also associated with the thickening of the posterior capsule. The thicker the capsule, the more laser energy is used to break the capsule. Your doctor aims to use as little laser power as possible while doing this procedure, and thus it's not a good thing if your posterior capsule is very thick.

Conclusion

PCO is a fairly common occurrence after cataract surgery and requires a YAG-laser to correct. It is a very short procedure and one must consider getting it done if they are experiencing blurred vision after their cataract surgery. Speak to your cataract specialist to know when would be the best time for you to get it done.

Video showing a Yag Caps Laser

Frequently Asked Questions ?

How much time does Yag Caps take ?
This procedure takes under 5 minutes per eye. Sometimes both eyes are done, and it is equally fast.
What is the cost of Yag Capsulotomy ?
We charge Rs 4000 per eye for this procedure.
What are the complications of Yag Caps ?
Yag Caps is a relatively safe procedure and vision threatening complications are rare.

Some vision blurs after the laser for a day or two. There is also a slight chance of developing retinal detachment, and if you notice any vision blurring after a day, you must report to your doctor immediately.
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