In a steady and caring tone, Dr. Gerald Lane patiently explains each step of the process for a patient preparing to undergo a procedure known by the acronym – YAG. According to Lane, YAG stands for Yttrium Aluminum Garnet – the three metals that are joined together to form the incisive surgery.
“(The metals are) what forms the laser,” Lane explained. “And, YAG is a procedure done on post-cataract patients who develop opacity, or clouding, in the posterior capsule.”
The natural lens has a cellophane-like outer lining called the capsule. During cataract surgery the back membrane of the natural lens (posterior capsule) is left in place to support the artificial, intraocular lens implant. The posterior capsule is normally clear, however, people who have cataract surgery will eventually develop cloudiness of this membrane.
“It is normal for all patients, after cataract surgery, to develop posterior capsule opacity and between three months to three years or so they will need this (YAG) procedure,” Lane said. “A patient will perhaps realize a need for this procedure as their vision becomes blurry.”
The condition should not be a complete surprise to patients, according to Lane, as most cataract surgeons warn their patients that this condition may develop in the future. They examine patients at around six months after a cataract procedure to see if the condition is in fact developing.
“The cause of the condition which prompts the (YAG) procedure occurs following cataract surgery,” Lane said. “We remove the natural frosty lens from the eye and then we try to clean cellular debris from the capsular bag. Some transparent cells remain that later opacify. They then tend to migrate across the capsule causing a fog in one’s vision.”
The decision to have this procedure is based on the same criteria as the decision to have the original cataract surgery:
§ Vision problems are affecting your work or lifestyle.
§ Glare caused by bright lights is a problem.
§ You cannot pass a vision test required for a driver's license.
§ You have double vision.
§ The difference in vision between your two eyes is significant.
§ You have 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.
The procedure, more formally called “YAG laser capsulotomy” is as simple as a routine office visit. After dilation of the pupil, the patient sits at the slit lamp. The surgeon focuses the laser beam precisely on a part of the clouded capsule and applies the laser beam. This makes an opening in the cloudy membrane without affecting any other part of the eye.
“The procedure itself is very brief and takes only 30 to 60 seconds per eye,” Lane said. “We have the patient arrive 30 minutes prior to their procedure so that one or both eyes can be dilated. Patients are allowed to stay in their normal clothing”
Done on an outpatient basis, Lane says the procedure, is relatively simple and he added, “it is not painful.”
“A topical anesthesia is used to numb the eye temporarily and a patient may hear a ‘snap, snap’ or clicking sound during the procedure, but they will feel no pain,” he said. “Visual improvement occurs in 3 to 4 hours when the dilated pupil constricts and after the procedure, patients are able to resume their normal activities very quickly.”
As with most procedures, there is a chance for some complications, however, they are extremely rare. Most common complications are floaters, which may be present for a few days or a few weeks. Occasionally, the eye pressure will increase and medication may be required.
The benefits are great.
“It clears ones vision, much like it was cleared after the original cataract surgery,” Lane said.
There is really no age limit for the procedure, according to Lane.
“Most cataract patients I perform this procedure on are age 50 on up; however, on a rare occasion we do cataract surgery on teens or younger patients,” he said.
Lane has been very busy with YAG procedures at Southwest Medical Center in Liberal.
“Most months I do 10 to 15 YAG laser treatments on eyes at Southwest Medical Center,” he said. “In June, I performed 33. We are delighted that the practice is growing. YAG laser creates an elegant central clarity that restores the patient’s vision. It is wonderful to live in an age where we can all benefit from the YAG laser surgery.”