Laser Peripheral Iridotomy (LPI)

Did LPIs on both eyes today.  This is necessary before ICL insertion, so the fluids in your eyes can flow as needed and eye pressure remains where it should be.

What is it?  More or less, the doctor puts two holes in each eye, at the top of the iris, using a laser.

This was the part of the procedure that concerned me the most.  Do a search and you’re likely to find more than a few people talking about how painful it is, how they’re experiencing side-effects, such as “white lines” in their vision, etc.

My experience…

Got to the doctors office this afternoon and checked in.  They called my name almost immediately and I was taken to the back where I was given a test for the cell count of my corneas.  Machine looked like all the other machines I’ve used.  “Put your chin here, rest your forehead against the bar. stare at the light, blink, don’t blink…”  This took about 2-3 minutes.

After that, was taken to another exam room where I was given drops that do the opposite of dilate your eyes.  The reason for this is because the holes the doctor makes are through the iris and he needs the pigment spread out, giving him as much room to work with as possible.

Waiting 15 minutes for the drops to work.  After that, was given numbing drops and it was time for the laser (YAG).  The machine it’s hooked up to looked like all of other “rest your chin here and put your forehead against this strap” machines.  There was a sign on the door that said something like, “WARNING!  Laser in use!”

Tech took my blood pressure.  Doctor came in and put a lens that looks like a monocle on my eye.  This kept me from blinking.  Tech held my head against the machine.

He fired 13 “shots” into the right eye, making a low-volume “clicking” sound and leaving me with two small holes above my iris.  Does another 13 on the left.

It was a lot more mild than I expected.  After reading all the (negative) experiences online, I was expecting something like Star Wars.  This thing was more like a laser pointer you’d see a college professor use and felt like it was hooked up to a 9-volt battery.  A little pressure, but more of an annoyance than anything painful.  It’s hardly anything to get worked up over.

As a comparison, I was at the dentist earlier in the day getting my teeth cleaned and x-rays done.  Putting the x-ray film in my mouth was more of a hassle and I don’t think that’s a big deal at all.

You have no reason to fear this part of the procedure.

After he was done, I waited about 10 minutes and did a final test to check the pressure of my eyes.  Got more numbing drops and tech touched the corneas of my eyes with a pen like instrument.  Not painful at all.

Total appointment time was about 30 minutes.  Time in the “laser room” was about 3 minutes.

Vision is a little hazy.  Feels like the colors are a bit off.  Could be all the drops I was given today.  Very little pressure still in the eyes, but no big deal.

ICL in left eye is one week from today.  Until then, I have some steroid eye drops to use four times per day.

13 responses to “Laser Peripheral Iridotomy (LPI)

  1. hi richard,
    Its almost been 1.5 years since u had the iridotomy and icl implants done. I am have booked in for my operation in 2 weeks time but now am feeling apprehensive about the whole thing especially after reading all the negative things eg white lines.. online.
    Can u pls share ur experience with me and ur satisfaction rate with the whole thing. Thanks so much
    Michelle

    • Hey, Michelle.

      For me, it was a very good decision and I would do it again. With that said, I understand being nervous. For me, there was the issue of surgery, but also little “mental” things, such as operating on perfectly good eyes, even though they were nearsighted.

      My biggest issue since the surgery has been halos at night. They’re not debilitating, but driving after dark can be a little scary. Not something you won’t be able to work around though.

      Overall, I love the freedom of not having to worry about losing a contact lens. To me, that was the biggest issue. Swimming is a lot more fun. :)

      I read as much as I could before going through with this, but in the end, you’ll never know how well it can work for you until you do it. If you’ve done research on the doctor though, I think you can feel confident about going forward.

      Hope this helps!! If you have other questions, please let me know!

  2. Hello Richard,
    I am scheduled to have the ICL procedure in the coming weeks. I had been wearing RGP lenses and so now I’ve transitioned to soft lenses (so I only have to be without contacts for 1 week vs. 4 weeks) before my pre-op. Your blog has been very helpful in my decision making. I hate to wear my glasses -I’ve spent most of my life out of glasses -most people don’t even know I have such high myopia because I’ve always been in contacts… but now wearing contacts make my eyes irritated and bloodshot and I’m just so fed up of dealing with them. That being said, the possibility of retinal detachment and/or cataracts does make me have second thoughts about the procedure. How did you “accept” these risks?
    Also, my surgeon performs the surgery on both eyes the same day; in the past they used to do it separately (due to the possibility of elevated eye pressure) but they found it didn’t really make a difference (he said something like that anyway!). They could still do it on separate days if I really wanted so I’m not sure…. right now I’ve agreed to same day.
    Lastly, were you able to wear contacts after the LPI? I’ve had to postpone my surgery by 1 week but I’m wondering if I should just get the LPI as scheduled (so it’d be 2 weeks before surgery). I’m told I can wear my contacts after the lpi but just wondering if you did and if it was comfortable.
    Thanks so much in advance!!

  3. Hey, Zina.

    The risk of retinal detachment is already “high” for people with severe or extreme myopia. When I looked at the numbers, I wasn’t convinced that this didn’t have something to do with it.

    Still, it’s a concern and something that I thought about. Because of this, I’m getting regular (once per year) checkups in addition to any followup from the surgeon.

    As far as cataracts, I asked about this and it mainly happens when the natural lens is touched during surgery. So if it’s going to happen, it will probably happen very quickly. My surgeon told me that it had only happened once, after hundreds of implants, and that was because the guy on the table jumped.

    That’s not to say it couldn’t happen, but if you have a good surgeon, with a steady hand, the likelihood is low.

    To make you feel better, one of the things they did to me, when I was on the table, was “tape” my head down, to remind me not to move it.

    Something else I heard mentioned was a cataract forming in a guy after getting a touchup procedure with LASIK. There is a “suction” or something, which he felt may have caused the implant to touch the lens, causing a cataract. This is one of the reasons he only does PRK (which is what I had done) as a touchup.

    Yes, I was able to wear contacts immediately after getting the LPIs done. That process was pretty much painless and not nearly as bad as some of the stories you’ll read about.

    One of the great things about getting both eyes done on the same day is that you only have to prepare for surgery and go through the mental worries once. Something that I found pretty cool about doing it separately though was that I was much more present during the second one. Don’t let this scare you, but I was actually awake during the procedure and remember him moving the lens around (to put it in place) and giving me instructions.

    Again, don’t let that freak you out. It was totally comfortable and actually enjoyable, since I was an “active” participant in something I feel has been one of the most important decisions I’ve ever made.

    I know the process is scary. You can read about it, talk to people, watch videos, or whatever else, but the only way to really experience it is to jump in and do it. Trust the surgeon, trust the process, trust the research, and trust yourself.

    Best wishes for a great experience!! If you have any more questions, feel free to ask. :)

    • Thank you so much fro your reply Richard. It really helps to connect with someone who has gone through the experience. I think they will definitely have to tape down my head as I always jump/flinch during a regular eye exam. :)
      My surgeon said he had performed around 140 ICL surgeries and 2 of his patients have developed cataracts (over a period of 1-4 years post-surgery). He’s not sure why, as he has patients who have a “low vault” and haven’t developed cataracts. So he did stress the risk of cataracts developing but didn’t really think retinal detachment was anything major to worry about (as it relates to the ICL). He too suggested PRK if any touch-up was needed after surgery.
      I’m feeling anxious and I just want to get it over and done with now but it’s been delayed a little more as the surgeon had to reschedule. This is all assuming I’m deemed a good candidate after the pre-op. My concern right now is the state of my corneas. The soft lenses I was put in have turned my eyes bloodshot (again! -It was the reason why I had to switch to the hard lenses). Hopefully those blood vessels should clear up now that I’m out of them, and will be out of them for a week until the pre-op. fingers crossed! Thanks again for answering my questions!

    • Hi Richard!
      Had the LPI done today… it was pretty rough. The actual laser part was not bad at all but the headache I got from the pilocarpine drops was brutal. It also made me nauseated and I threw up after one eye was done (I knew it was coming so was well prepared with brown bag -Excuse the detail lol.) They offered me some pain meds before the procedure (once my headache started) and the tech suggested I eat something so I had a granola bar….. probably should’ve stayed on a empty stomach though. Anyways, soooo glad that is over with, I hope I NEVER have to have my pupils constricted again! Surgery is next week. Nervous and excited.
      Oh I also ended up seeing a retina specialist just to double check my retinas and was given the all clear. :)

  4. Best wishes, Zina! Please drop by here with any updates and let me know if you have any more questions about the experience. :)

  5. Hi Richard,
    Im scheduled to have the LPI surgery soon in preparation for ICL implants. Im starting to feel a bit nervous about having it done after reading up on Iridotomy surgeries. i want to be informed and prepared, but at the same time reading all these stories is freaking me out a bit.

    I have a few questions that maybe you could answer.
    Do the holes ever close, or are they permanent? does the LPI affect your vision? And if you have to have LPI surgery in the future if you develop Glaucoma, does having it done now interfere with a possible future surgery?
    I know these are really Questions for a doctor, but i was hoping id get an unbiased opinion from someone in my position or whose been in my position.

    And then, from your own experience, did you see this horizontal white line ive read about that occurs if light gets onto the point of your eye where the holes are? and the halos…i thought that didnt happen with ICL, only with LASIK/LASEK? i drive at night and wouldnt want that to be a problem.

    I’d really appreciate any info you can provide me with!
    thanks

    • Nadia –

      For me, this procedure was almost painless. I was at the dentist earlier that day for a teeth cleaning and that was much worse. :)

      Somebody once described it like “snapping a rubber band on your skin” and it was able that level of discomfort. I was expecting it to be a lot worse.

      No problems at all. Just had an annual exam with my eye doctor and everything about the LPI is looking good!

      Best wishes!!

      • I went to have the LPI done this weekend past, but unfortunately the doc said i turned out not to be a good candidate (they did some additional tests-ultrasound and pressure tests) as they discovered that i in fact did not have enough space for the lens and if inserted i would be at greater risk of developing Glaucoma.

        The doc then suggested LASIK….but im not too sure if i want to have that done due to all the risks and complications. So im researching it now and very unsure of which way to go on this matter :(

      • Having the space is important. I remember doing those tests as well as was lucky enough to have plenty in that department.

        I would not have done LASIK. PRK is similar, but without the “flap” but I would not have done that without the help of the ICLs to take some of the correction away.

        WIth that said, LASIK has worked well for a lot of people! :)

        The good news is that there are other options coming available!! You may want to check FDA trials, assuming you are in the US.

      • Ah, thanks for the info Richard.

        No, i am currently living in South Korea.

        Yes, the flap is one of my big concerns, and also the complications with regard to the fact that my prescription is so high.

        what are these other options you mentioned? can you send me a link so i can read up on it. i will probably be in S.Korea for another year, so if any new development arise during that time, i could possibly try another option.

        Thanks again

      • I think South Korea is more progressive than the US, so you probably have a lot of things I don’t know about. I know we have a few things under FDA trial, but they have not been approved for general use.

        If you have a high prescription, I’d say to avoid PRK and LASIK, unless they’re a “touch up” for something like ICL, which can take off a lot of the correction you need.

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