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Posterior Capsular Opacification: Frequently Asked Questions

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What is Posterior Capsular Opacification (PCO)?

PCO is a clouding or opacification of a previously transparent layer behind the plastic lens that is placed in the eye during cataract surgery. 

What are the Symptoms of Posterior Capsular Opacification?

  • Blurring of vision: this usually develops slowly, typically several years or longer after the original cataract surgery, although can occasionally happen as soon as a few weeks or months after cataract surgery. The blurring from capsular opacity is not correctible with glasses and gradually worsens. 
  • Glare or other visual sensations: you might notice that the vision is impaired in certain conditions such as bright sunlight, low light or when looking at street-lights in the evening.
  • Double vision out of one eye: if you shut one eye and the other eye sees double or there is a second blurred edge around objects, you may have PCO.

Can posterior capsule opacification cause dizziness?

PCO does not usually cause dizziness, although the reduction in vision can cause people to be unsteady and at risk of falls.

What does posterior capsule opacification look like?

PCO looks like a window that has become frosted up in winter. Here are some pictures of it 

What are the Causes of Posterior Capsular Opacification?

The precise cause of PCO is not known, but it probably occurs because of contact between the lens implant and the posterior capsule. 

How common is posterior capsule opacification (PCO)?

PCO used to occur far more frequently and quickly with some of the older lens implants but modern implants are designed in a way that reduces PCO formation. However, a few years after cataract surgery, at least a quarter of people will develop some degree of PCO.

Schaumberg DA, Dana MR, Christen WG, Glynn RJ . A systematic overview of the incidence of posterior capsule opacification. Ophthalmology 1998; 105(7): 1213–1221.

Can Posterior Capsular Opacification be Prevented?

Some intraocular lenses (the lens that is put in the eye during cataract surgery) result in less PCO than other lenses. However, once the lens is in the eye, there is no known way of preventing PCO developing.

How is Posterior Capsular Opacification diagnosed 

PCO is usually diagnosed by your optician, although you may have had made an appointment to see them because you have become aware of a reduction in vision, or a feeling as if the cataract is ‘returning’. 

How can Posterior Capsular Opacification be corrected

PCO is corrected by making an opening in the posterior capsule so that there is a clear passage for light from the cornea at the front of the eye to the retina at the back of the eye. The opening in the opacified capsule used to be cleared with a surgical procedure, but nowadays since lasers have been developed, surgery is hardly ever used and an opening in the capsule is created with a laser procedure called a YAG capsulotomy. 

Can posterior capsular opacification disappear

Posterior capsular can’t either improve or disappear on its own. 

What types of Posterior Capsular Opacification are there?

There are two types of posterior capsular opacification: fibrous and pearl (also called proliferative). Fibrous PCO looks like wrinkles and folds. Pearl PCO looks like lots of shiny deposits. The type of PCO does not make any difference to YAG capsulotomy treatment, which is equally and very effective for both types. 

What is a YAG Capsulotomy?

YAG is a type of laser that is used for eye treatments and capsulotomy means making an opening in the capsule. The capsule is the layer that supports the plastic lens which has become cloudy. A YAG capsulotomy is done in the laser room of the eye clinic with you sitting at a slit lamp (ophthalmic microscope) and is a ‘walk-in, walk-out’ procedure.

How do I know if I need YAG surgery?

Your optician is likely to have advised you that you are developing PCO and you will probably have noticed it affecting your vision. Your optician is likely to also advise you that you need a YAG capsulotomy.

What does YAG stand for? 

YAG stands for Yttrium Aluminium Garnet which is a crystal that is used to generate the laser light.

How does YAG laser work?

YAG laser light is focussed on the object on which the its power is to be delivered – on the posterior capsule in this case. The power of the laser is used to accurately make small holes or openings in the capsule, which are carefully joined up to make a large central opening. The power of the laser is only delivered to the structure that it is focussed on, which means that as long as it is used carefully it does minimal or no damage to surrounding structures.

How is YAG laser capsulotomy performed?

Eye drops will be applied to your eye(s) so that the doctor can carry out an examination to confirm that YAG laser treatment is indicated and a dilated pupil also allows an adequately sized capsulotomy (hole in the posterior capsule) to be created. The examination and laser treatment is carried out at a standard slit lamp, i.e. the type of microscope used by an ophthalmologist / optician to examine eyes.

Sometimes a contact lens is used to stabilise the eye and improve the surgeon’s view. You will be asked to look at a fixation light or the surgeon’s ear when the procedure is carried out, which is painless and usually takes just a couple of minutes per eye.

How do I prepare for a YAG laser?

No special preparation is required. The vision in the treated eye(s) is likely to be a little blurred for a few hours after the laser treatment so it is sensible to consider this with regard to your plans for the rest of the day and, generally, it is a good idea not to drive to your YAG laser appointment.

How long does the YAG procedure take?

This can vary depending on the degree of opacification and other patient-specific factors, but generally a few minutes per eye.

Do I need to be accompanied for my treatment?

Not necessarily, but it is advisable not to drive yourself to/from your YAG laser ppointment.

Can you have YAG laser more than once?

It is usually only required once because the procedure removes the scaffold upon which the opacification forms. However, it is possible to enlarge a capsulotomy at a later date if necessary.

What is the cost of YAG Capsulotomy?

The cost of YAG capsulotomy varies widely in different places. However, at Worthing Laser & Skin Clinic and West Terrace Dental Clinic it costs £400 for YAG laser treatment to one eye and £600 for both eyes. This treatment is conducted on state of the art machines and highly experienced and expert consultant ophthalmologists. It is considerably less expensive than some other places, because of the number of YAG capsulotomies that we perform allows the price to be less expensive. 

Finance for YAG Capsulotomy

There are no financing options for this treatment at Worthing Laser & Skin Clinic or West Terrace Dental Clinic.

Insurance cover for YAG capsulotomy

If your insurer authorise this procedure, currently it is possible to use medical insurance for YAG laser capsulotomy at Worthing Laser & Skin clinic

Can you get YAG laser surgery on the NHS?

YAG capsulotomy treatment is available on the NHS. The main advantages of private treatment with us are a very short waiting time and treatment by a named consultant with expertise and huge experience in conducting this procedure.

What is the Recovery Time for YAG Capsulotomy?

Recovery after YAG capsulotomy is usually very quick. The dilating drops used to enlarge the pupil will last a few hours, after which time your vision should start to return to normal. Most patients report improvement in vision by the next day, if not sooner.

Some patients experience new floaters for the first few days after YAG capsulotomy, but these do not tend to be intrusive or disabling in any way.

Can YAG surgery be repeated or is it a one off treatment?

It is usually only required once because the procedure removes the scaffold upon which the opacification forms. However, very occasionally a YAG capsulotomy needs to be enlarged at a later date and even more rarely YAG laser needs to be conducted to opacification in front of the lens implant.

Does YAG surgery improve vision?

Yes. Posterior capsule opacification impairs visual acuity, reduces contrast sensitivity and causes glare – all of which degrade the quality of a patient’s vision. YAG capsulotomy cures posterior capsule opacification (PCO) and reverses all of these effects.

If there is other pathology, e.g. age-related macular degeneration (AMD), then this might limit the improvement in vision, but your eyes should have been carefully checked by your optometrist and examination on the day of YAG capsulotomy will confirm that the procedure is indicated.

Will I need aftercare?

No special aftercare is required. Most patients choose to see their optometrist for a sight test following YAG capsulotomy. YAG capsulotomy does not alter the glasses prescription, but an optician’s test is often more accurate after treatment of posterior capsule opacification (PCO).

Will I need a follow up appointment?

Routine follow-up is not required. Most patients choose to see their optometrist for a sight test following YAG capsulotomy. YAG capsulotomy does not alter the glasses prescription, but an optometrist’s test is often more accurate after treatment of posterior capsule opacification (PCO).

Can I fly after YAG laser treatment?

Yes. There is no restriction on flying after YAG capsulotomy.

Can I drive after YAG laser treatment?

It is advisable not to drive yourself to/from your YAG laser appointment, but once the drops used to dilate your pupil(s) have worn off (2-3 hours) you should be able to drive as normal.

What are the side effects, complications and risks of YAG laser treatment

YAG capsulotomy is a very safe procedure. The chance of developing a sight-threating complication is extremely rare.

Some patients experience new floaters for the first few days after YAG capsulotomy, but these do not tend to be intrusive or disabling in any way.

Documented but rare complications include, transient rise in intraocular pressure, retinal detachment, lens subluxation or dislocation, lens pitting, and exacerbation of local endophthalmitis.

The risks and benefits of YAG capsulotomy will be discussed before the procedure is carried out and patients will have a chance to ask specific questions. Any potential risks or side effects that are relevant to a particular patient will be highlighted.

Blurry vision after YAG laser

Recovery after YAG capsulotomy is usually very quick. The dilating drops used to enlarge the pupil will last a few hours, after which time your vision should start to return to normal. Most patients report improvement in vision by the next day, if not sooner.

Some patients experience new floaters for the first few days after YAG capsulotomy, but these do not tend to be intrusive or disabling in any way.

How long do floaters last after YAG capsulotomy?

Some patients experience new floaters for the first few days after YAG capsulotomy, but these do not tend to be intrusive or disabling in any way.

How safe is YAG capsulotomy?

It is a very safe procedure. Other than the possibility of new floaters for a short time after the procedure, YAG capsulotomy is very unlikely to cause any problems.

Rare complications of YAG capsulotomy include inflammation, raised intraocular pressure, damage to the intraocular lens implant and retinal detachment. However, the risk of any of these problems is very small indeed.

The risks and benefits of YAG capsulotomy will be discussed on an individual basis when you attend for YAG laser treatment.

Problems after YAG laser capsulotomy

Should you have any concerns following YAG laser capsulotomy, you should get in touch with the clinic where the procedure was carried out and one of our doctors will contact you to advise the best course of action.

YAG laser posterior capsulotomy is a very safe procedure and problems are very rare. However, sometimes vision can be affected by other pre-existing problems such as age-related macular degeneration which are sometimes easier to identify and assess following YAG laser treatment because this improves the view to the back of the eye.

Is YAG laser capsulotomy treatment painful?

No. YAG laser capsulotomy is not painful at all. Patients are likely to be aware of a clicking sound when the laser ’shots’ are applied to the posterior capsule, but this is not unpleasant or painful.

Can the laser damage my lens implant?

It is possible to cause ‘pitting’ of the intraocular lens implant if the laser is focussed slightly in front of the posterior capsule. This does not happen very often and although these ‘pits’ are visible through the microscope, they do not tend to affect the quality of a patient’s vision.

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