New findings from a study published in Optometry and Vision Science assessed the efficacy and safety of optometrists performing Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomies.
Give me some background.
Currently, 10 states (AL, AK, CO, IN, KY, LA, MS, OK, WY, VA) include Nd:YAG laser capsulotomies in their optometry scope of practice for patients who develop posterior capsule opacification (PCO) following cataract surgery.
Now talk about the study.
This prospective, observational study (NCT04036214) enrolled an estimated 200 patients diagnosed with PCO that reduced vision and subjective visual complaints.
The research team also measured the rates of complications including:
- Intraocular pressure spikes
- Inflammation
- Intraocular lens pitting
- Post-operative cystoid macular edema (CME)
- Retinal detachment
Tell me more about the cohort.
A total of 92 eyes in 79 participants returned for the 1-month follow-up visit, while 81 eyes in 69 subjects completed the study through the 3-month follow-up period.
Findings?
At the 1-month mark, the Snellen visual acuity of participants improved from an average of 20/40 to 20/23 (P<0.001).
Similar results were observed at 3 months, with patients improving from 20/41 at baseline to 20/23 following the procedure (P<0.001).
Did participants report an improvement in vision?
Yes, 77 of 78 participants (99%) reported a subjective improvement in vision in response to the survey question, “Has your vision improved after the capsulotomy procedure?
One patient reported no noticeable change in vision in both eyes though their Snellen acuity improved from 20/30 to 20/20 OD and 20/25 to 20/20 OS.
Go on …
Further, 87 of 92 eyes (95%) demonstrated objective visual improvement of at least one line of Snellen acuity.
Of the five participants who did not improve at least one line, four sustained the same visual acuity (VA) (20/25 pre- and post-procedure for each) and one subject decreased from 20/25 to 20/30.
All five participants self-reported an improvement in vision.
What about intraocular pressure?
The mean baseline intraocular pressure (IOP) was 14.2 mmHg for all eyes and the average 1-week post-procedure IOP was 14.4 mmHg.
Only four subjects had an IOP increase above 5 mmHG at any time after the procedure.
What about adverse events?
No eyes experienced significant adverse events such as inflammation, increase in vitreous floaters, corneal edema, cystoid macular edema (CME), retinal detachment, or any permanent vision loss.
Intraocular lens (IOL) pitting within the central 3 mm was observed in 13 of 92 eyes (14%), but no patients reported visual symptoms such as glare or image degradation.
Limitations?
A potential limitation of this study included a lack of masking/blinding when measuring pre- and postoperative VA.
Also, while participants were asked about the quality of their vision following the procedure, a formal assessment of the quality of vision (i.e., contrast sensitivity, glare testing) was not performed.
Expert opinion?
According to the study authors, “With minimal risk, a quick learning curve, and required slit lamp skills already possessed by optometrists, laser procedures can be effectively used by optometrists to provide patients easier access to high-quality eye care.”
Take home.
This study demonstrates that Nd:YAG capsulotomies can be effectively and safely performed by optometrists with minimal risk to patients and significant benefit to visual function.
Further, these findings are evidence to support the use of Nd:YAG capsulotomy in optometric practice.