|This study noted an average improvement in vision from 20/41 at baseline to 20/23 at three weeks post-op in patients who underwent optometrist-performed YAG capsulotomy. Photo: Nathan Lighthizer, OD. Click image to enlarge.|
A growing body of research supports the safety of optometrists performing YAG capsulotomy on patients who develop posterior capsule opacification (PCO) after cataract surgery. Ten states now include the common procedure in the profession’s scope of practice, and several others are in the midst of legal pursuits. Adding to the arsenal of evidence on the safety of OD-performed capsulotomies is a recent study that assessed the outcomes of nearly 80 patients who underwent the procedure. The investigators concluded that optometrists were able to perform the procedure both safely and effectively, significantly improving patients’ vision.
The study included patients who developed PCO post-cataract surgery. A total of 92 eyes of 79 participants completed one month of follow-up and 81 eyes of 69 participants followed up for three months. The mean visual acuity of patients who followed up for one month improved from 20/40 to 20/23 post-capsulotomy, with similar visual outcomes reported among those who completed three months of follow-up (20/41 at baseline to 20/23 after the capsulotomy).
No patients experienced significant adverse events such as inflammation, increase in vitreous floaters, corneal edema, cystoid macular edema, retinal detachment or permanent vision loss. The researchers noted that while 14% of eyes did experience intraocular lens pitting within the central 3mm, no associated visual symptoms were reported by those patients.
The complication of increased intraocular pressure (IOP) was also negligible; the average IOP for all eyes was 14.2mm Hg at baseline and only raised to 14.4mm Hg at the one-week follow-up. Only four patients experienced an increase above 5mm Hg at any time after the procedure.
The researchers also gauged patient satisfaction through a survey distributed after the procedure, in which patients reported very positive outcomes. When asked, “Has your vision improved after the capsulotomy procedure?,” 99% of patients answered “yes.” Though one patient noted no subjective improvement in vision, that individual’s visual acuity had improved from 20/30 to 20/20.
In their paper on the study results, published in Optometry Vision Science, the researchers noted that the findings mirror those of similar studies. “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,” they concluded.
Lighthizer N, Johnson S, Holthaus J, et al. Nd:YAG laser capsulotomy: efficacy and outcomes performed by optometrists. Optom Vis Sci. August 18, 2023. [Epub ahead of print].