Clinical Report: Tips and Tricks for In-Office Laser Peripheral Iridotomy

Overview

Nicholas R. Green, OD, MPH, FAAO, emphasizes the importance of careful patient selection and best practices for in-office laser peripheral iridotomy (LPI) during his presentation at Optometry's Meeting 2026. He outlines indications, contraindications, and procedural recommendations.

Background

Laser peripheral iridotomy (LPI) is a procedure for managing angle-closure glaucoma. Understanding the indications and contraindications for LPI is essential for optometrists as they expand their scope of practice to include in-office laser procedures.

Data Highlights

No numerical data available in the source material.

Key Findings

• Careful patient selection is crucial; contraindications include secondary angle closure without pupillary block and significant intraocular inflammation.
• Indications for LPI include primary angle-closure glaucoma and acute angle-closure attacks.
• Preoperative gonioscopy and administration of antiglaucoma medications are recommended before LPI.
• Postoperative monitoring of intraocular pressure (IOP) and iridotomy patency is essential.
• Reported risk of dysphotopsias after LPI is approximately 2% to 3%.
• Clear lens extraction may provide better long-term IOP reduction compared to LPI for primary angle-closure glaucoma.

Clinical Implications

Optometrists should ensure thorough patient evaluation and informed consent prior to performing LPI.

Conclusion

Incorporating LPI into clinical practice requires understanding of patient selection and procedural techniques.

Related Resources & Content

1. Green NR, Optometric Management, 2026 -- Tips, Tricks, and New Technologies for In-Office Laser Procedures
2. American Academy of Ophthalmology, Ophthalmology, 2026 -- Primary Angle-Closure Disease Preferred Practice Pattern
3. Asia-Pacific Glaucoma Society, ScienceDirect, 2025 -- Controversies, consensuses, and guidelines for acute primary angle closure attack
4. Ophthalmology Management — Performing Office-Based Glaucoma Procedures
5. Ophthalmology Management — Better Iridotomies Prior to ICL Implantation
6. Optometric Management — Preparing to Offer In-Office Laser Procedures
7. Performing Office-Based Glaucoma Procedures
8. Better Iridotomies Prior to ICL Implantation
9. Primary Angle-Closure Disease Preferred Practice Pattern® - Ophthalmology
10. Laser Peripheral Iridotomy - EyeWiki
11. Controversies, consensuses, and guidelines for acute primary angle closure attack (APACA) by the Asia-Pacific Glaucoma Society (APGS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) - ScienceDirect
12. Contemplating the Laser Question for Primary Angle Closure Suspect | Ophthalmology | JAMA Ophthalmology | JAMA Network
13. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial
14. Progression of primary angle closure suspects: a systematic review and meta-analysis | Eye
15. Outcomes of laser peripheral iridotomy in subgroups of primary angle closure disease eyes according to swept-source optical coherence tomography parameters | Eye