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Optometric Management

Article | 2026 AOA

Tips and Tricks for In-Office Laser Peripheral Iridotomy

Careful patient selection is essential, regardless of the procedure, Nicholas R. Green, OD, MPH, FAAO, said in his session at Optometry’s Meeting 2026.

By: Sarah Fackler, managing editor, Optometric Management
Optometric Management June 18, 2026

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

At a Glance

CategoryDetail
ConditionLaser Peripheral Iridotomy
Key MechanismsFacilitates aqueous movement from posterior to anterior chamber, reduces pupillary block, relieves angle crowding.
Target PopulationPatients with primary angle-closure glaucoma, acute angle-closure attacks, plateau iris configuration, normal and reverse pupillary block, and primary angle-closure suspects.
Care SettingIn-office laser procedures

Key Highlights

  • Careful patient selection is essential for laser procedures.
  • Indications for LPI include various forms of angle-closure glaucoma.
  • Preoperative gonioscopy and antiglaucoma medication are recommended.
  • Postoperative monitoring includes IOP check and PI examination.
  • Reported risk of dysphotopsias after treatment is approximately 2% to 3%.

Guideline-Based Recommendations

Diagnosis

  • Use gonioscopy to assess angle closure.
  • Measure IOP before and after treatment.

Management

  • Administer antiglaucoma medication and pilocarpine before treatment.
  • Use laser energies ranging from 3 mJ to 8 mJ.

Monitoring & Follow-up

  • Check IOP and PI patency 30 to 60 minutes postoperatively.
  • Follow up at 1 week for gonioscopy and IOP check.

Risks

  • Complications may include iris bleeding, cataract progression, and nonpatency of the PI.

Patient & Prescribing Data

Patients undergoing laser peripheral iridotomy for angle-closure glaucoma.

Topical steroid prescribed 2 to 4 times daily postoperatively.

Clinical Best Practices

  • Obtain written informed consent before procedures.
  • Use the lowest effective laser energy to minimize complications.
  • Document blood pressure and pulse prior to treatment.

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