Laser iridotomy vs surgical iridectomy. Have the indications changed?

The number of laser iridotomies in 1982 was more than four times the annual rate of surgical iridectomies performed before the laser was in common use at the Bascom Palmer Eye Institute, Miami. No single reason accounts for the increase. Only a minority of the increase is due to a 32% increase in our outpatient volume, a backlog of individuals with borderline indications who had not undergone surgery, or the number of iridotomies performed prophylactically for asymptomatic narrow angles. The proportion of eyes treated for each of several classic indications (acute attacks, chronic angle closure with pressure elevation or synechiae, aphakic pupillary block, etc) remained the same. However, eyes with acute attacks and their fellow eyes had iridotomy more promptly and more often with the availability of laser. In addition, the laser was applied earlier in the course of chronic angle closure. We believe that the increased use of an easy, low-risk procedure represents an improvement in the quality of care.