Concierge ophthalmology · London
YAG laser iridotomy and SLT for glaucoma, by a consultant glaucoma specialist.
The right laser for the right eye — YAG peripheral iridotomy for narrow angles, SLT for open-angle glaucoma — done at a proper slit-lamp by a named specialist, not a general clinic list.
Why patients choose us
- 01
A consultant glaucoma specialist, at the laser
Not a nurse-led list and not a training room. A named ophthalmologist with a glaucoma sub-specialty at a laser slit-lamp, not a general clinic.
- 02
The right laser for the right angle
YAG iridotomy for narrow angles; SLT (selective laser trabeculoplasty) for open-angle glaucoma. We say which one your eye actually needs.
- 03
Independent, and free
We are paid by no clinic, so the recommendation — laser, drops or lens surgery — is impartial and costs you nothing.
Indicative pricing
What a private YAG iridotomy or SLT costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A YAG iridotomy in our network: £400–£900 per eye, home the same visit.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| YAG peripheral iridotomy — one eye | £400–£900 | 15–20 min | Same visit |
| YAG peripheral iridotomy — both eyes | £700–£1,600 | 30 min | Same visit |
| Selective laser trabeculoplasty (SLT) — one eye | £500–£1,100 | 15–20 min | Same visit |
| SLT — both eyes (LiGHT-trial first-line) | £900–£1,900 | 30 min | Same visit |
| Glaucoma consultation + gonioscopy + AS-OCT | £280–£450 | 45 min | Same visit |
| Repeat / top-up laser | £300–£700 | 15 min | Same visit |
Prices vary by clinic, by which consultant does the laser, by whether one or both eyes are treated, and by the assessment package. Under the NHS the laser is provided for a clinical indication; these figures are for private, same-week access. We come back with a firm quote within one working day.
The problem
The right laser, the right eye, at the right time.
Glaucoma laser is a quiet corner of ophthalmology that is easy to get wrong: the wrong laser for the angle, delayed prophylaxis after an acute attack, or SLT never offered when NICE now says it should be first-line. We fix all three before you commit.
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Not sure it is needed?
For a narrow-but-quiet angle the ZAP-trial answer is nuanced. We say when to laser and when to watch.
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Worried about drops for life?
SLT is first-line under NICE NG81 since LiGHT — a single laser can reduce or replace drops for years.
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Want it done properly?
A named consultant glaucoma specialist, a proper laser slit-lamp, and post-laser IOP checked before you leave.
The journey
From enquiry to angle recheck — what happens, in order.
One consultant from first message to the four-to-six week gonioscopy recheck — including the post-laser IOP check the same afternoon.
Phase 1 · Before your laser
Concierge, off-stage for you
Phase 2 · On the day
A couple of hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Symptoms, family history, current eye drops, and any recent gonioscopy or AS-OCT findings.
- 02
Before
We come back with a recommendation
Within one working day: whether YAG iridotomy, SLT, drops, or lens extraction is the right first step. If laser is not needed, we say so.
- 03
Before
We arrange the appointment
Usually within one to two weeks. A full angle assessment — gonioscopy, IOP, disc, AS-OCT — is booked with the same consultant who will do the laser.
- 04
On the day
Arrival at the clinic
Anaesthetic drops (proxymetacaine) and pilocarpine 1% to constrict the pupil. Consent, IOP baseline and a chat with the consultant.
- 05
On the day
The laser itself
Five to ten minutes at the slit-lamp with an Abraham lens. Nd:YAG pulses at 11 or 1 o’clock in the peripheral iris — chosen to reduce dysphotopsia.
- 06
On the day
IOP check and home
Brimonidine drop, IOP re-checked at 30–60 minutes, and home the same visit. No patch, no driving that afternoon while the pupil is small.
- 07
After
Recovery and review
Steroid drops for two to three weeks, IOP recheck at one to two weeks, then gonioscopy at four to six weeks to confirm the angle has opened.
Typical end-to-end: 1–2 weeks from enquiry to laser. Angle recheck: 4–6 weeks.
When it helps
When YAG iridotomy or SLT is the right step.
Risk is higher in older, hyperopic, Asian or Inuit patients and where there is a family history — the situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Primary angle-closure suspect (PACS)
Narrow angles on gonioscopy, IOP still normal — prophylactic YAG iridotomy is a considered decision, informed by the ZAP trial.
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Primary angle-closure (PAC)
Narrow angles with peripheral synechiae or a raised IOP — YAG iridotomy relieves pupillary block and protects the drainage angle.
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Primary angle-closure glaucoma (PACG)
Angle closure with optic-nerve damage — YAG plus drops, and increasingly lens extraction per the EAGLE trial.
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Acute angle-closure attack
A red, painful eye with haloes and a mid-dilated pupil is an emergency — IV and topical treatment first, YAG once the cornea clears, fellow eye done prophylactically.
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Pigment dispersion syndrome
Reverse pupillary block — YAG iridotomy flattens the iris and reduces pigment liberation.
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Open-angle glaucoma / ocular hypertension
Not an iridotomy case — SLT is the NICE NG81 first-line since LiGHT: 360° of the trabecular meshwork, no drops needed for many patients.
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Phacomorphic pre-op or silicone-oil eye
Secondary angle closure from a large lens or oil intolerance — a temporising YAG iridotomy while surgery is planned.
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Red flag: acute painful red eye + haloes
Sudden pain, blurring and haloes around lights is an acute angle-closure attack — same-day A&E or eye casualty, not a clinic booking.
Laser options
YAG iridotomy is not the only glaucoma laser.
What each option on the table actually involves — and which fits which glaucoma.
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YAG peripheral iridotomy (LPI)
A tiny hole made with a Nd:YAG laser in the peripheral iris to relieve pupillary block — the definitive treatment for narrow angles.
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Selective laser trabeculoplasty (SLT)
A 532 nm frequency-doubled Nd:YAG laser applied to the trabecular meshwork — first-line for open-angle glaucoma since the LiGHT trial.
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Bilateral iridotomy — same visit
Both eyes done the same afternoon when both angles are narrow. Common after an acute attack, to protect the fellow eye.
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Repeat / top-up YAG
A second treatment if the iridotomy closes over or is not patent enough — quick, done at the slit-lamp.
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YAG capsulotomy (different indication)
A YAG laser also treats posterior capsule opacification after cataract surgery — a separate condition, same laser, different aim.
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Clear lens extraction (EAGLE trial option)
For angle-closure glaucoma, removing the natural lens can control IOP better than laser alone — the RCOphth 2023 pathway increasingly favours this.
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Drops-only pathway
For some patients — mild ocular hypertension, or a very shallow anterior chamber that is not narrowing further — drops alone are still reasonable.
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Glaucoma consultation only
An honest gonioscopy, IOP, disc and visual-field assessment with a specialist — sometimes the answer is monitoring, not laser.
Our vetted London network
A small panel of glaucoma specialists, we picked them.
Consultant ophthalmologists with a formal glaucoma sub-specialty across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every glaucoma specialist in our network.
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Consultant ophthalmologists with a glaucoma sub-specialty, not general clinicians
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Gonioscopy, AS-OCT and visual fields on the same day as the assessment
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Both YAG iridotomy and SLT offered, so the recommendation is not forced by kit
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Lens-extraction pathway (EAGLE-style) available when laser is not enough
Safety and recovery
What to expect after the laser — honestly.
YAG iridotomy and SLT are quick, safe outpatient lasers. The things worth planning are the post-laser IOP check, the short course of steroid drops, and knowing what dysphotopsia is if it happens.
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A short-lived IOP spike
In about 1–5% of eyes the pressure rises for a few hours after the laser. A brimonidine drop given at the end reduces it, and we recheck IOP before you leave.
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Transient inflammation
A mild iritis is nearly universal. Steroid drops (prednisolone or dexamethasone) for two to three weeks settle it — kept short to protect IOP.
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Transient blur and small pupil
The pilocarpine pupil stays small for a few hours and vision is dim. No driving that afternoon; normal by the next morning.
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Dysphotopsia — a linear glare
A thin line of glare visible in bright light. Placing the iridotomy at 11 or 1 o’clock — tucked under the upper lid — reduces this materially (Ophthalmology 2022).
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Incomplete patency
Occasionally the iridotomy is not fully through and needs a top-up. Quick, done at the same slit-lamp on a return visit.
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Corneal endothelial change
Rare, usually cystic and clinically silent — a reason to keep the laser energy modest and to space pulses.
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Cataract acceleration
The evidence is mixed and the effect small. It is a reason to be selective in PACS, not a reason to avoid laser when the angle is genuinely closing.
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Late lens dislocation
Very rare. Reported mainly in eyes with pseudoexfoliation — worth flagging, not worth losing sleep over.
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Red flags after laser
A painful, red eye with worsening vision, haloes, or nausea after laser is not normal — call the clinic or eye casualty the same day.
Reading your laser note
Your laser note in four parts. Read the last one first.
Whichever laser was used, the note the consultant sends you keeps to the same shape.
A quiet reminder
Ophthalmic language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and laser chosen
Why the laser was done — PACS, PAC, PACG, pigment dispersion, or open-angle for SLT — and which laser was used.
- 02 Technique
Settings, site and pulses
Site of the iridotomy (usually 11 or 1 o’clock), energy in mJ, number of pulses, patency confirmed by aqueous escape, and any pigment dispersion.
- 03 Findings
IOP before and after, angle status
Baseline IOP, IOP at 30–60 minutes, Shaffer or Spaeth grade at the pre-laser gonioscopy, and any peripheral anterior synechiae seen.
- 04 Impression
Drops, review and next steps
Read this first: which steroid drop and for how long, when IOP and gonioscopy are rechecked, and whether the fellow eye or a lens extraction is on the plan.
Recognised by major UK insurers
Cover for YAG iridotomy and SLT varies by insurer — usually funded when clinically indicated for angle-closure disease or established glaucoma, self-pay for prophylactic PACS laser. We confirm cover before booking.
Frequently asked
Everything we get asked about YAG iridotomy and SLT.
Quick answers on pain, cost, alternatives, and when SLT beats a lifetime of drops.
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What does a YAG peripheral iridotomy actually do?
A Nd:YAG laser makes a tiny hole in the peripheral iris. That hole equalises pressure between the front and back chambers of the eye, so the iris cannot bow forward and block the drainage angle. It relieves pupillary block and either treats or prevents angle-closure glaucoma.
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How is YAG iridotomy different from SLT?
They treat different diseases. YAG iridotomy is for narrow or closed angles — it opens a hole in the iris. SLT (selective laser trabeculoplasty) is for open-angle glaucoma — it lasers the trabecular meshwork itself to lower pressure. Since the LiGHT trial and NICE NG81, SLT is first-line for most open-angle glaucoma in the UK, ahead of drops.
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Does the laser hurt?
Not really. The eye is fully numb with anaesthetic drops, and most patients feel a series of quick clicks with a brief pinprick at each pulse. It is over in ten to fifteen minutes and there is no injection.
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Do I need to have the other eye done too?
Often yes. If your angle is narrow in one eye, the fellow eye is usually narrow as well, and the risk of an acute attack there is high enough to warrant a prophylactic iridotomy in the same visit or shortly after.
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How much does private YAG iridotomy or SLT cost in London?
Roughly £400–£900 per eye for YAG iridotomy and £500–£1,100 per eye for SLT, plus a consultation with gonioscopy and AS-OCT at £280–£450. Bilateral packages are usually a little less. We confirm a firm figure within one working day.
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Is it always better to have a lens extraction instead?
Not always. The EAGLE trial (2016) showed that in established angle-closure glaucoma, clear lens exchange gave better IOP control and quality of life than laser alone — and RCOphth guidance has increasingly followed that. For milder cases and for the fellow eye, YAG iridotomy remains a proportionate first step.
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How long before the drops or the pressure change?
The angle usually opens immediately. Long-term, some patients still need drops, and some come off them entirely — especially after SLT for open-angle glaucoma, where about three-quarters of eyes are drop-free at three years in the LiGHT data.
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Will I see the iridotomy afterwards?
You should not, because we place it under the upper lid at 11 or 1 o’clock. Some patients notice a thin line of glare in bright light — dysphotopsia — but placing the hole under the lid materially reduces that risk (Ophthalmology 2022).
Related tests
Looking for something else?
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Trabeculectomy for glaucoma
Filtering surgery when laser and drops are not enough.
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All tests and procedures
Every test and procedure we arrange.
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Cataract surgery
Lens exchange — also relevant to angle-closure disease.
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Eye examination
Comprehensive private ophthalmology assessment.
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