Contents
Ophthalmology is one of the first areas of medicine to start using the laser for treatment. Today it has become a tool routinely used for saving and improving eyesight.
The first attempts were made in the 60s, but only 20 years later the laser began to be increasingly used for ophthalmic procedures. Now, it is difficult to imagine eye surgery without it. It is sterile, precise and very fast. In a fraction of a second, it eliminates the target cells – the damaged tissue simply evaporates. No blood, no damage to adjacent tissues. It can correct eye defects, treat cataracts, glaucoma and retinal diseases. In addition to the procedure, it is usually enough to anesthetize the eye with drops
Depending on the type of surgery and the part of the eye to be treated, lasers of different wavelengths are used. For operations on the retina due to complications from diabetes and vascular diseases, an argon laser is used, the anterior segment of the eye – a yag laser, and a corneal laser – excimer. Most treatments are performed with an excimer laser. It is used for treatments correcting myopia, hyperopia and astigmatism.
The eyeglass generation, or why do we need laser vision correction
According to fairly conservative estimates, half of the world’s people have some kind of visual impairment that impairs vision in different ways
* myopia – the image is not transmitted directly to the retina of the eye, but right in front of it. This is the result of an eyeball that is too long or that the lens or cornea is bulging. The nearsighted person can clearly only see objects that are close.
* hyperopia – instead of on the retina, the light rays focus behind the retina. The reason is too short eyeball and / or too convex or too flat cornea. The farsight viewer can clearly see objects at a considerable distance, and those nearby – out of focus.
* astigmatism – light rays refract at different angles because the surface of the cornea has the wrong shape. This defect most often occurs in conjunction with short-sighted or farsightedness. Astigmatism causes the objects to be seen distorted.
Each of these defects can be corrected with glasses. Or laser therapy – changing the shape of the surface of the cornea (flattening it or bulging it) makes it possible to dispense with glasses.
Wearing glasses and lenses can be tedious more than once. Glasses can be damaged and lenses need to be replaced frequently. If you want to forget about them forever, take advantage of the Medonet Market offer and sign up for a laser vision correction treatment, tailored to the individual needs of the patient.
Slippers on the eyes
The oldest of the methods of correcting vision defects used today is PRK (photorefractive keratectomy). During such a procedure, first a thin layer of the corneal epithelium is mechanically removed, and then the laser vaporizes its deeper layers in specific places. The thickness of the removal is precisely calculated by the computer. The entire painless procedure takes a few or a dozen minutes, and the emission of laser radiation takes several dozen seconds. The PRK technique is used to correct, first of all, myopia in the range of -6 diopters, and to a lesser extent slight hyperopia and astigmatism. Only one eye is operated on, because after the procedure, a sterile dressing must be applied for the time of epithelial reconstruction, which takes 2-3 days. The other eye can be operated 10-14 days after the first treatment. It is the cheapest method of correction (about PLN 2 for one eye), but it also takes longer to heal compared to other methods of laser therapy, and the stable effect of vision improvement appears only after 2-3 months.
These imperfections led to the development of other methods of laser refraction: LASEK and LASIK. They are connected by … a “flap” (or flap), which is prepared from the corneal epithelium and temporarily tilted to the side to make the field of operation available for the laser. In the LASEK treatment, the flake is chemically prepared with the use of alcohol. A laser beam is applied to the surface of the cornea, thus prepared and deprived of epithelium, to correct its shape, and then the epithelial flap is placed again and, as a dressing, a contact lens is inserted for a few days. LASIK, on the other hand, uses a mechanical device called a microkeratome, with which the cornea is precisely cut horizontally, thus creating a thin flap. After it is tilted, a computer-controlled laser removes the microscopic layer of the cornea. After the treatment, the flap returns to its place, becoming a perfect dressing.
A more delicate modification of this technique is SBK-LASIK, in which a super-thin flake (on the order of 100 microns) is produced from the cornea using a microkeratome. It is a very precise and quick method, the entire laser correction procedure takes 2-3 minutes and can be performed by people with a thin cornea who cannot use any other technique. FemtoLASIK is the newest method, which is also being used by Polish ophthalmology clinics. This is a procedure that uses a computer-controlled femtosecond laser to create a flap from the cornea, instead of a mechanical microkeratome. This further shortens the treatment and recovery time.
LASIK allows you to correct myopia up to -10 diopters, farsightedness up to +4, and astigmatism up to 6 diopters. Among all the methods, it causes the least discomfort for the patient, allows the operation of both eyes in one session and heals the fastest. In the opinion of ophthalmologists, LASEK is less invasive, simpler and cheaper (about PLN 2,3 thousand for one eye) than LASIK (about PLN 2,7 thousand for one eye). It is worth taking this into account, because refractive procedures are not reimbursed by the National Health Fund.
Pros and cons of laser vision correction
Laser vision correction is a very safe procedure (the risk of complications is about 1%) and very effective, because it helps 90%. patients who qualify for such surgery (there are numerous contraindications, e.g. changes in the retina or pathological dry eye, glaucoma or its suspicion, diabetes, severe allergies). After the procedure, the defect remains within 1 diopters (if someone had 8-9 diopters, then after correction they have 1 D), which usually does not require wearing glasses anymore. But…
The treatment significantly thinns the cornea and such an eye is more susceptible to injury – the cornea may burst in the event of an impact. In addition, laser correction does not provide eagle vision for the rest of your life, because reading glasses may be needed after the age of XNUMX, when the ability of the eye to accommodate decreases.
The world behind the fog
The laser has become an indispensable tool not only in ophthalmic “cosmetology”, that is in the correction of vision defects, but more importantly – in eye-saving surgeries. All thanks to laser vision correction.
Every fifty Pole suffers from cataracts that gradually but inevitably lead to loss of vision. The progressive clouding of the eye lens is a natural symptom of the aging of the organism. Most often, even before the age of fifty, the current biochemical and osmotic balance, necessary to maintain the transparency of the lens, begins to change. Protein metabolism is disturbed and their synthesis slows down, the lens loses its elasticity and transparency, preventing light from entering the eyeball. The image you see becomes more and more hazy and out of focus, and finally it becomes possible to distinguish only day from night.
For an active and working person, the loss of visual acuity is a big problem, so it is worth starting treatment quickly. Just as it is impossible to avoid cataracts – there is no prophylaxis here, and there is no conservative treatment method – changes in the solubility of lens proteins and clouding are irreversible. This is where laser vision correction comes in.
The artificial one is better than the real one
The only effective treatment for cataracts is surgical replacement of the natural, but opaque, lens with an artificial one.
The method commonly used today is phacoemulsification. A probe is inserted through the incision in the cornea (2-3 mm) and the opaque lens is broken with ultrasound, and then gently sucked out of the eye. A newer and even more delicate method is fluid emulsification – the lens is broken and rinsed with a compressed fluid stream.
After the cloudy lens is removed, an artificial foldable intraocular lens is inserted through the same incision and immediately takes the correct shape. There is no need for stitches, because the wound itself closes tightly under the pressure inside the eyeball. After putting a special cover on the eye to protect it overnight, you can go home.
Cataracts usually appear in both eyes, although it often develops faster in one. Ophthalmologists never operate on both eyes at the same time. It’s all about safety – although postoperative complications are very rare, they do.
The National Health Fund refunds treatments using single vision lenses. Most patients after this procedure no longer need glasses for long-distance viewing, but must wear them when reading. You can also opt for lenses that allow you to see well both near and far, and even eliminate astigmatism. Unfortunately, you have to pay for such lenses out of your own pocket (about PLN 4-6 thousand). However, it is worth remembering that this is an investment for a lifetime, because once a cataract is removed, it does not come back.
A nerve worth saving
Glaucoma can also lead to irreversible vision loss. The eyeball produces a fluid that flows into the systemic circulation at a place known as the drainage angle. In the case of glaucoma, the outflow of fluid is inhibited – it accumulates in the eye and puts pressure on the nerve fibers, which leads to atrophy of the optic nerve. There are two types of this disease – open-angle and closed-angle. Unfortunately, the figure with an open angle is more frequent, it is tricky and dangerous because it is asymptomatic.
Although glaucoma cannot be completely cured, it can be caused to slow down or slow down the changes. So the idea is to lower the intraocular pressure. Eye drops are usually used first to reduce the production of aqueous humor or increase its outflow. However, if the disease is rapid or the drops are ineffective, a surgical laser can help. In open-angle glaucoma, laser trabeculoplasty is performed – by performing focal photocoagulation, the fluid outflow holes are widened, which lowers the pressure in the eye. The effect is not permanent, but fortunately such treatments can be repeated. In the treatment of closed-angle glaucoma, laser iridomy is used. It consists in making holes in the iris of the eye with a laser so that, even with dilated pupils, when the outflow path is closed, the aqueous fluid can drain through these additional holes.
Volleyball to be repaired
Without laser vision correction, vision loss caused by changes in the retina of the eye would also not be possible to stop. Most often these are changes related to diabetes (diabetic retinopathy). Initially, the disease damages the fine vessels of the retina, resulting in ischemic areas. This results in proliferation of the retinal vessels, accompanied by recurrent bleeding and retinal detachment.
The appearance of changes indicating the beginning of retinal hypoxia, which may lead to the formation of new abnormal vessels and vitreous haemorrhages in the future, is an indication for laser therapy. In the case of minor changes, focal photocoagulation is performed, the purpose of which is to directly destroy the damaged fragments of the fundus vascular system. In the case of more advanced lesions, diffuse photocoagulation is used. The laser can also “weld” a torn retina or “stick” a detached one.
Thus, the laser has become an indispensable tool in the hands of ophthalmologists. The advantage of treatments performed with this unique tool is speed, precision and a short recovery period. In addition, these are usually outpatient procedures, after which you can go home immediately, and after a few days – to normal activities.
Text: Anna Guttman
The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.