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Lasers for Vision Care

Lasers have long been used in eye care for therapeutic and corrective procedures.  While the thought of a laser anywhere near the eyes can strike fear in many people, in the right hands, lasers can improve vision and prevent vision loss, usually with very little risk.

Glaucoma

Lasers have been used to help treat nerve damage caused by glaucoma for years.  In narrow angle glaucoma, a laser is used to make a small hole in the peripheral part of the iris, causing it to fall away from the natural drainage meshwork and allowing better aqueous outflow. For open angle glaucoma, the laser can be used directly on the meshwork to create a chemical and biological change to the tissue, resulting in better drainage of fluid from the eye.

Cataracts

Many people are familiar with cataract surgery. In approximately 20% of cases, patients will eventually develop haze on the membrane behind their intraocular implant lens.  This will lead to cloudy vision, similar to that experienced before the cataract was removed.  A laser can be used to create an opening in the hazy membrane and restore vision to its prior level of clarity.  Some surgeons now even use lasers to assist in the actual cataract surgery procedure itself, to make it more precise.  Enhanced computer accuracy in laser cataract surgery will likely lead to even better outcomes.

Refractive surgery

Probably the most well-known use of lasers in vision care is laser refractive surgery.  Lasers help surgeons reshape the cornea, the clear tissue at the front of the eye, to allow for better light refraction and clearer vision in people with myopia, hyperopia, and astigmatism.

Since its beginnings in the 1980s, laser refractive surgery has come a long way, with newer techniques allowing faster healing, fewer side effects, and less post-operative pain. 

Current procedures include:

  • LASIK (laser-assisted in situ keratomileusis). A surgeon uses a blade or laser to cut a flap in the cornea and uses a computer-guided laser to reshape the tissue underneath. Recovery time is typically a day or two, with almost immediate vision improvement.
  • Wavefront-guided LASIK. A computer maps out the surface of the eye, which helps the surgeon reshape the eye with a bladeless laser to change the way the cornea reflects light.
  • PRK (photorefractive keratectomy). The entire layer of corneal epithelium is removed, so that a laser can remove and reshape the tissue underneath (no flap is created). The recovery time is approximately one week, and vision usually improves within two weeks.

Not everyone is a good candidate for laser refractive surgery.  See your optometrist for an eye health and vision assessment to determine your particular risk factors and candidacy.

Laser photo ablation for trichiasis

Trichiasis is defined as a misdirection of one or more eyelashes back toward the eye. As the lashes chafe against the ocular surface, they cause irritation and inflammation. If this goes on for a prolonged period of time the lashes can cause a corneal abrasion, leading to further discomfort and the potential for infections. Corneal scarring can result if this condition is not properly managed.

Laser photoablation has been used successfully to correct trichiasis.  A low-energy laser is aimed at the lash line and vaporizes both the eyelash and the follicle.  Complication rates are low, as is the recurrence of eyelash growth.

References

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