The use of lasers in medicine has led to major advancements in the treatment of disease over the last 25 years and especially over the last decade. “Laser” is an acronym that stands for “light amplification by stimulated emission of radiation.” Lasers work by exciting molecules to a high energy state. The excited molecules then release energy which is then focused into a beam. Lasers may have a long wavelength that produces thermal effects, or a short wavelength that disrupts molecular bonds. The effect on tissue depends upon the wavelength of light applied. For laser vision correction we use the excimer laser. This laser uses a combination of argon and fluoride gases which when electrically stimulated temporarily form an unstable compound which releases ultraviolet energy. This energy is directed into a beam which vaporizes tissue. This makes it possible to finely sculpt a cornea to a shape that better focuses images on the retina.
We use other types of lasers for glaucoma surgery, retina surgery, and to break up membranes or floaters. I am frequently asked if we use lasers for cataract surgery. The answer is no. The state of the art for cataract surgery is the use of ultrasound energy to break up the cataract.
When we perform lasik, a thin flap is made in the outer layer of the cornea. The flap is retracted and the excimer laser is then used to reshape the cornea. Afterwards, the flap is placed back in position where it bonds without the need for sutures. A microkeratome is a device that uses a finely honed blade that oscillates at high frequency and passes over the cornea to make a flap. The alternative to this is the femtosecond laser which creates a corneal flap by applying numerous laser pulses to the cornea at a set depth, close enough together to dissect a flap. There are pros and cons to both. Both the femtosecond laser and the current microkeratomes are highly reliable. I have years of experience using both and can say that for the creation of a corneal flap, they are both excellent.
Lasers have greatly expanded our ability to treat certain conditions with safety and precision. However, it is important to remember that a laser is only a tool, and its usefulness depends entirely upon what the tool is being used for. Sometimes, as is the case with a loaf of bread, a knife is the instrument of choice!
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