The ABC’s of Lasers in Eye Care: It’s not all Lasik

Lasers have been a boon when it comes to eye surgery. It has made this delicate surgery very precise and lessened both the pain of the operation and the recovery time. Many people think of Lasik surgery when they think of laser eye surgery, but there are many more applications for lasers when it comes to treating the eye. Here are some:

Laser Cataract Surgery 
Cataract is a condition where proteins in the lens of the eye start to clump together and interfere with the person’s ability to see. When a cataract causes a person so much trouble with their vision that they can no longer perform ordinary tasks, surgery is the only option. During cataract surgery, the clouded lens is removed and replaced with an artificial, interocular lens. Before that, the surgeon needs to incise the cornea, which lies above the lens. Traditionally, this is done with a fine scalpel, but now it can be one with a laser. The laser is so precise that it can make a perfect circle around the cornea. The heat of the laser then softens the cataract and breaks it up. Breaking it into pieces allows the surgeon to remove the cataract with less trauma to the eye. At the end of the surgery, the incision may not even need to be sutured but can close up on its own.

Besides making it easier to remove the cataract, the perfect circle made by the laser makes it easier to insert the artificial lens. Best of all is that most patients who are good candidates for traditional cataract surgery are good candidates for laser surgery.

Laser Glaucoma Surgery 
Lasers are also used to correct open angle glaucoma. This is a condition where pressure from fluid starts to build up in the eye. The condition is painless, and the person doesn’t notice until their eyesight is affected. Once their eyesight is affected, it can’t be returned to normal. Most people are prescribed eye drops to control their glaucoma, but in some cases this doesn’t work. Laser surgery then becomes an option. Laser treatment for glaucoma is called selective laser trabeculoplasty, or SLT

During SLT, the laser is trained on the drainage structures in the eye. This changes the tissue there to allow the fluid in the eye to drain better. The name selective means that the laser operates on low energy and only affects certain pigments in the patient’s eye. The result is less pain and scarring. Studies show that SLT lowers the pressure inside the eye by about 30 percent. This is comparable to eye drops. It is even more effective if the patient is already taking medicine for their glaucoma.

Patients start to notice the effects of SLT after about one to three months, and the effects can last for years. Fortunately, the patient can return for another treatment though it won’t be as effective as the first.

Another type of glaucoma is closed angle glaucoma. This can lead to a very painful medical emergency though an ophthalmologist can tell if a patient is at risk for closed angle glaucoma through a test called a gonioscopy. The angle in question is one between the iris, the colored part of the eye and the cornea. The doctor numbs the patient’s eye, places a contact lens over the iris and targets it with a laser to open up the angle. After the surgery, the contact lens is removed, and the eye is rinsed. The patient needs to stay in the doctor’s office for a while so the pressure in their eye can be checked. Then, they can go home.

Laser Surgery for Diabetic Retinopathy
One of the complications of diabetes is diabetic retinopathy. This happens when the blood vessels that serve the retina start to leak. This not only starves the cells in the retina of oxygen but damages them. Diabetic retinopathy can lead to blindness if its is not treated. Lasers cauterize the leaking blood vessels and ablates the abnormal tissue that gives rise to them.

Laser Surgery for Diabetic Macular Edema
The macula is the very center of the retina where images are the sharpest. Macular edema occurs when this part of the eye starts to swell. It is another complication of diabetes. Laser surgery can stop more fluid from entering the macula and can improve the patient’s vision.

Laser Surgery for Retinal Tears
Sometimes tiny tears can appear in the retina. These tears allow fluid to seep behind the retina and can lead it to detach from the back of the eye. If laser therapy is used before this happens, it causes the retina to adhere to the scar tissue made by the laser and not detach.

Laser Therapy for Eye Cancer
Lasers can also be used to treat malignancies in the eye, especially eye melanoma. One popular treatment is transpupillary thermotherapy, or TTT. This kills small tumors in the eyes through infrared heat.