The idea — to take and cut a lens in a transparent cornea — is not new. At first it was done manually, with a scalpel directly on the surface (difficult and very rough, with a sea of side effects). The first laser was used in 1979, then it was a pulsed infrared emitter with an effective pulse length of 4 nanoseconds.


Step 1: creating a plasma bubble, in fact — a microburst. Step 2: expansion of the shock and heat waves. Step 3: cavitation bubble (plasma expansion). Step 4: the formation of a parallel slice at the expense of several adjacent laser focus points.

The lens in your eye can change its optical power: when you focus somewhere on the vision, this is what happens. Payback for the «moving parts of the mechanism» — wear with age. At about 40-45 years old, problems usually begin with age-related visual impairment; in 60-70 years, you need up to three pairs of different points. At the same time, the clarity of view is reduced due to the process of sclerosis and lens opacity — it is worth thinking about replacing the lens, until it becomes dim and becomes completely rigid.

To date, the technology of replacing the lens is standardized and well developed. Potential risks are generally somewhat higher than with laser vision correction, but at present this type of surgery is performed even on transparent lenses with refractive purpose (when the patient does not like to wear glasses with thick glasses), that is, it is quite a “household” task for ophthalmology.

Among the eye diseases are those that are especially dangerous. At first they are asymptomatic — nothing hurts, there are no complaints, they can “disguise” as other “mild” diseases and, most importantly, appear at any age and irrevocably “destroy” their eyesight.

Imagine if you left your left eye accidentally, but with your right, everything is “like a fog”! Read on the Internet how to help yourself or call your friends, and they — do not worry, blink. While they were waiting, it seemed that the fog was really over. This is how periods of anxiety recur, but at first there is little concern. And he (the murderer) began his insidious business. And as a rule, in both eyes, even if the second does not bother! And age is not an obstacle — children are also susceptible to this disease — 10% of children are blind from glaucoma.

Glaucoma is quite common in all countries — in 15% of cases of blindness, it is she who is the cause. This puts her in second place to the causes of incurable blindness!

And all is why — because the human brain very well «replaces» the dips in the field of view, if they arise gradually, adapt, and only when 30-40% of the optic nerve the feeling of «fog» begins. And all — hello, lost non-renewable!

Imagine the situation — you live in peace, nothing hurts and does not blush, wear glasses or lenses, or do not use anything and see perfectly — and you accidentally get an appointment with an ophthalmologist. For example, because of conscription into the army, because of pregnancy, or just for a dispensary examination. And suddenly you will find out that your retina is “full of holes” or stretched and is about to break.

And they recommend you to “sew it on”. And you doubt — and this is exactly what you need? And how safe is it? But nothing bothers — then why? Or maybe they want to earn money on me? And the first thing you start is to read posts on the Internet, what a “independent” expert like Google will say.

And in the future everything depends on your discipline and attention to your own health. You can get to the ophthalmologist-laser specialist, who will be the last resort, and he will do preventive laser coagulation.

Or «forget it» for everything and continue to live as before — nothing bothers you. What is the risk?

What do you think, how many operations can be done on one eye? A clinical case of one of my patients confirms that more than 20 operations of various kinds are not the limit. Although, no doubt, this case is a record for Russia and the world of ophthalmology.

In 1978, everything was trivial — there was an 18 year old boy (let's call him “A”) who wanted to become a test pilot like his father. This was hampered by weak myopia of the right eye — only minus 1, it did not interfere with life, but the future pilot needed good vision. He decided to correct the optics of one eye by keratotomy — the old “manual” correction method at the Fedorov Institute (of course, through an acquaintance), but something went wrong. This was the first operation. Then four more in Russia, then seven more — in Switzerland. He did not become a pilot, but he became an oligarch, a man who manages serious business projects, but does not control the situation with his vision.

To me, «A» got completely disappointed in the world of ophthalmology, with 10% vision, the impossibility of correction by standard methods and high intraocular pressure. And it was a young 50-year-old businessman, successful in life (this is important — because not everything went further «like that» either). So — the next eight operations are mine. And although we expected that one or two would be enough — we had to go through almost total ophthalmic surgery — all possible types of operations.

By the way, instead of keratotomy, there would be a correction of SMILE (ReLEX SMILE) or, at least, Femto-LASIK — there wouldn’t be anything to write about — it’s impossible to do anything like that!

This is a model of an intraocular multifocal lens from Carl Zeiss. The real size of such a lens is 11 millimeters, the diameter of the optical zone is 6 mm.

The cataract is, simplifying, age opacification and consolidation of a crystalline lens. According to the classical definition, we are talking about the turbidity of any type. First, something gets in the field of view, a general “fog” appears, you want to wipe dirty glasses, then you do not see the letters in the book, then you want to turn on the light brighter or, on the contrary, you hide from the bright light, and then wake up one fine morning and understand that you can not find slippers. And you see nothing at all — only the shadows. This process sometimes stretches for many years, but slippers are still lost. Mention of clouding that develops in the eyeball, there are still thousands of years before our era.

The treatment procedure has historically been very peculiar — reclination of a cloudy lens. The doctor took the patient with a very dense lens — to that dense stage that the patient is already blind. During the excavations of the settlements of ancient Greece and Rome, the tools used by doctors to remove cataracts were found — sharp needles that pierced the eye and lens, destroying its supporting apparatus. The lens could come off and, by virtue of its gravity, could also fall down from hitting the back of the head with a heavy stick several times. Sometimes the patient died during the emergency eye care, sometimes he had a concussion, and sometimes the lens fell off the ligaments and flew deep into the eye. The patient began to see again — he had a huge lump and vision of about +10 +15 diopters.

Now two news. The bad — people began to live to cataracts more often, and it is inevitable. Good — we have something better than sharp needles and a heavy stick.

— Are small-invasive laser vision correction operations done in Russia using the Small Incision Lenticule Extraction method?

Yes, about 10 years already. Every year, more and more at conferences of ophthalmologists, questions arise not at the level of “What is this?”, But at specific practical nuances of technology. VisuMax lasers exist in several clinics in Russia, but it is much less used under ReLEx SMILE than under femtoLASIK. Historically, it happened in Russia that this technology is little used in the central part and is actively used beyond the Urals.

— What is the story with licenses for specific operations?

Zeiss sells cones with licenses. A cone — a replacement part adjacent to the eye — is purchased with a license to use a laser procedure, usually in batches of 10 or 100 operations. For example, 10 cones and 10 licenses are received. Licenses are driven through the laser menu, and it allows you to use the appropriate cones for the appropriate program types. Licenses for SMILE separately, for femtoLASIK separately, for FLEX, rings and additional corrections are also separate licenses. Most manufacturers of femtosecond and some excimer lasers have a similar situation. Licenses for excimer operations are not needed, perhaps, except on models of about 5 years old and older.

— And you can not get such a license for SMILE?

Easily. Firstly, this module in the laser is as an expensive option, so the device itself without the SMILE option is cheaper. Secondly, if this option is available, then licenses to carry out the operation ReLEx SMILE can be acquired only after conducting 5–10 test runs on pig eyes, then performing at least 10 femtoLASIK operations on patients, then 50 FLEX operations, and only after that Buy a SMILE license for a specific surgeon.

Today, without the «tin», as you asked

There is already a post about how the laser cuts by creating millions of cavitation bubbles in the cornea layer of the eye, and analyzing telemetry from the real operation in seconds with comments of the surgeon's actions.

Now FAQ about various related things

— If I look away while the laser is running, what will happen?

You simply will not work. In fact, immediately after anesthesia, the eye is pressed against a special pneumocapture. To blink at you too will not leave because of fixing (it is not long and not for long). The only moment where it is possible to seriously disrupt the course of the operation is to pull the head down strongly, pulling it out of the headrest by a serious willed effort. In this case, the operation will instantly stop. More precisely, it will stop even before the loss of capture (details below).

— How should an operating room be prepared?

In general — as a normal operating room, that is, a room with a clean area (air filtration, overpressure to prevent contamination from the outside after cleaning). It is important for the procedure that microparticles of dust flying in the air do not fall between the laser lens and the eye.

Friends, after a break, we resume publications on vision and technology to restore it. The pause was connected with my workload of operations and participation in conferences: in the near future I will publish a review of the most interesting technical innovations in ophthalmology that were presented at them, and today we will talk about astigmatism.


Modern statistics depressing. More than half of the world's population suffers from visual impairment, the most common problems are myopia and hyperopia. But ophthalmologists often diagnose another disease, the name of which is unfamiliar to many. Astigmatism is a defect in the optical system of the eye when the sharpness of the image is asymmetric vertically and horizontally. And the parallel rays of light passing through the eye are focused not into a point, but into the “eight”. For a person, this means that the visibility of the image becomes unsharp, and this often applies to both distant and close objects. As a result, instead of a normal image, a person sees a distorted image, in which some lines are clear, others are blurred. An idea of ​​this can be obtained if you look at your distorted reflection in an oval teaspoon.

Ophthalmologists say that almost two thirds of the world's inhabitants face such a problem. But since the degree of astigmatism may be small, many people practically do not feel any discomfort. It is difficult for doctors to identify a clear list of common symptoms indicating that a patient has astigmatism. In each case, they will differ. In the very early stages, it is often confused with tired eyes.

However, quite a few people need special treatment or correction of this disorder with the help of glasses, contact lenses or even surgery.