Lazers

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?

Of course, “we cannot do it ourselves” —the surgery requires another surgeon whom you trust 100%. Answering the question of who the relatives trust — I use mine myself. I did the operation to my mother, aunt, daughter, husband — who needed something “to fix”. Walter operated on his wife and father-in-law.

We can usually do this while shooting or tell how it happens, with the consent of loved ones. We do this when we need to “sacrifice” someone for the sake of science. In our clinic already 6 people after laser vision correction. In the network of clinics SMILE EYES also a few people. The last case — we have 7 years of work in the position of operating nurse-administrator girl Anya, she meets and escorts patients for refractive operations. She is experienced with experience: by the age of 35, fifteen she wore soft contact lenses, sometimes she used glasses. The idea of ​​correction lived in her for all 7 years — as it happens, she saw many times in the form of records from the operating rooms. She saw both Lasik and femtoLasik, and only the operation of vision correction ReLEX SMILE (minimally invasive lenticle extraction) instilled in her confidence in safety and painlessness.

About Anya: I was preparing for the operation as it should be — for a week I honestly took off contact lenses and used glasses. The patients of the clinic were surprised and asked why she was wearing glasses, explaining that she was preparing for a correction. The day was chosen so that she spent the morning in the clinic; in the afternoon, a correction could be made. On this day, I had several SMILE, several SMILE operations — with Walter, who came from Germany. We agreed that Anya will be operated by Professor Sekundo, and I will help camera operators with shooting.

— 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.

Now I will show what doctors usually never show to patients. More precisely, it shows everything in the form of a beautiful render, from which it does not follow at all that a piece of metal will stick up in your cornea for a couple of minutes. Fortunately, you will not feel this because of the anesthetic premedication, you will not know and do not remember, because the piece of iron will be out of focus.



So, watch the video, and I will show the frames with comments. This is a real operation on a patient in a German clinic, the recording was made on a device like the “black box” of the VisuMAX device. In this case, the patient has agreed to use the recording for training purposes, usually access to such records is strictly limited.

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.