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The Miracle of Sight — Beams of Light Restore Vision for Millions

This article is part four of a series of web features that explores the wonderment of eyesight, the care and keeping of eyes, common eye ailments and treatments, the future of eye care and the emerging hope for the blind.

It's just a tiny beam of light, yet its power and precision are remarkable: A laser is able to remove portions of tissue smaller than the thickness of a human hair. For more than 30 years, laser technology has been used in a procedure called refractive surgery to correct a variety of common vision problems.

  

Etched human hair

A human hair, etched by a laser.

  

LASIK procedure illustration - 1
LASIK procedure illustration - 2
LASIK procedure illustration - 3

The LASIK procedure involves making a corneal flap and then sculpting the cornea under the flap with a laser.

A strange and good idea

In the early 1970's a Russian physician named Dr. Svyatoslav Fyodorov treated a patient with glass fragments in his eyes. The doctor noted that after the glass fragments were removed and the cornea had healed, the patient was able to see better without glasses. After researching past efforts at refractive surgery, he worked out a formula that made this procedure more predictable. In 1978, he then began working on methods with cuts being made to the outer surface of the cornea to change the shape of the eye, which later became known as radial keratotomy. Since it was introduced, radial keratotomy has been performed on over 2 million patients in the United States alone. However, a number of limitations of radial keratotomy prompted research into alternate forms of refractive surgery.

The excimer laser

Refractive procedures dramatically improved with the introduction of the excimer laser in the early 1980s. The excimer laser is a computer-controlled ultraviolet beam of light used to reshape the cornea so light can focus more directly on the retina. It is widely used around the world today for laser vision correction procedures, including PRK(photorefractive keratectomy) and LASEK (laser-assisted subepithelial keratomileusis).

LASIK

One well-known type of LASEK surgery is known as LASIK (Laser-Assisted In-Situ Keratomileusis). The word "keratomileusis" is derived from two Greek words that literally mean "to shape the cornea". "In-situ" means "in place". Thus, the term LASIK literally means "to reshape the cornea in place using a laser". LASIK has been around since the early 1990s and is considered one of this century's most amazing technological breakthroughs in eye care.

The difference between LASIK and PRK

LASIK and PRK can treat both myopia (nearsightedness) and hyperopia (farsightedness), with or without astigmatism.Both PRK and LASIK use an excimer laser to reshape the corneal layer, called the stroma. Since the stroma is the second layer down, beneath the epithelium on the surface, the doctors must somehow get to it – it's in creating this access that the two procedures differ:

  • LASIK creates a surface flap, bends it back on a hinge, and then replaces it after the work is done. A new type of LASIK surgery allows doctors to use a laser, instead of a mechanical device with a blade, to create this surface flap, resulting in a greater precision of flap creation and fewer complications.
  • PRK entirely removes a thin layer of surface tissue and you would wear a bandage contact lens for about two weeks while those cells grow back. PRK is typically used today to treat patients with thinner corneas. The major benefit of PRK is that the integrity and strength of the corneal dome is retained.

For some people, LASIK is the better choice, and for others, PRK is better.

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