Conversation with Andrzej King, MD - ophthalmic surgeon, graduate of the Naval Academy in Łódź.
Laserowa korekcja wzroku. Coraz gorętszy temat…
Reality. More and more patients are asking for it and more and more people are opting for it. Laser vision correction is an increasingly popular and affordable method of getting rid of glasses or the hassle of using contact lenses. It allows full functioning in all conditions, e.g. at night, and is particularly recommended for active people practising extreme sports such as diving, parachute jumping, cycling or motorcycling, where it is necessary to use protective helmets, making the wearing of glasses particularly difficult, if not impossible.
It is also dedicated to women whose glasses spoil an elaborate image or interfere with their daily work, e.g. models or stewardesses.
Laser vision correction has a history, and when did it start?
The beginning of refractive surgery - as this field of ophthalmology is called - dates back to the 1970s. The Soviet ophthalmologist Prof. Fyodorov pioneered the method of radial corneal incisions that modelled the anterior surface of the cornea, resulting in a reduction of the visual defect in the myopic eye (so-called minus). In the 1980s, the laser was harnessed to model the cornea. Since then, there has been a rapid increase in the quality and number of laser procedures.
Pierwszą metodą laserową, którą wykorzystuje się do dnia dzisiejszego jest metoda PRK polegająca na wykorzystaniu promienia laserowego do zmiany krzywizny rogówki w efekcie czego uzyskuje się korekcję wady wzroku. Metoda wykorzystywana głównie w leczeniu myopia do – 8 dioptrii (minusy) lub nadwzroczności (+) do 4 dioptrii. W toku rozwoju tej dziedziny okulistyki rozwijano nowe metody korekcji wad wzroku takie jak LASEK, LASIK czy epi-LASIK.
At the same time, the range and type of defects to be corrected has increased. The differences between these methods are not very clear to most patients. The selection of the treatment method that is most beneficial for the individual patient takes place during a meeting with the doctor, where, in the course of the conversation, the patient outlines the nature of his or her work and expectations for the outcome of the treatment. After a detailed eye examination, during which imaging (mapping) of the anterior cornea is performed, the thickness of the cornea, the condition of the fundus and, of course, the size of the defect are determined, a choice of treatment method is made and presented to the patient for approval.
During the qualifying examination, the size of the defect that can be corrected during surgery is determined. Normally, we move in the area of - 10 diopters for nearsightedness to +6 diopters for farsightedness with a astigmatism up to 5 dioptres. We can also perform so-called presbyopia treatments, where people over the age of 40 - in a significant proportion of cases - will be able - after such treatment - to read without the aid of glasses.
The excimer laser is apparently not the laser alone, but a whole system of several devices in one. Technology in general is rushing forward, but what about in laser correction?
Blikpol's current VISX STAR S4 IR excimer laser from the American company AMO uses the latest technology in eye tracking (Eye Tracker), iris registration to compensate for cyclotorsional eye movements (Iris Registration) and uses variable laser frequency (VRR) with simultaneous variation of the ablation diameter (VSS). This system allows vision correction to be carried out in a way that takes into account all the individual parameters of the eye. The method is called Advanced CustomVue. This technique, through the use of the WaveFront analysis used in the WaveScan device, allows individualised correction tailored by computer to the varying requirements of patients. The technique of measuring the patient's „optical apparatus” uses Fourier analysis, which to date is not used in any other device of this class.
Dzięki tak zaawansowanej technologii pomiaru możliwe jest korygowanie nie tylko podstawowych refractive errors z dokładnością do setnych części dioptrii, ale również wad związanych z jakością widzenia co określane jest mianem aberracji wyższego rzędu. Można to porównać do robienia butów na miarę u szewca, gdzie oprócz długości stopy brane są pod uwagę wszystkie inne charakterystyczne dla danej osoby cechy jego stopy. W sklepie obuwniczym wszystkie buty są uśrednione, tak, aby pasowały na jak najwięcej stóp. Podczas laser vision correction tzw. Advanced CustomVue pacjenci odczuwają znaczną poprawę widzenia w nocy, w półmroku czy przy niekorzystnych warunkach pogodowych. Wrażenia takie zgłaszane są także przez osoby nie noszące okularów a posiadające taką wadę tzw. aberracje wyższego rzędu. Dolegliwości powyższe są szczególnie uciążliwe podczas prowadzenia samochodu w nocy, kiedy rozmyte światła pojazdów jadących z naprzeciwka powodują dyskomfort jazdy kierowcy.
Excimer lasers from other manufacturers do not have this?
Many devices from other manufacturers use optimised methods, which allow laser correction to be performed based on the length of the eyeball and the curvature of the cornea, without considering many eye-specific criteria. On more than one occasion, Blikpol's Advanced CustomVue system with WaveFront analysis is used to „dock” surgeries performed with optimised methods. Doctors strive to offer each patient a correction exactly for his or her eye defect and anatomy, taking into account all his or her parameters. The WaveScan device with WaveFront analysis, mentioned earlier, is used in this process. The WaveScan is part of the laser, it examines both the visual defect and higher-order aberrations, moreover, during this examination, characteristic points on the patient's cornea are marked, which later serve to identify the patient and model the cornea correctly and very accurately. On the WaveScan, treatment is planned for each eye individually.
The most important thing for the patient is the safety of the procedure. How can you tell if a system is really good? Every manufacturer claims that its device „is the best in the world”....
For my own use, I try to find out how long a manufacturer has been on the market and what users think of its equipment. Here it is simple. VISX introduced its first lasers in 1987 and has been improving them ever since. It currently manufactures 4th generation excimer lasers.
Confirmation of the system's effectiveness is provided by the total number of VISX systems installed worldwide, with approximately half of all lasers installed in the US being VISX lasers. These are the ones used, among other things, for the eye operations of ladies and gentlemen during the popular TV show „Extreme Makeovers”. But the highest certification is given to them by the military.
The military? After all, I've heard the military doesn't allow such procedures to be performed in some of its formations such as the air force or navy....
This has changed radically in recent years. Let me give you an example. Identical to the VISX STAR 4S IR laser system owned by Blikpol, the VISX STAR 4S IR has been approved and is used - as the only system in the world - for the correction of visual defects in US Air Force pilots. In most cases, pilots have their residual or residual defects corrected by using the individualised Advanced CustomVue procedure. Pilots, after all, need to see perfectly. The same is true for NASA personnel. Laser correction of visual defects has been approved by the US Army Air Forces Command as mandatory for some key personnel and at least 17 air bases already have VISX lasers in operation.
And what is it like in the Polish army?
W Polsce obecnie prowadzone są badania kliniczne nad wykorzystaniem metody laserowej korekcji wzroku dla pilotów. Blikpol jest gotowy do wykonywania takich zabiegów dla ludzi z tzw. służb mundurowych działających w skrajnych warunkach jak np. wojsko, straż pożarna czy policja. Często lekarze dopuszczający kandydatów do służby np. w policji kierują ich na zabieg korekcji wzroku.
When is it worth it, when is it not worth operating?
Operacje laserowej korekcji wzroku przeznaczone są dla osób powyżej 21 roku życia z ugruntowaną wadą wzroku, bez schorzeń oka takich jak np. jaskra, stany zapalne przedniego odcinka oka, nasilone alergie, zaćma, odwarstwienie siatkówki, nystagmus etc. Also, the period of pregnancy and breastfeeding is a contraindication for this type of treatment.
It all depends on the patient and his body. His or her feelings about his or her vision and expectations of the end result are the most important thing here. The doctor only checks whether he has a chance of bringing about the desired result. The boundary parameters are defined, but a thorough examination of the visual apparatus has to be carried out for each eye and each patient individually. And only after this first thorough qualifying examination can something be said with certainty.
In general, at this level of technological advancement, with the above-mentioned health conditions, the operations are very effective and eminently improve the quality of life of most patients.
And what is the risk that the operation will fail ?
As with all surgical interventions of an invasive nature, there is also a risk of not achieving a fully satisfactory result, although with CustomVue's individualised procedures, this risk is practically the least possible.
Overall, the risk as determined by the FDA (Research and Control Organisation under the US Department of Health) - based on independent studies - in the US, where several million such operations have been performed to date, is less than 1% cases.
Thank you for the interview.
