The latest methods allow us to free people with high vision defects or presbyopia from wearing glasses, says Prof. Jerzy Szaflik, a pioneer of refractive surgery in Poland and head of the Oka Laser Microsurgery Center in Warsaw, the largest private ophthalmology clinic in the country.
Professor, first of all, let us explain the concept of refractive surgery.
Simply put, these are all eye surgical methods that allow us to bring the patient to normopia, i.e. normal vision, or at least to significantly reduce the vision defect that the patient has.
Is a laser used for this purpose?
Most often, yes, we willingly use very advanced methods of laser vision correction, but in some cases excellent results are also achieved by implanting phakic lenses. However, this is a completely different surgical technique.
Let’s start with laser methods. Which of them would you mention as particularly advanced and why?
Definitely ReLEx SMILE and PRESBYOND. The first one corrects myopia, the second one corrects presbyopia and the accompanying vision defects. Both of them gave us the opportunity to correct in areas where it was not possible before. Additionally, the SMILE method is based on technology so groundbreaking that the Nobel Prize was recently awarded for its invention.
That’s interesting, could you elaborate?
It’s about CPA technology. This is an abbreviation of the English Chirped Pulse Amplification, which translates as “amplification of ultra-short pulses” or “chirping” impulses.
It enables the generation of laser pulses that are very intense and very short at the same time.
Such an impulse makes cuts with incredible precision, and its duration is so short that it does not actually change the temperature of the operated tissue. Therefore, it does not destroy nearby cells. In many ophthalmological cases, this is crucial because, for example, corneal endothelial cells are damaged when the temperature is increased by 1-1.5°C. This is one of the reasons why CPA technology was awarded the Nobel Prize in Physics in 2018.
What is the use of this technology in SMILE correction?
CPA technology uses a femtosecond laser to perform SMILE correction. I will add that a femtosecond is one quadrillionth of a second, which gives you some idea of how short the pulses this laser generates.
What is SMILE correction?
The essence of the procedure is to cut out a microlens inside the cornea, i.e. the outer layer of the eye, using the mentioned femtosecond laser. This microlens is then removed through an incision just 2.5-4 mm long. The name of the procedure, i.e. “smile”, refers to the arched shape of this incision, but it is also developed from the English SMall Incision Lenticule Extraction, i.e. “extraction of the lens with a small incision”.
Apart from the use of CPA, what is the innovation of this method?
The femtosecond laser is so precise that it can be used to create an extremely thin microlens. This method allows you to correct quite large vision defects, even up to -10 diopters. These values are unavailable for other laser correction methods. Secondly, due to the mentioned “gentleness” of the femtosecond laser, SMILE® ensures extremely fast recovery and is the most comfortable for the patient. The expected visual acuity is achieved the next day after the procedure.
You also mentioned another modern method intended to correct presbyopia. What exactly is this defect?
Presbyopia, or presbyopia, is basically a natural consequence of aging eyes, not a visual defect in the strict sense. To a greater or lesser extent, it will affect every person over 40 years of age. The reason is the loss of elasticity of the eye lens. This makes it difficult to focus the image on closely located objects, so the sharpness of near vision weakens. The patient finds it increasingly difficult to read or perform more precise activities. People with presbyopia often say that their arms are too short, meaning that they reflexively move the objects they are viewing as far away from their eyes as possible. However, this is slowly not enough.
There may also be symptoms of constant strain on the eyes – headaches, eye pain, fatigue…
Is this why people over forty often wear “plus” glasses?
Yes, presbyopia is normally corrected with “plus” glasses. They are mainly used for reading because they make it difficult for a person with presbyopia to see at a distance. There are also glasses and progressive contact lenses. They have different zones that allow a person with presbyopia to see close, intermediate and far. However, they require some getting used to. You need to learn how to use this type of correction and accept its limitations.
And the mentioned method of laser correction of presbyopia?
It’s about the PRESBYOND method, which is finally a solution that I would describe as satisfactory and comprehensive. This procedure allows you to get rid of reading or progressive glasses. Alternatively, becoming independent from them in the vast majority of situations. However, almost all patients regain full vision at any distance thanks to it, because at the same time not only presbyopia is corrected, but also the accompanying myopia up to -8.5 D or hyperopia up to +5.75 D. Importantly, the effects of the procedure are stable and excellent tolerated by our patients.
What does such a procedure look like?
A “flap” is cut out in the cornea using a laser – also with the help of a femtosecond laser. After appropriate modification of the surface under such a flap, it is closed. This procedure on both eyes takes only about fifteen minutes. After the procedure, each eye sees slightly differently. One is slightly better for distance, the other is slightly better for near, and both eyes are equally good for intermediate distances. The PRESBYOND® procedure thus recreates the natural asymmetry of vision.
Almost all of us have a dominant eye, on which the visual system “relies” more during binocular vision than on the other eye, called the non-dominant eye. After the brain gets used to the vision corrected in this way, it becomes completely natural for the patient.
Concluding the topic of laser vision correction, I will ask about older methods. Are they still used?
Yes, many of them. There are cases in which the older method may be the optimal choice. An example is the surface EBK method, in which the corneal epithelium is removed and then reshaped to obtain normopia. Complete regeneration of the epithelium takes about a week, and the patient then wears special dressing lenses. EBK will work well in patients with unusually flat or steep corneas or with recurrent erosions and degenerations of the epithelial basement membrane. However, it is used in a narrow range of vision defects.
In my clinic, the most beneficial method for a given patient is always selected, taking into account all factors.
And the mentioned phakic lenses?
This solution is most often used in the case of very large vision defects, beyond the reach of laser correction methods, or in cases of smaller defects when laser correction cannot be used for some reason. Such correction involves implanting an individually selected, artificial, flexible lens between the patient’s own lens and the iris, which corrects the entire optical structure of the eye.
It is currently a very modern and safe technique that allows you to get rid of glasses or contact lenses. If it becomes necessary to replace it, this procedure is fully reversible! However, our many years of experience show that patients are very satisfied with the effects of this method and this satisfaction continues over the years.
Please tell me a few more words about the new projects of your clinic.
We have recently launched a unique project, the EsteLaser aesthetic medicine office, located in Warsaw’s Nowy Świat district. The idea was actually proposed by our patients, who often come with the problem of various types of skin lesions around the eyes or for eyelid surgery. Following their suggestion, we decided to supplement the oculoplastic offer with treatments purely in the field of aesthetic medicine, which allows us to help many people more comprehensively and synergistically.
Very demanding manual work with delicate areas around the eyes also allows us to improve the aesthetics of other areas of the face with equal precision. We have even prepared “CMO Laser x EsteLaser” packages, combining oculoplasty or ophthalmology with aesthetic medicine, which is probably an unprecedented situation on the market. You are cordially invited, more information can be found at estelaser.com.pl.
Interview by Dawid Krążyński