What is vision like years after a laser eye surgery?

Silmade laseroperatsiooni näol on tegu maailma populaarseima plaanilise operatsiooniga – aastas tehakse üle 30 miljoni laseroperatsiooni. Lisaks on tegu ühe turvaliseima operatsiooniga, mille õnnestumise tõenäosus on väga kõrge ja komplikatsioonide oht ülimalt madal. Meditsiiniajaloo mõttes on aga laserrefraktiivkirurgia näol tegemist üsna noore meditsiiniharuga. Esimesest teostatud laseroperatsioonist on tänaseks möödas pea 40 aastat. Laiema avalikkuse hulgas muutus prillidest ja läätsedest vabanemine populaarseks umbes 30 aastat tagasi.

It is often a valid question for patients to ask whether enough data has been collected over this time to understand what a person's vision is like years after a laser procedure. Is the result still permanent? Does the vision of someone who has undergone laser surgery change with age, similar to someone who hasn't had the procedure? We discussed this topic with Dr. Ants Haavel, a refractive surgeon at the KSA Vision Clinic.

Please briefly explain the history of laser eye surgery. How long have laser procedures been performed, and how did it start?

The first lasers used in eye surgery were excimer lasers, which were previously used only for industrial purposes, such as microchip manufacturing. Lasers were first used in eye surgery in 1987 when German eye surgeon Theo Sailer and Columbia University researcher Stephen Trokel collaborated to perform the first corneal surgery known as photorefractive keratectomy, or PRK. The term LASIK was first coined in 1991 by the legendary Greek eye surgeon Ioannis Pallikaris, who is also considered the first surgeon to perform a LASIK procedure.

Laser refractive surgery started in Estonia in the early 21st century. The KSA Vision Clinic performed its first laser procedure in 2005. Until 2010, LASIK was the predominant method at KSA, but afterward, we shifted towards no-cut / bladeless procedures.

At KSA, we have performed both LASIK and no-cut procedures. When comparing LASIK and no-cut procedures, is the long-term outcome the same? Or do no-cut procedures have advantages?

Me saame teha järeldusi vaid erialakirjanduse ja oma kogemuse põhjal. Oleme KSAs jälginud oma tulemusi 18 aastat, teinud üle 30 tuhande protseduuri ja mitusada tuhat uuringut. Meie järeldus on lihtne ja lühike – mida õrnemalt sarvkesta protseduuri ajal ja selle järgselt kohelda, seda turvalisem protseduur, seda parem nägemiskvaliteet ja seda püsivam efekt. Seetõttu me 2010. aastal lõikega protseduuridest loobusime, kuigi sellel ajal olime Eestis ja Baltimaades kõige enam LASIK protseduure teostav kliinik. Toonitan, et see on KSA Silmakeskuse vaatenurk, sest maailmas on tuhandeid kliinikuid, kes teostavad siiani lõikega protseduure ja on oma tulemustega rahul.

How long does the result of the Flow3 laser procedure last? Is it lifelong?

When patients ask whether the result is permanent and lifelong, meaning that they will never need glasses again, we can say that once the cornea and the eye have fully recovered from the procedure, the effect of the procedure is indeed permanent.

Occasionally, a small amount of myopia can return, and then a repeat procedure may be necessary. In the early days of laser surgery, the percentage of repeat procedures was 30-40 % , but with advancements in technology, increased experience, and more stricter patient selection criteria, procedures have become much more precise and safer. At KSA Eye Center, the rate of repeat procedures is currently less than 1 %.

However, it's essential to remember that laser surgery does not protect the eye from age-related changes or more complex eye diseases. This is why it's crucial for clinics to select their patients very carefully. We, at KSA, are highly selective. If during the pre-procedure examination, we have any doubts about a patient's suitability, we put them on hold and do not proceed with the procedure. We invest substantial amounts in diagnostic technology, continually train our staff in international and domestic programs, and work closely with patients during pre-procedure examinations. When patients are carefully chosen, the results are very good and long-lasting.

Is it true that the manipulation of the eye during the laser procedure is so minimal that there are no visible traces even under a microscope after recovery?

Indeed, ideally, there should be nothing visible under a microscope after complete recovery, which takes a few months. The cornea should be perfectly clear, with no visible traces of the laser procedure. This means that an eye doctor should not be able to detect any manipulations done on the eye.

However, diagnostic devices can still identify that a procedure has been performed by noting that the cornea is slightly thinner and flatter than in the case of the average person. To put this into perspective, the thickness of a regular sheet of printer paper is 100 micrometers. If a person has myopia, say 6 diopters, which indicates fairly severe myopia, the laser will remove approximately 100 micrometers of the cornea to correct it. As you can see, only minimal changes in eye characteristics are needed to achieve life-changing vision improvement. Such microsurgical manipulations would be inconceivable without laser technology.

Is it true that the manipulation of the eye during a laser procedure is so minimal that, after recovery, it is impossible to tell through a microscope that anything has been done to the human eye?

Indeed, ideally, there should be nothing visible under a microscope after complete recovery, which takes a few months. The cornea should be perfectly clear, with no visible traces of the laser procedure. This means that an eye doctor should not be able to detect any manipulations done on the eye.

However, diagnostic devices can still identify that a procedure has been performed by noting that the cornea is slightly thinner and flatter than in the case of the average person. To put this into perspective, the thickness of a regular sheet of printer paper is 100 micrometers. If a person has myopia, say 6 diopters, which indicates fairly severe myopia, the laser will remove approximately 100 micrometers of the cornea to correct it. As you can see, only minimal changes in eye characteristics are needed to achieve life-changing vision improvement. Such microsurgical manipulations would be inconceivable without laser technology.