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Pindara Private Hospital Magazine - Issue Three

HEALTH & BEAUTY There a few things that are certain in life, but as we all know, what we can count on are aging and taxes! The implication of this is that time moves on – the movement of time in ophthalmology has produced some great developments for us all in technology specifically directed towards the improvement and restoration of the wonderful gift of sight. We are all living longer thanks to the many other wonders of modern medicine (in Australia the average lifespan has increased to 87 years for women and 84 years for men,) meaning that the eye diseases of aging are being seen more frequently. Not that the advances are restricted to aging eyes, some wonderful advances are now available for eye diseases that affect young people as well. Sight is one of the gifts that dramatically improves the quality of life even when other afflictions are present. The first collection of advances that come to mind in a discussion like this are the devices that we use to improve sight (about which I will write shortly) but there are many eye diseases that are incurable and the exciting thing in this realm are the advances in technology that have provided us with the ability to diagnose the incurable diseases at an earlier stage and introduce treatments that would otherwise have been delayed, in some instances, to a much later time in the course of disease when return of function or at least stabilisation is too late. Lasers We glibly use the term LASER (an acronym meaning - Light Amplification by Stimulated Emission of Radiation), and while LASERS have been around for a while, the refinement has been dramatic - so much so that we now have at least 10 forms of laser with refinements in many of them. EXCIMER Laser This is one of the more well known lasers also named by acronym (EXCited dIMER), that we have used for many years as a corneal treatment for refractive surgery for the removal of spectacles, but in the last five years, the accuracy and speed of the Excimer Laser has improved so much that any inaccuracies nowadays relate more to variance in personal healing properties than laser variance. Much of this is contributed to by the speed and regulation of the laser delivery (the speed of delivery has increased from 10 pulses per second to 600 pulses per second) making the laser treatment much easier for the patient. FEMTOSECOND Laser This laser energy is capable of making preprogrammed cuts in the cornea of the eye at virtually any angle depth length or breadth. Such is the accuracy of this laser that lenticules of tissue can be removed through small incisions from the less important deeper tissues of the cornea to provide refractive correction as accurate as the Excimer but making a much safer refractive procedure. This process also permits treatments on thinner and irregular corneas such as in certain milder forms of keratoconus, never before possible. In respect of keratoconus (an eye disease progressive in childhood and young adulthood), this laser can be used to assist with the rectification of the corneal distortions of keratoconus by cutting tracks for another new technological advance – Intra-Corneal Stromal Ring Segments (ICSRS – Kerarings / Intacs / Ferrara Rings) that are strategically implanted into the cornea to correct the distortions permitting significant improvement in quality of vision (invariably, particularly in the young progressive keratoconus, after strengthening the cornea with Collagen Crossslinking – CXL, the state of the art being “Pulsed Accelerated Transepithelial CXL”). Similarly the Femtosecond laser can be used to accurately - correct astigmatism, perform corneal grafts and cut the flaps required for Lasik as well as prepare cataracts for surgery. Nd:YAG & DIODE Lasers The Nd:YAG (or YAG laser as it commonly shortened to) permits cutting inside the eye without the need to enter the eye with surgical instruments and used often to cut a Peripheral Iridectomy, a pressure release valve for angle closure glaucoma (qv) or to cut a thickened posterior capsule, the membrane supporting an intra-ocular lens after cataract surgery. This laser too has been refined in recent times to add further functions to it’s cutting ability such as permitting lysis and photodisruption (“evaporation”) of floaters in back of the eye, a very common and frustrating problem for many people). This is called Laser Vitreo-Lysis. Additionally by scientifically doubling the frequency of Nd:YAG laser which means cutting pindaramagazine.com.au Pindara Magazine 65


Pindara Private Hospital Magazine - Issue Three
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