Eye Health

Updated 15 October 2015

The miracle of eye laser surgery

Laser eye surgery is a common and simple procedure for improving your vision. But that is not all it is good for – it can also save your sight.

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Fifty years ago my father suffered a tear and partial detachment of the retina in his right eye. It was stitched back on and he spent six weeks in hospital, two of them with his head sandbagged to prevent any movement.

A month after returning to work his retina tore and detached again. This time it was repaired with 150 micro-stitches and required another six-week hospital stay.

Twenty-five years later he completely lost the sight in the eye when a specialist attempted to remove the cataract that had developed in it. Because his lazy left eye (a condition called amblyopia) had gone undetected for most of his life (which meant he hadn't been able to see out of it from birth), my father is now blind.

The story would have been very different if my father's retina problems had occurred today, thanks to the revolutionary breakthrough of laser eye surgery.

Laser eye surgery first hit the headlines in the 1990s when photorefractive keratectomy (PRK) and then Lasik surgery started being routinely performed to correct myopia (short-sightedness), hyperopia (far-sightedness) and astigmatism (distorted vision). However, lasers can do far more than allow you to throw your corrective glasses and contact lenses away: today they are saving the sight of millions of people around the world.

First-hand fright

At the end of October last year I suffered a retinal tear. It happened quite spontaneously and for no reason. Within a few minutes of my ophthalmologist's diagnosis, I underwent laser surgery and walked out of his rooms 15 minutes later.

Unfortunately my story didn't end there. When my retina tore it ruptured a blood vessel, which burst again three weeks later. This time I required an in-patient surgical procedure called a vitrectomy which meant recovery took a whole lot longer. It also means I have to undergo surgery to remove a cataract in the very near future because the development of a cataract is one of the side effects of any form of retinal surgery, and it's already made its presence felt.

Once again, the miracle of laser will be coming to the rescue.

Revolutionary technology

Lasers were first used in the 1960s to treat eye disorders such as diabetic retinopathy (a disease of the retina that can result in a severe loss of vision in diabetics).

Since then this state-of-the-art technology has revolutionised many aspects of ophthalmology. This is because lasers can get inside the eye and do their work without the eye having to be cut open, as is the case with conventional eye surgery.

It's a quick (it usually takes about 10 minutes), painless and safe procedure, with no need for a general anaesthetic (except for drops to numb the eye) and it's done while you are sitting up in a chair – similar to an ordinary eye examination.

Some specialists will perform the procedure in their rooms if they have the equipment, but you usually have to go to an eye hospital.

There are several different types of lasers that can be used for a number of clinical indications, including the following:

Diabetic eye disease

Lasers have been used to make harmless scars on the retinas of diabetics ever since it was discovered that patients who had retinal scars were less likely to develop diabetic retinopathy. Laser is also used to seal leaking retinal blood vessels. However, if the laser treatment does not work, a vitrectomy may need to be performed.

Glaucoma

Glaucoma is a build-up of pressure inside the eye that damages the optic nerve. Its cause is not usually known but if the pressure remains elevated for a prolonged period (months or years) extensive damage, which cannot be repaired, can occur.

Lasers are used to make tiny holes within the eye to allow the intraocular fluid to drain out more efficiently, thereby lowering the intraocular pressure for open-angle glaucoma, and to make a hole in the iris (similar to a small extra pupil) to release pressure build-up in closed-angle glaucoma.

Cataracts

Although lasers are not used to remove cataracts, they play an important role in cataract surgery. They are used to measure the eye before the operation to work out the size of the lens that will be implanted and can also be used years later to clean the lens implant.

Retinal holes and tears

Your eyes contain vitreous jelly, which is situated behind the lens and is attached to the retina. It helps your eyes to grow before birth, but after the age of three, when your eyes have fully developed, it has little function except filling them up.

As you age, the jelly eventually detaches from your retina spontaneously (a posterior vitreous detachment, not to be confused with a retinal detachment) and it's usually a non-event. You may notice the presence of a few extra floaters in your vision or remain completely unaware of it.

However, in some people the pulling away of the vitreous jelly may create a hole or tear in the retina. If this happens you should consult a specialist immediately. Other spontaneous holes or tears may be caused by acute trauma, such as being hit in the eye by a squash or tennis ball, or after bungee jumping.

Retinal lattice degeneration

Three years ago, Cheryl Pearson's younger brother woke up and discovered that the bottom half of his vision had disappeared in one eye. "As the day progressed he felt what he describes as a black "blind" moving up his eye, so he went to see a retinal specialist," she explains. "He immediately underwent laser treatment to 'weld' together the pinhead-sized holes in his retina. He was told it was a genetic condition called retinal lattice degeneration, which can lead to retinal detachment if not corrected. The doctor advised that all his siblings be checked for the condition."

Soon afterwards Cheryl, 54, found herself undergoing laser surgery in both her eyes and her sister and other brother also had to have the treatment. "It was very frightening," she recalls, "I'd never had any problems with my eyes before and suddenly I was told that my retinas could be detaching."

While Cheryl admits she found the whole situation "pretty scary", it was, she says, "a really quick fix and I'm so grateful that, unlike my brother, we were all fortunate enough to be warned and could do something about it. I've since been for check-ups and there's no sign of further degeneration – without the laser it could have been a whole lot worse."

The family's children will have to have ongoing check-ups and future generations will probably need to undergo the same treatment but, says Cheryl, "It's a small price to pay for something so valuable – your eyesight."

Retinal detachment

Vanessa Obers, 47, says, "At the age of 26 I became short-sighted, probably due to the intense microscopic work I do as a pathologist.

"Twelve years ago we were on a game drive in the bush when I realised there was something wrong with my eyesight. Back at the lodge I sat in the bath trying to shave under my arms. It was quite bizarre – I couldn't see under my right arm – and when I looked in the mirror to put my make-up on I could only see half of my face.

"Being in the medical profession, I knew I was in trouble – I thought I had a tumour. We left the game lodge early the next morning and I consulted a neurologist who did an MRI scan, which was normal. He referred me to an ophthalmologist who told me I had a detached retina.

"This completely floored me because it had come out of the blue. I was 35 years old and earned my living through my eyesight. I was terrified.

"I was sent straight to hospital where I underwent laser surgery in both eyes after they picked up degenerative changes in my right eye and wanted to prevent the retina detaching in my other eye. I was off work for three months and had to lie on my left side to allow the retina to heal. Thanks to world-class specialist care and the miracle of laser surgery my vision returned to normal within six months.

"I've been left with a lot of floaters across my field of vision, but I've learnt to see past them and to live with a new reality. I've also learnt that you can't put a price on good health, and I've learned just how precious your eyes are. Like every other healthy part of the body, they should never be taken for granted."

Lynne Gidish spoke to Dr Clive Novis, an ophthalmologist in private practice in Benoni, and Dr Alison Taylor, a retinal specialist in private practice in Johannesburg.

Read more:
Sight-saving eye ops
Laser vision correction: the latest

 

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Optometrist

Megan Goodman qualified as an optometrist from the University of Johannesburg and is currently practising at Tygerberg Academic Hospital in Cape Town. She has recently completed a Masters degree in Clinical Epidemiology at Stellenbosch University. She has a keen interest in ocular pathology and evidence based medicine as well as contact lenses.

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