The potential of lasers in refractive surgery

Abstract

The information about to be imparted is of an experimental nature. This is state of the art technology and by the end of this paper I hope you will get the feel of where this technology currently stands, some of the problems that remain to be solved and also a feel for the possible potential of laser applications for this type of surgery. The subject really needs to cover knowledge in a number of different fields and therefore the journey I am going to take you on is quite a complex one. It will start in the field of radiation biology, it will then wander into nuclear physics, it will then continue on to ocular anatomy, a little bit of physiological optics, some pathology and then at the end of the day back into the field of bio-engineering. The laser field is an international one, the real pioneer being Dr Stephen Trokel from New York who first perceived the potential of excimer lasers for ophthalmic surgery. There are a number of other individuals and of particular note is Dr Stephen Tuft, one of my research students, who has done a lot of work on the stromal collagen remodelling; Dr Ralph Zabell who has developed a new photo-keratascope the results of which you will see later on and Malcolm Kerr-Muir of St Thomas's Hospital who has undertaken some of the first clinical exposures. Lasers have a certain reputation amongst the public and it really all stemmed from the film in which Goldfinger chose to operate on J ames Bond. The problems of this film was that it really led the public to expect a potential and a level of output from lasers which at the time they really were not capable of delivering. This is not the case today. Lasers are now available which will deliver terror or gigowatts of power. 14.4 terrorwatts hours is the equivalent of the total power consumption of London for a year. Lasers are indeed extremely powerful devices.