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Lasers have revolutionized the treatment of many eye conditions, and in some instances have made treatment possible in previously untreatable diseases. We will discuss some general facts regarding lasers, specific conditions that can be treated by laser, and also mention some common misconceptions regarding the use of lasers.    The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Laser light is a form of high energy-density monochromatic light that can be utilized to accomplish one of the following effects:     1: Coagulation of blood vessels or other bodily tissues through the generation of heat,   2: Disruption of tissues, in other words to create a mini-explosion at microscopic level,   or   3: Ablation of tissues, meaning to make molecules disappear.   Your ophthalmologist will decide which type of laser to use after examining you.    All lasers have an aiming beam to guide the surgeon to apply the laser energy in exactly the right spot, and the laser energy-levels can be adjusted to deliver precisely the correct amount of energy. In some types of lasers, the size of the laser spot can also be manipulated. Lasers produce their effects due to the fact that certain tissues absorb the transmitted energy better than others, and this can be utilized to selectively treat specific tissues.   Some patients are afraid of laser treatment, thinking that it will be very painful, or that it may damage other eye structures. The truth is that laser therapy is almost never painful or uncomfortable when done by an experienced ophthalmic surgeon, because he will use anesthetic drops if necessary.   The Laser also has the advantage that it can be precisely focused to selectively treat a specific ocular structure without damaging the surrounding tissues.   Another misconception is that you will have to be admitted to hospital for laser treatment. Almost all laser procedures are done on an outpatient basis, and under local anesthetic.   It is vital to remember that lasers can be dangerous if not used properly, and if you are in a profession which uses high energy industrial lasers, you should be very cautious and wear protective glasses to prevent permanent damage to your eyes. Ophthalmic lasers however, utilize very low levels of energy, and are generally safe to work around.    Specific conditions where laser therapy is indicated, include the following:     1: Diabetic eye disease is one condition where laser therapy has benefited patients immensely, and where the whole course of the disease can now be altered, resulting in better long term visual outcomes.   All diabetic patients should be seen at least once a year by an ophthalmologist, so that early retinal changes can be evaluated, and treatment can be started if necessary to prevent damage. If there are already diabetic eye changes present, the patient should, depending on the severity of the disease, be seen much more often. It is important to note that there may already be retinal disease present, even though your vision may still be normal!   2: Lasers are used in diabetics to coagulate abnormal retinal blood vessels and retinal areas to prevent leakage and further formation of abnormal blood vessels that could lead to bleeding in the eye and traction on the retina, and ultimately result in blindness. Another type of laser is used to treat a type of glaucoma that diabetics can develop, called neovascular glaucoma.   3: Other conditions such as retinal vein thrombosis might need laser treatment to prevent long-term complications, such as glaucoma.   4: Some intra-ocular tumors can be treated by laser if they  are diagnosed while still small enough.   5: Laser therapy can be useful in the treatment of "after-cataract", a condition where the little membrane   that supports the implanted artificial lens after a cataract extraction, undergoes clouding. This opaque membrane   can be opened centrally, using a special type of laser called a YAG Laser that will create a little window through which the patient will be able to see again, without having to undergo another operation.   6: The newest application of lasers is in the field of refractive surgery, where a special type of laser can be   used to change the shape of the cornea, to improve nearsightedness, farsightedness or astigmatism. This procedure may replace spectacles and contact lenses   almost completely! This is precisely the result which   LASIK and PRK have for most patients. Once the patient becomes presbyopic however, glasses will  again be required, at least for reading.   7: Lasers can be used to create or enlarge drainage openings inside the front part of the eye in the treatment of most types of glaucoma, to increase outflow of aqueous fluid and decrease the intra-ocular pressure.   The future of lasers include exciting new developments such as automated controls that will enable programming for specific degrees of treatment, use of lasers in diagnostic instruments to map visual fields, and to examine the back of the eye through an undilated pupil, and further refining of lasers as surgical tools in cataract and other intra-ocular surgery.    Patients often have the misconception that lasers can treat any eye condition, and this creates false hopes and expectations. They usually know someone, or have heard of someone who has had successful laser treatment, and then they believe that their own eye problem can be similarly treated and cured. You should consult your ophthalmologist to find out whether your eye problem is amenable to laser therapy.      If you have any further questions regarding Lasers and your eyes, please consult your eye specialist.

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