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You are here: MEDICA Portal. Our Topics in 2009. Topic of the Month October: Laser Medicine. Senses.

„Even Lasered Astronauts Fly Into the Outer Space“

„Even Lasered Astronauts Fly Into the Outer Space“

Photo: Wolf Eckard Weingärtner

A quick, ambulant treatment promises rescue says Wolf Eckhard Weingärtner. spoke with the Senior Consultant of EuroEyes Laser Centre in Stuttgart about modern lasers, content patients and the Lasik-Tüv. Mister Weingärtner, many people seek to get rid of their glasses by laser surgery. Is an eye laser surgery first of all a plastic surgery?

Wolf Eckhard Weingärtner: No, since the correction of the ametropia is the first priority. The lawgiver sees it the same way: plastic surgeries are liable to tax on sales in Germany. An eye laser surgery, however, is not. An expertise has decided on that. So it is obvious that eye laser surgery is officially not regarded as plastic surgery. The most frequently used technique, called lasik, makes cutting the cornea necessary. This procedure cannot be reversed. That sounds like a high risk for the patient.

Weingärtner: With an experienced surgeon and modern lasers, this is a very safe technique. If something goes wrong, this, in most cases, does not mean that a lasting damage is caused. It only means that the surgery has to be repeated to correct the result. This happens in three to five percent of all cases. The layer of the cornea that was cut to get behind it needs months to grow together again so that another cut is unnecessary to carry out the correction. A really dangerous complication - as for example an infection inside the eye - does only occur in one out of 10,000 cases. In the media, many cases are reported that suffer from extremely dry eyes after having undergone eye laser surgery. Others report a blurred view at night because contrasts are perceived less clearly. Are these merely scare stories?

Weingärtner: In earlier times, nobody was aware that our pupil enlarges in the dark, and that the increase in size differs from one person to another. Today, patients are examined ahead of the surgery. The patients have to sit in a dark room to measure the size of their pupil and to see where the laser has to hit the pupil to receive the desired result. The eye laser surgery is based on this computer analysis. In the first weeks after the operation, the eyes usually are sensitive and blended. But these side effects disappear after a short while. Around one or two percent suffer from it for the longer term. In general, I do not really hear patients complain about light sensitivity, except for shortly after the surgery. If this was the case, we surely had thousands of sueing patients in front of our door. Yet, so far, we had no lawsuits. Eye laser technology has improved a lot then during the last years?

Weingärtner: When the laser technology was at its beginning, the surgeon had to readjust the laser manually to exactly determine the point the laser should hit. Even these very first results were not too bad. Otherwise the technology would not have become established. In recent years, the laser technology has once again extremely progressed. For example, the flying spot laser has made surgeries safer. This laser never hits two times consecutively the same spot of the cornea so that the cornea cannot heat up too much. Moreover, modern lasers identify the iris of the patient and follow automatically even if the patient moves his eye. On your website it is written: After the lasik was used a million times in surgeries, it is considered an approved treatment for the correction of short-sightedness, long-sightedness and irregular curvatures of the cornea. Why is it then still not paid by the statutory health insurance?

Weingärtner: As soon as the statutory health insurances would agree to pay for laser surgery, millions of people would have the right to undergo the surgery. Just imagine the costs. And, furthermore, statutory health insurances do not even pay any more for glasses. Not all patients are suitable for a laser treatment.

Weingärtner: In fact, most of the problems occur if the wrong patients are lasered. People whose cornea is too thin, who suffer from dry eyes, who are too long-sighted or others are not eligible for this surgery. For these reasons, we reject around ten to fifteen percent of all people that come to us. There are many laser centres that compete for the customers. How can a customer be sure that he is advised honestly?

Weingärtner: The customers should take care that the laser centre they chose offers many different treatments – various laser treatments up to artificial lenses – so that the best can be chosen for each individual case. For some years, the Lasik-Tüv also aims to protect the patient. The Lasik-Tüv is a seal of quality. Centres that would like to receive it have to fulfil certain criteria. For instance, they have to have experienced surgeons, modern devices, a low complication rate and many possible treatments. The company Tüv Süd inspects the centres routinely. Critics of the laser surgery do advise against the lasik as there are no long-term experiences yet.

Weingärtner: Laser surgery started already at the end of the 80s. That means the phase is not that short. Also, studies were done already over longer periods of time, for example seven years. One of the most prominent studies regarding lasik, however, is the so-called CRS-USA study that was published in 1998. This study highlighted that the view of all lasik patients does not differ significantly around three months after the surgery. Even those who had suffered complications had a similar good view as the others after three months. After such tests, in the USA the Femtolasik was approved even for air force soldiers and the NASA in 2007. Thus, even lasered astronauts fly into the outer space.

The interview was conducted by Anke Barth


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