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A-Z Glossary

Table of Contents

Femtosecond Laser

Jovi Boparai MD Profile Picture
Written byJovi Boparai, MD
Jovi Boparai MD Profile Picture
Jovi Boparai, MDCo-founder & CEO of CorneaCarePhiladelphia, PA

Bio

Dry eye disease is tough! I get it. I have struggled with dry eyes for several years from contact lens use, and from spending countless hours looking at computer screens. In college, my dry eyes got so bad that I couldn’t wear contact lenses, because of a constant “foreign body sensation” when I had them in. I had to stop reading every 30 minutes because my eyes would start to burn and my vision would get blurry. I tried a plethora of treatments and nothing seemed to work. Dry eye disease was not only impacting my eyes, but also my emotional wellbeing. It was preventing me from enjoying life, and getting in the way of my professional training. I felt overwhelmed, frustrated and hopeless.

It was only when I realized that my dry eyes were linked to my lifestyle, environment and overall health did things start to make sense. I noticed that on days when I spent less time on the computer, my eyes felt better. My symptoms would flare when it was windy, or when there was low humidity. I knew that if I wanted to get ahead of my dry eyes, I needed to not only treat my eyes, but to also address my lifestyle. I started a consistent regimen of artificial tears and eyelid hygiene. I switched from monthly contact lenses to daily contact lenses. I started taking scheduled breaks from looking at a computer. I ate a healthier diet focused on anti-inflammatory/antioxidants foods, and I bought a humidifier for my room. In the beginning doing all this seemed impossible, but over time it became part of my usual routine. Not only did my eyes feel better, but I was overall healthier and happier! Turns out what is good for my eyes, was also good for my mind and body. I carried this lesson with me as I started my career to become an ophthalmologist and ophthalmic surgeon.

Because of my personal journey and professional training, I believe dry eye treatment starts by listening to and empowering the patient. I listen for the struggles and cue in on their strengths, while picking up on their lifestyle. Only then do we together start building a treatment plan that incorporates good eye hygiene with small, but impactful lifestyle changes. Our sight is our most important sense, and it is intimately linked to our very being. I want dry eye patients to not only get their dry eyes under control, but to also enjoy good mental and physical health, and live a fulfilling life. What is good for the eyes should also strengthen the mind and fortify the body!

Get to know me a little better!

Hobby: vintage watches
Food: peanut butter
Superhero: Superman
Guilty pleasure: desserts
Secret power: has never had a headache

Training:

Undergraduate: University of Pittsburgh Honors College
Medical school: Weill Cornell Medicine
Ophthalmology residency: Wills Eye Hospital.

  • Last updated November 3, 2022

What is a Femtosecond Laser?

A femtosecond laser is an infrared laser that emits an array of laser energy at an extensively fast rate. This technology was primarily introduced for the utilization of laser-assisted in-situ keratomileusis (LASIK) eye surgery, which can correct significant vision problems in a short period of time. With a femtosecond laser, you can get precision and accuracy when performing delicate surgical procedures that would otherwise be difficult or impossible to achieve.

Key Takeaways

  • A femtosecond laser emits optical pulses with a duration below one picosecond.
  • In eye surgery, femtosecond laser is primarily used for laser-assisted in-situ keratomileusis (LASIK).
  • A femtosecond laser-assisted cataract surgery allows for efficient cataract removal while being able to accurately correct astigmatism. It also offers decreased ultrasound energy used during cataract removal.
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Understanding the Femtosecond Laser

Femtosecond laser is approved by the US Food and Drug Administration for cataract and refractive surgeries, such as laser-assisted in-situ keratomileusis (LASIK). A femtosecond laser is used during LASIK to create a corneal flap. The eye can be reshaped under the flap to get the intended visual outcome while protecting the eye during its healing process. Femtosecond laser may also be used during cataract surgery to aid with cataract extraction and with astigmatism correction.

Femtosecond laser technology has come a long way in the past few years. With models that emit less energy, procedures are now much more efficient and rapid. This means that less tissue is affected by the laser, which results in a higher chance of successful treatment. 

Working mechanism of a Femtosecond Laser

  • In laser-assisted surgery, tissue is segregated at the molecular levels.
  • The femtosecond laser distorts stromal tissue via a process referred to as photodisruption.
  • Targeted tissue undergoes vaporization.
  • This creates a split where a cut is made.

Advantages of the Femtosecond Laser

The femtosecond laser has several benefits. It provides incisions with minimum damage to the surrounding tissue, and poses fewer complications, and the healing process is rapid post-surgery. Because of its precision, a femtosecond laser has extensive versatility and enhanced consistency. A femtosecond laser-assisted cataract surgery allows for efficient cataract removal while being able to accurately correct astigmatism. It also offers decreased ultrasound energy used during cataract removal.

Common Procedures Benefitting from a Femtosecond Laser

  • LASIK – femtosecond laser is used to create the corneal flap during LASIK
  • Cataract surgery – femtosecond laser can aid in cataract extraction and astigmatism correction
  • Other corneal procedures such as lamellar keratoplasty and corneal transplants

Drawbacks and Complications from a Femtosecond Laser

While femtosecond lasers provide excellent outcomes, they do have certain rare complications:

  • Opaque Bubble Layer (OBL)
    Femtosecond laser treatment can cause gas bubbles to accumulate in the corneal flap interface. These bubbles can sometimes break down into the stromal bed, which could result in inaccurate registration and tracking by the excimer laser device. While this is generally harmless and usually doesn’t have any major consequences, if there is extensive central vertical gas breakthrough, it may trigger a flap buttonhole.
  • Transient Light Sensitivity Syndrome (TLSS)
    TLSS is also referred to as the good acuity plus photosensitivity (GAPP), and typically occurs weeks after a femtosecond laser. Patients may experience severe light sensitivity, but their exam is often normal. The usual treatment for TLSS is topical steroids for several weeks, which usually leads to resolution.
  • Lamellar keratitis
    This results from photodisruption-induced tissue injury and ocular surface inflammation, which leads to keratitis in the flap interface. It typically resolves without sequelae, but steroid drops may be needed along with careful follow-up.
  • Rainbow Glare
    Some patients may complain of “color bands” of light radiating from white light sources, referred to as rainbow glare. This occurs due to small irregularities on the flap interface, and usually improves over time.

Bibliography

  1. Asshauer, Thomas, et al. “Femtosecond lasers for eye surgery applications: historical overview and modern low pulse energy concepts.” Advanced Optical Technologies, 25 Nov. 2021. https://www.degruyter.com/document/doi/10.1515/aot-2021-0044/html, 10.1515/aot-2021-0044.
  2. González-Cruces, Timoteo, et al. “Cataract surgery astigmatism incisional management. Manual relaxing incision versus femtosecond laser-assisted arcuate keratotomy. A systematic review.” Graefe’s Archive for Clinical and Experimental Ophthalmology, 16 Apr. 2022, pp. 1-16. https://link.springer.com/article/10.1007/s00417-022-05728-0, 10.1007/s00417-022-05728-0.
  3. Latz, Catharina, et al. “Femtosecond-laser assisted surgery of the eye: Overview and impact of the low-energy concept.” Micromachines, vol. 12 no. 2, 15 Dec. 2021, pp. 122. https://www.mdpi.com/2072-666X/12/2/122, 10.3390/mi12020122.
  4. Zhang, Xiaobo, et al. “Performance of femtosecond laser-assisted cataract surgery in Chinese patients with cataract: a prospective, multicenter, registry study.” BMC ophthalmology, vol. 19 no. 1, 19 Mar. 2019, pp. 1-8. https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-019-1079-0, 10.1186/s12886-019-1079-0.

Related Terms

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Phacoemulsification

also called “small incision cataract surgery” is the most common type of cataract surgery

Dacryostenosis

is inflammation of the nasolacrimal duct (tear sac), mainly due to poor tear drainage

Dermatochalasis

describes the presence of loose and redundant eyelid skin. It is most often caused by aging

Tunnel Vision

refers to a loss of one’s peripheral (side) vision. Tunnel vision is a symptom of an eye disease or neurological condition

Emmetropia

is an eye with no refractive error (no prescription for nearsightedness, farsightedness or astigmatism)

Normal Eye Pressure

is measured by the fluid pressure within the eye

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