Although lasers have found widespread applications across various medical fields, their most significant and early use has been in ophthalmology. This is due to the fact that the eye itself functions as an optical system, allowing light to reach different layers of the eyeball through its refractive media. The unique properties of laser light—such as its uniform wavelength and excellent directionality—make it possible to precisely target specific tissues within the eye. As a result, lasers were first introduced in ophthalmology, leading to the development of a specialized branch of medicine known as laser ophthalmology.
One of the primary applications of lasers in ophthalmology is the treatment of eye diseases. Different wavelengths of laser light interact with ocular tissues in distinct ways, depending on the pigments present in those tissues. For instance, melanin absorbs shorter wavelengths more effectively, while hemoglobin has a higher absorption rate for blue, green, and yellow light. Lutein, a pigment found in the macula, strongly absorbs blue light, which is why blue light is avoided in the macular region to prevent damage to the retinal neuroepithelium.
Lasers with longer wavelengths, such as red and infrared, are often used for deeper structures like the choroid and retinal pigment epithelium because they can penetrate further without being absorbed by lutein. However, these wavelengths may not be as effective in areas lacking pigmentation and can risk damaging deeper tissues if not carefully controlled. On the other hand, ultraviolet light (below 295 nm) is mostly absorbed by the cornea and is therefore primarily used in corneal surgeries.
The mechanisms by which lasers treat eye conditions include several key biological effects. The most common is photothermal effect, where laser energy is converted into heat, causing localized tissue changes such as coagulation, vaporization, or cutting. The extent of these effects depends on factors like laser power density, exposure time, and the absorption characteristics of the tissue. In addition to thermal effects, lasers can also trigger photochemical reactions, such as photodecomposition and photodynamic therapy, which are used in treating conditions like retinoblastoma.
Another important mechanism is the electromagnetic field effect, where the intense energy of laser light can generate strong electric fields that influence biological tissues. This effect becomes more pronounced with high-energy laser pulses, such as those produced by Q-switched or mode-locked lasers. Additionally, lasers can induce pressure within tissues through thermal expansion, vaporization, or shock waves, leading to further biological responses.
Finally, lasers can be used for precise vaporization, cutting, or puncturing of tissues. When high-power continuous-wave lasers are applied, the heat generated causes water in the tissue to evaporate, creating steam pressure that can lead to tissue removal. This process is widely used in surgical procedures, where surface vaporization is referred to as "burning," linear vaporization as "cutting," and point vaporization as "perforation." The depth and precision of these effects depend on the duration and intensity of laser exposure, making lasers a powerful tool in modern ophthalmic surgery.
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