That Led to Modern-Day Laser Corrective Eye Surgeries 現代激光矯視手術的誕生故事 7 femtosecond laser applications in ophthalmology. This was where the development of bladeless LASIK began. Together they founded a successful startup to commercialize bladeless LASIK, and the company was acquired a decade later for US$808 million in 2007. Notably, Mourou and Strickland were awarded a Nobel Prize in Physics “for their method of generating high-intensity, ultrashort optical pulses” in 2018. LASIK vs SMILE Bladeless LASIK is a well-established option considered to be effective with more than 95% of patients satisfied with the outcome of the surgery [1]. In the surgery, a femtosecond laser is used to create a thin, circular flap of the upper layers of cornea, after which the underlying stromal tissue is reshaped using an excimer laser [5]. The ultraviolet energy (greatly amplified ultraviolet light) emitted by the excimer laser functions to break the organic molecular bonds in the stromal tissue without causing any thermal damage [6]. After precisely removing the stromal tissue, the corneal flap is flipped back to its original position and the cornea is allowed to heal naturally. Recently, a novel refractive surgery procedure known as “small incision lenticule extraction” (SMILE) has also gained popularity since its introduction in 2016 [7]. This minimally invasive procedure adjusts the refractive power of the cornea by carving out a lenticule from the corneal stroma with a femtosecond laser, followed by the extraction of the lenticule through a small incision also made by a femtosecond laser [8]. Primary advantages of SMILE come from its small incision size. LASIK requires cutting a 270 degree, 20 mm circular flap [7], while SMILE involves only a 2–4 mm incision [7, 9]. This greatly reduces the transection of corneal nerves, and hence lessens the experience of dry eyes after the surgery [8]. SMILE also suits contact sport players (e.g. soccer and martial arts) more because it does not involved a corneal flap which may move in some unlikely cases [8, 10]. Additionally, SMILE was also found to be more stable in high myopia [8]. For the downside, LASIK allows touch-ups to finetune vision after some years, but this is not possible for SMILE [7]. If an enhancement procedure is needed for an eye treated by SMILE, the options are to perform LASIK or an older PRK technique (footnote 1) on the SMILE cap. In addition, SMILE has not been approved to treat hyperopia in the US, so LASIK remains the only choice for people with far-sightedness at the moment [8]. While both procedures demonstrate efficacy and safety, the choice between SMILE and LASIK ultimately depends on individual patients and specific eye conditions. Please seek medical advice from your eye doctor if you are considering one of these corrective eye surgeries.
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