Generation I – PRK
Generation II – FemtoLASIK
Generation III – Lenticular surgery
Laser refractive surgery has come a long way in recent years, with the technology behind it getting better and better with each generation. The first refractive laser, developed in the 1980s, with PRK technology, the first-generation laser, managed to break a technological barrier and offer for the first time to patients with diopters, the chance to see without glasses. Nearly 30 years later, the second generation of refractive laser, LASIK, was introduced, allowing the restoration of vision with a minimum of discomfort, and also covering plus diopters. The even more recent version of this technology allows incision to be made with a femtolaser and is called FemtoLASIK. It is more precise and faster. Corneal reshaping, however, is still performed with the laser used in PRK surgery.
The third-generation laser, and the most advanced, the latest, is lenticular surgery, basically a completely new technology, which makes a lenticule in the cornea, and by removing the lenticule, the shape of the cornea is changed, correcting the refractive error.
The 3 laser generations involve different technologies, different devices and equipment, and different medical approaches. They can only be recommended in certain cases after thorough and very specific investigations.
The investigations required in each case are essential, and often make the difference between a possible complication and a successful case.
An example of this would be the suite of corneal investigations, performed with 3 different devices, each dedicated to a segment of the cornea. Of these, the MS-39 multifunctional device stands out, a high-performance OCT and topographer that offers a superior level of corneal detail and analysis. The HD images provide more detail, excellent resolution and reveal the structure of the cornea down to the last detail. Investigations with the MS-39 allow us to diagnose even incipient keratoconus, and thus avoid possible complications that could arise with laser surgery.
At the opposite pole of refractive errors is presbyopia, which is not a refractive error like myopia or hypermetropia. Presbyopia occurs with ageing, usually after the age of 40, and is manifested by blurred vision, especially at near, as the lens loses its elasticity and also its power of accommodation. In Dr. Holhoș clinics we also perform laser surgery for presbyopia, which involves a minimally invasive treatment tailored to each eye individually, in which the refractive power of the cornea is modified, differentially in the two eyes. The surgery takes a few minutes and is performed on both eyes in the same session, with local anesthesia.