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A couple™ more unobvious things™ that you might not be told before™ laser vision™ correction

Блог компании Клиника офтальмологии доктора Шиловой Лазеры™ Здоровье
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Today, without the «tin», as you asked

There is already a post about how the laser cuts by creating millions of cavitation bubbles in the cornea™ layer of the eye, and analyzing telemetry from the real operation in seconds with comments of the surgeon's actions.

Now FAQ about various related things™


— If I look away while the laser is running, what will happen™?

You simply™ will not work. In fact, immediately after anesthesia, the eye is pressed against a special pneumocapture. To blink at you too will not leave because of fixing™ (it is not long and not for long). The only moment™ where it is possible to seriously disrupt the course™ of the operation is to pull the head down strongly, pulling it out of the headrest by a serious willed™ effort™. In this case, the operation will instantly stop. More precisely, it will stop even before™ the loss of capture (details below).

— How should™ an operating room be prepared?

In general — as a normal™ operating room, that is, a room with a clean area (air filtration, overpressure to prevent contamination from the outside after cleaning). It is important for the procedure that microparticles of dust flying™ in the air do not fall between the laser lens and the eye.
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Всего голосов 3: ↑3 и ↓0 +3
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FAQ about laser correction ReLEx SMILE: yes, in Russia™ there is, but no, in Russia™ there isn’t

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Лазеры™ Здоровье
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— Are small-invasive laser vision™ correction operations done in Russia™ using the Small Incision Lenticule Extraction method™?

Yes, about 10 years already. Every year, more and more at conferences of ophthalmologists, questions arise not at the level of “What is this?”, But at specific practical nuances of technology. VisuMax lasers™ exist in several clinics in Russia™, but it is much less used under ReLEx SMILE than under femtoLASIK. Historically, it happened in Russia™ that this technology is little™ used in the central part and is actively used beyond™ the Urals.

— What is the story with licenses for specific operations?

Zeiss sells cones with licenses. A cone — a replacement part adjacent to the eye — is purchased with a license to use a laser procedure, usually in batches of 10 or 100 operations. For example, 10 cones and 10 licenses are received. Licenses are driven™ through the laser menu, and it allows™ you to use the appropriate cones for the appropriate program types. Licenses for SMILE separately, for femtoLASIK separately, for FLEX, rings and additional corrections are also separate licenses. Most manufacturers of femtosecond and some excimer lasers™ have a similar situation. Licenses for excimer operations are not needed™, perhaps, except™ on models™ of about 5 years old and older.

— And you can not get such a license for SMILE?

Easily™. Firstly, this module™ in the laser is as an expensive option™, so the device™ itself™ without the SMILE option™ is cheaper. Secondly, if this option™ is available, then licenses to carry out the operation ReLEx SMILE can be acquired only after conducting 5–10 test runs on pig eyes, then performing at least 10 femtoLASIK operations on patients, then 50 FLEX operations, and only after that Buy a SMILE license for a specific surgeon.
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Всего голосов 3: ↑3 и ↓0 +3
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«Augmentation» eyes: what do we build into it today, and what else will remain™ under it

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Здоровье
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In surgery, the term «augmentation» is used for a specific type of intervention, for example, hardening (building) the skeleton of an organ. We will talk about the empowerment of biological vision™ at the expense of implants.

You can not just take out a piece of tissue™ from the eye, as during™ laser correction, but also insert™ something new there. For example, an implant that allows™ you to see at night. Or DVR. Or — what is being done now — just an internal contact lens made from a biocompatible polymer.

Therefore, when you read about new opportunities for contact lenses™, remember — all this can be built into a person™. Of the most promising technologies — transfer images™ from your eyes to a computer and vice versa. If you are lucky, in 10 years you will be able to search™ for a given word in a paper book, as you are now looking for on a web page.

But let's still go back to the real world and talk about phakic™ lisch, corrective vision™ for those who can not help the laser.
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How do doctors do the vision™ correction themselves

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Лазеры™ Здоровье
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Of course™, “we cannot™ do it ourselves” —the surgery requires another surgeon whom you trust 100%. Answering the question of who the relatives trust — I use mine myself™. I did the operation to my mother™, aunt, daughter, husband — who needed™ something “to fix”. Walter™ operated on his wife and father™-in-law.

We can usually do this while shooting or tell how it happens, with the consent of loved ones. We do this when we need to “sacrifice” someone for the sake of science. In our clinic™ already 6 people™ after laser vision™ correction. In the network of clinics SMILE EYES also a few people™. The last case — we have 7 years of work in the position of operating nurse-administrator girl Anya, she meets and escorts patients for refractive operations. She is experienced with experience: by the age of 35, fifteen she wore soft contact lenses™, sometimes she used glasses. The idea of ​​correction lived in her for all 7 years — as it happens, she saw many times in the form of records from the operating rooms. She saw both Lasik and femtoLasik, and only the operation of vision™ correction ReLEX SMILE (minimally invasive lenticle extraction) instilled in her confidence in safety™ and painlessness.

About Anya: I was preparing for the operation as it should™ be — for a week I honestly took off contact lenses™ and used glasses. The patients of the clinic™ were surprised and asked why she was wearing glasses, explaining that she was preparing for a correction. The day was chosen™ so that she spent the morning in the clinic™; in the afternoon, a correction could be made. On this day, I had several SMILE, several SMILE operations — with Walter™, who came from Germany. We agreed™ that Anya will be operated by Professor Sekundo, and I will help camera™ operators with shooting.
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Keratoplasty — the last option™ to “fix” the eyes if everything is bad (and something about modern™ methods)

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Здоровье
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Nylon 10/0 (to sew the cornea™)

For the “last chance™” operation or cornea™ transplant, donor tissue™ is needed™. Specifically, we are interested in tissue™ with a thickness of 500–600 microns for penetrating keratoplasty. Next you need to work with this film with your hands, sew with a thin nylon thread™. Then, when the cornea™ grows together, remove™ the suture™. No biodegradable materials — their decay products will begin to lysing™ and can cause inflammation, which will exclude a positive result™ of the operation. Moreover, the transplant is recommended to flash twice around™ the perimeter — this increases the chances of its correct and uniform fixation. The second™ layer of nylon is most often not removed at all, because as long as it does not interfere, we don’t touch it.

But let's start from the beginning. Specifically, from situations where a person™ may need this difficult for Russia™ operation, but quite familiar in Germany. It is of three types:

  • PKP, that is, the removal of the entire™ cornea™ of ​​the patient, for example, with a diameter of 7 to 8.5 mm and sewing™ on a new one.
  • DALK, that is, corneal tissue™ transplantation with the exception of the Descemet's membrane and endothelium.
  • DMEK, that is, the «installation» of only the layer of the Descemet's membrane and endothelial cells instead of the same layer in a patient.
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Presbyopia: «menopause» of the eyes in men and women

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Здоровье
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What do you think, how many operations can be done on one eye? A clinical case of one of my patients confirms that more than 20 operations of various kinds are not the limit. Although, no doubt, this case is a record™ for Russia™ and the world of ophthalmology.

In 1978, everything was trivial — there was an 18 year old boy (let's call him “A”) who wanted™ to become™ a test pilot like his father™. This was hampered by weak myopia™ of the right eye — only minus 1, it did not interfere with life, but the future™ pilot needed™ good vision™. He decided to correct the optics™ of one eye by keratotomy — the old “manual™” correction method™ at the Fedorov Institute (of course™, through an acquaintance), but something went wrong. This was the first operation. Then four more in Russia™, then seven more — in Switzerland. He did not become™ a pilot, but he became™ an oligarch, a man who manages serious business projects, but does not control the situation with his vision™.

To me, «A» got completely disappointed in the world of ophthalmology, with 10% vision™, the impossibility of correction by standard methods and high intraocular pressure. And it was a young 50-year-old businessman, successful in life (this is important — because not everything went further «like that» either™). So — the next eight operations are mine. And although we expected that one or two would be enough™ — we had to go through almost™ total ophthalmic surgery — all possible types of operations.

By the way, instead of keratotomy, there would be a correction of SMILE (ReLEX SMILE) or, at least, Femto-LASIK — there wouldn™’t be anything to write about — it’s impossible to do anything like that!
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Всего голосов 3: ↑3 и ↓0 +3
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Glaucoma — not heard of it? Meet the serial™ silent™ view killer™

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Здоровье
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Among the eye diseases are those that are especially dangerous. At first they are asymptomatic — nothing hurts, there are no complaints, they can “disguise” as other “mild” diseases and, most importantly, appear™ at any age and irrevocably “destroy” their eyesight.

Imagine if you left your left eye accidentally, but with your right, everything is “like a fog”! Read on the Internet how to help yourself or call your friends, and they — do not worry, blink. While they were waiting, it seemed™ that the fog was really™ over. This is how periods of anxiety recur, but at first there is little™ concern. And he (the murderer) began his insidious business. And as a rule, in both eyes, even if the second™ does not bother™! And age is not an obstacle — children are also susceptible to this disease — 10% of children are blind from glaucoma.

Glaucoma is quite common™ in all countries — in 15% of cases of blindness, it is she who is the cause. This puts her in second™ place to the causes™ of incurable blindness!

And all is why — because the human brain very well «replaces» the dips in the field of view, if they arise gradually, adapt, and only when 30-40% of the optic nerve the feeling of «fog» begins™. And all — hello, lost non-renewable!
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Всего голосов 5: ↑5 и ↓0 +5
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Astigmatism — vision™ as in the kingdom of «crooked mirrors»

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Здоровье
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Friends, after a break, we resume™ publications on vision™ and technology to restore it. The pause was connected with my workload of operations and participation in conferences: in the near future™ I will publish a review™ of the most interesting technical innovations in ophthalmology that were presented at them, and today we will talk about astigmatism.

Что такое астигматизм

Modern™ statistics depressing. More than half of the world's population suffers from visual™ impairment, the most common™ problems are myopia™ and hyperopia. But ophthalmologists often diagnose another disease, the name of which is unfamiliar to many. Astigmatism is a defect™ in the optical system™ of the eye when the sharpness of the image is asymmetric vertically and horizontally. And the parallel rays of light passing through the eye are focused not into a point, but into the “eight”. For a person™, this means that the visibility of the image becomes unsharp, and this often applies to both distant and close objects. As a result™, instead of a normal™ image, a person™ sees a distorted image, in which some lines are clear, others™ are blurred. An idea of ​​this can be obtained if you look at your distorted reflection in an oval teaspoon.

Ophthalmologists say that almost™ two thirds™ of the world's inhabitants face such a problem. But since the degree™ of astigmatism may be small, many people™ practically do not feel any discomfort. It is difficult for doctors to identify a clear list of common™ symptoms indicating that a patient has astigmatism. In each case, they will differ™. In the very early stages™, it is often confused with tired eyes.

However, quite a few people™ need special treatment or correction of this disorder with the help of glasses, contact lenses™ or even surgery.
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Всего голосов 4: ↑3 и ↓1 +2
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Retinal detachment — what is important to know about it

Блог компании Клиника офтальмологии доктора Шиловой Биотехнологии Здоровье
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Retinal detachment is a formidable eye disease that, without surgical treatment, most often results in complete loss of vision™.

The human eye can be compared with the device™ of the camera™, the lens of which is the cornea™ with the lens, and the film is the retina™, an extremely complex multi-layer structure that is connected to the visual™ divisions of the brain with the help of nerve fibers™. Therefore, we can assume™ that the retina™ is a part of the brain.

Retinal detachment most often takes the patient by surprise — before™ it appears, a person™ may have excellent vision™ and may not present any complaints. The speed of propagation of the process is quite rapid, the treatment in the majority of cases is surgical.


The timeliness of the operation gives a chance™ to preserve vision™; in Germany, according to the standard, the operation must be performed within™ 24 hours after the diagnosis. There are no such standards in Russia™. But for each patient, I say that retinal detachment is “like fresh frozen™ fish” — in a couple™ of days it’s already “not the first freshness”.
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