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12th December 2014

Scandinavia opens its eyes to laser surgery

If you’re one of the millions of people around the world who chooses contact lenses (or has perfect sight), you’ll already know how amazing it feels to drive, swim or just go for a walk in the rain without having to take your glasses along for the journey.

But contact lenses come with their own set of problems, which is why 24-year-old Stockholmer John Sandvall opted to try out a new laser surgery technique that’s becoming especially popular in Scandinavia.

Scandinavians, known to be early-adopters of technology, are leading the way on laser surgery for corrective vision (photo: Fotolia)

“My eyes were becoming dry and this made me get tired in the afternoons. I was also just fed up of having to remember to take spare lenses or solutions with me if I slept at a friend’s house”.

Following in the footsteps of his brother and several friends, he decided have his short sight permanently reversed and chose an emerging laser procedure known as Smile.

“Six hours after the operation I started to see better and then the following morning I saw perfectly. I went out celebrating the next day. It is the best thing I’ve ever done,” he says.

Like most eye surgery, Smile works by reshaping the cornea (the transparent layer covering the front of the eye) to help correct the refractive error that causes vision problems. The Smile method involves using a laser to create an incredibly thin disc of tissue inside the cornea, which is then extracted. Its supporters argue it disrupts the cornea less than other techniques which use lasers to cut a foldable flap in the cornea, before ‘polishing’ it and putting the flap back.

Stockholmer John Sandvall says a student discount made it easier for him to get the Smile laser procedure (photo: Maddy Savage)

“There is much less impact on the corneal tissue and because you don’t cut so many nerves, you’re less likely to be left with dry eyes than with other laser techniques,” says Dr Carlos Sjöholm, a specialist at one of the first clinics in Sweden to start offering Smile surgery.

“We only launched this a few months ago but now we are doing these operations several days a week,” he adds.

The Smile laser procedure is also available in several other countries including Denmark and Finland and Sjöholm believes it is no coincidence that the system is becoming a hit with Scandinavians, who have a reputation for being early adopters of new technologies and craving efficiency in their everyday lives.

“I think this technique is popular because the recovery is very fast. You can usually go back to work in one to three days. If you are working in an office you can do it earlier; for someone working in a factory I’d suggest a bit longer”.

For economics student John Sandvall, a discount for young Swedes with vision problems added to his list of reasons for completing the procedure.

“I decided to do it now while I am still studying and before I start working – while I have the time and a little bit of extra help to pay for it,” he says.

Despite the low risks, the idea of laser surgery still makes many uneasy (photo: Fotolia)

Complications occur in less than 5 percent of eye surgery cases in safety-conscious Sweden. But despite the low risks involved, many glasses or contact lens wearers still feel uncomfortable opting for laser operations, which require patients to remain awake throughout the procedure.

“I wasn’t that scared but it was a bit futuristic with all the machines,” explains Sandvall.

“You get a tranquilliser which helps you to relax. Even though I was in there for about half an hour, it only felt like about five minutes”.

As for the future, Dr Sjöholm believes laser technology (or femtosecond laser technology, as it’s known in technical circles) is set to become more widely used to help both short and long-sighted patients around the world as well as those with other eye problems.

“It can be used for cataracts and it is also a possible treatment for glaucoma,” he says.

Laser eye surgery: Who’s doing what and where? (illustration: Emily Fischer)

While Sweden has yet to embrace the use of laser technology beyond corrective vision surgery, several (mostly private) clinics around Europe already using lasers to assist or replace several aspects of manual cataract surgery (the removal of proteins that lead to the clouding of an eye’s lens) using fine knives. These aspects include the creation of the initial surgical incisions in the cornea and the initial fragmenting (breaking up) of a cataract. Advanced “intraocular” lenses can also be implanted at the time of the surgery, making it possible for some patients to go without eyeglasses.

“By using the laser to break up the cataract, the amount of energy used to remove the cataract subsequently, using conventional ultrasound technology, is minimised,” says Dr Scott Robbie from the London Eye Hospital.

“The less energy delivered to the eye, the less chance of damaging the delicate cells that line the inside of the cornea and maintain corneal clarity. The laser will also minimise the amount of manipulation inside the eye…we know that the duration of surgery correlates with the risks of a complication,” he adds.

Like other eye doctors in this field, he is careful to point out that not all of these findings have been proven in clinical trials, but he insists that there are “sound reasons” supporting the use of the emerging technology.

Human error is the key downside to using lasers in cataract and other eye operations; surgeons need to ensure that any wounds made are stable and seal well. But Dr Robbie hopes that with adequate training, the technology can become commonplace in reputable clinics and hospitals around the world.

Cataracts tend to develop later in life and have been known to complicate many a golf game (photo: Fotolia)

According to Dr Sjöholm, expensive equipment and logistics are the main reasons that laser technology is mostly limited to operations to correct shortsightedness in Sweden for the moment.

“For cataracts for example you’d need to use two machines so you’d have to move the patient to a different operating theatre,” he says.

“But that might not always be the case. We’ll have to watch what happens”.

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