Presbyopietherapie mit Femtosekundenlaser

A review of the surgical options for the correction of presbyopia

Presbyopia is an age-related eye condition where one of the signs is the reduction in the amplitude of accommodation, resulting in the loss of ability to change the eye's focus from far to near. It is the most common age-related ailments affecting everyone around their mid-40s. Methods for the correction of presbyopia include contact lens and spectacle options but the surgical correction of presbyopia still remains a significant challenge for refractive surgeons. Surgical strategies for dealing with presbyopia may be extraocular (corneal or scleral) or intraocular (removal and replacement of the crystalline lens or some type of treatment on the crystalline lens itself). There are however a number of limitations and considerations that have limited the widespread acceptance of surgical correction of presbyopia. Each surgical strategy presents its own unique set of advantages and disadvantages. For example, lens removal and replacement with an intraocular lens may not be preferable in a young patient with presbyopia without a refractive error. Similarly treatment on the crystalline lens may not be a suitable choice for a patient with early signs of cataract. This article is a review of the options available and those that are in development stages and are likely to be available in the near future for the surgical correction of presbyopia.

An in vitro study on focusing fs-laser pulses into ocular media for ophthalmic surgery

BACKGROUND AND OBJECTIVE

To investigate femtosecond (fs)-laser patterns within ocular media for ophthalmic surgery.

METHODS

Vitreous and crystalline lens tissue from porcine eyes were treated with 2-dimensional fs-laser patterns and inspected under the optical microscope. Time resolved pump-probe experiments were conducted on vitreous tissue and gelatin, which should act as a model for crystalline lens tissue.

RESULTS

Within crystalline lens tissue, pulse overlap leads to the formation of large bubbles, which is caused by subsequent energy input from the surrounding plasma channel. This effect can be used for bubble size control. Vitreous tissue behaves similar to water under fs-laser treatment, but it still allows fs-laser cutting.

CONCLUSION

Bubble size control by laser bursts may reduce optical side-effects of fs-laser treatment. Furthermore, fs-laser treatment could be used for vitreoretinal applications.

Pig lenses in a lens stretcher: implications for presbyopia treatment

PURPOSE

To investigate porcine lenses in a lens stretcher with regard to presbyopia corrective procedures.

METHODS

A lens stretching device was designed, which allows to simultaneously determine all relevant geometrical and optical parameters at each stretch position. The setup was used to compare the optical and geometrical lens properties of young slaughter pigs (n = 5) with older sows (n = 7).

RESULTS

The change of optical power with stretching is about five times larger for young porcine lenses than for sows. For young pigs, the gradient index profile of the crystalline lens significantly contributes to the induced accommodation amplitude.

CONCLUSIONS

We have shown that sow lenses are a suitable model for in vitro experiments on possible treatments for presbyopia. The rapid decrease in the induced accommodation amplitude with age may be explained by a reduced change of all geometrical lens parameters, which in turn leads to a smaller contribution of the gradient index profile to accommodation.

Surgical applications of femtosecond lasers

Femtosecond laser ablation permits non-invasive surgeries in the bulk of a sample with submicrometer resolution. We briefly review the history of optical surgery techniques and the experimental background of femtosecond laser ablation. Next, we present several clinical applications, including dental surgery and eye surgery. We then summarize research applications, encompassing cell and tissue studies, research on C. elegans, and studies in zebrafish. We conclude by discussing future trends of femtosecond laser systems and some possible application directions.

Restoration of accommodation: surgical options for correction of presbyopia

Accommodation is a dioptric change in the power of the eye to see clearly at near. Ciliary muscle contraction causes a release in zonular tension at the lens equator, which permits the elastic capsule to mould the young lens into an accommodated form. Presbyopia, the gradual age-related loss of accommodation, occurs primarily through a gradual age-related stiffening of the lens. While there are many possible options for relieving the symptoms of presbyopia, only relatively recently has consideration been given to surgical restoration of accommodation to the presbyopic eye. To understand how this might be achieved, it is necessary to understand the accommodative anatomy, the mechanism of accommodation and the causes of presbyopia. A variety of different kinds of surgical procedures has been considered for restoring accommodation to the presbyopic eye, including surgical expansion of the sclera, using femtosecond lasers to treat the lens or with so-called accommodative intraocular lenses (IOLs). Evidence suggests that scleral expansion cannot and does not restore accommodation. Laser treatments of the lens are in their early infancy. Development and testing of accommodative IOLs are proliferating. They are designed to produce a myopic refractive change in the eye in response to ciliary muscle contraction either through a movement of an optic or through a change in surface curvature. Three general design principles are being considered. These are single optic IOLs that rely on a forward shift of the optic, dual optic IOLs that rely on an increased separation between the two optics, or IOLs that permit a change in surface curvature to produce an increase in optical power in response to ciliary muscle contraction. Several of these different IOLs are available and being used clinically, while many are still in research and development.

Group-velocity dispersion measurements of water, seawater, and ocular components using multiphoton intrapulse interference phase scan

The use of femtosecond lasers requires accurate measurements of the dispersive properties of media. Here we measure the second- and third-order dispersion of water, seawater, and ocular components in the range of 660-930 nm using a new method known as multiphoton intrapulse interference phase scan. Our direct dispersion measurements of water have the highest precision and accuracy to date. We found that the dispersion for seawater increases proportionally to the concentration of salt. The dispersion of the vitreous humor was found to be close to that of water. The chromatic dispersion of the cornea-lens complex was measured to obtain the full dispersive properties of the eye.