Advances in laser surgery have increased the opportunities to improve
the health of many people. Lasers are now used in most specialties including
cardiology (heart diseases), neurosurgery (surgery of the brain and nervous
system), Ears Nose and Throat, general surgery, dermatology (skin diseases),
and many others. One of the first specialties to harness the power of lasers
to cure disease was ophthalmology (eye diseases). Lasers were first used
in eye care in the early 1970’s. Research done in the 1970’s-1980’s
proved that laser surgery of the retina could preserve the vision of many
people with diabetes. The Phoenix Indian Medical Center (PIMC) began using
lasers in 1981 in a joint program with the Phoenix Veteran’s Hospital.
In 1983 PIMC obtained its own laser so that patients could receive laser
retinal surgery on-site. This laser clinic has been updated and expanded
many times to allow treatment of all patients in need with the latest laser
technology. Due to the availability of this surgery and the high demand
placed on it, retinal laser treatments are the most common eye surgery
done at PIMC.
Laser technology had seen considerable development over the past 20 years.
There are now specific lasers available for treating many diseases and
conditions at many different sites in the eye. (Fig. 1)
There are many
types of eye lasers and PIMC has several different lasers that are specialized
for specific eye conditions (see inset 1). However, the Argon-Krypton laser
is the type most commonly used at PIMC. This is a laser that can be used
for many purposes, but at PIMC is most commonly used to treat two eye diseases:
1. to prevent blindness from diabetic retinopathy, and 2. repair retinal
holes and tears before they progress to retinal detachment and blindness.
The most common reason a patient undergoes laser surgery at PIMC is for
diabetic retinopathy. Diabetic retinopathy (DR) is a very common complication
of diabetes and develops without symptoms until its latest stages.
DR is
the most common cause of new blindness among adults, but if detected and
treated early the risk of serious vision loss can be reduced to less than 2%.
The most dangerous form of DR leads to hemorrhage and retinal detachment (Fig. 2).
Another form of DR causes vision loss by leakage of fluid into
the retinal, preventing normal function and causing blurred vision. (Fig. 3)
Because this disease progresses to dangerous levels without symptoms
all individuals with diabetes must have an annual eye examination for DR.
If this examination shows DR at dangerous levels, laser treatments may
be prescribed.
(Fig.4) This treatment requires dilation eye drops and a
special lens applied to the eye. This is usually not painful, but in some
cases an injection is given to control discomfort. Depending on the specific
type of DR being treated, just a few or very many laser applications are
used. This usually takes 5-20 minutes and the patient is able to go home
immediately after the surgery. A follow-up examination is scheduled to
check on the effect of the laser.
|
In 2003 only 53% of people with diabetes in the Phoenix Area Indian
Health Service (PAIHS) obtained an annual retinal evaluation. This evaluation
can be obtained with a regular diabetic eye examination, or photographically
using a new electronic system called telemedicine. The eye examinations
in the PAIHS are done by an optometrist at facilities throughout the area,
or by a PIMC ophthalmologist that makes regular visits to many facilities
in Arizona and Nevada. The telemedicine method of a diabetic retinal evaluation
is provided at PIMC, Salt River, San Carlos, Parker, and Peach Springs. (Fig 6)
These images are obtained without dilation drops and transmitted
to a retinal reading center located at PIMC. If these images show dangerous levels of DR,
further follow-up and possible laser surgery at PIMC is scheduled.