university of karbalaa

collage of engineering
biomedical department

therapeutic devices lab.

laser in ophthalmology

student name: mahdi Mohamad

1
introduction
The application of the laser in medical treatment is based on the interaction
oflaser radiation with biological tissue. Laser radiation can be included in a
large category of electromagnetic radiation generated by many types of
radiation sources such as the sun, fire, bulbs, electric discharge, plasma,
etc. From ahistorical point of view, the sun’s radiation has been used as a
therapeutic tool forthe treatment of various pathological phenomena or to
improve health for many centuries. The laser’s pulses of light cut skin and
cauterized blood vessels simultaneously, paving the way for several other
applications The difficulty lay in controlling the power output and the
delivery rate of the laser radiation, as well as the relatively poorabsorptive
capacity of some types of tissue for ruby laser light. With the development
of laser physics and successive discoveries of other aspects of laser
technology3 such as the generation of new wavelengths, radiation with
various energy levels, high power and small beam divergence, a new
branch of science dealing with the applications of ‘laser medicine’ began to
develop. After 50 years of laser radiation application in medicine, the
background of the interaction between radiation and tissue is understood.
Because these facts are common to all the medical treatments presented in
this book (for therapeutics as well as for diagnostics), the relation of laser
radiation properties to particular medical treatments .

2
medical background
human eye lens
The lens is a transparent, biconvex structure in the eye that, along with
the cornea, helps to refract light to be focused on the retina. The lens, by
changing shape, functions to change the focal distance of the eye so that it
can focus on objects at various distances, thus allowing a sharp real
image of the object of interest to be formed on the retina. This adjustment
of the lens is known as accommodation(see also below). Accommodation
is similar to the focusing of a photographic camera via movement of
its lenses. The lens is more flat on its anterior side than on its posterior
side. The lens has three main parts: the lens capsule, the lens epithelium,
and the lens fibers. The lens capsule forms the outermost layer of the lens
and the lens fibers form the bulk of the interior of the lens. The cells of the
lens epithelium, located between the lens capsule and the outermost layer
of lens fibers, are found only on the anterior side of the lens. The lens itself
lacks nerves, blood vessels, or connective tissue.
The lens is flexible and its curvature is controlled by ciliary muscles through
the zonules. By changing the curvature of the lens, one can focus the eye
on objects at different distances from it. This process is
called accommodation. At short focal distance the ciliary muscle
contracts,zonule fibers loosen, and the lens thickens, resulting in a rounder
shape and thus high refractive power. Changing focus to an object at a
greater distance requires the relaxation of the lens and thus increasing
the focal distance.

3
indications
Diabetic retinopathy laser treatment
it is caused by microangiopathia, which occurs due to high levels of sugar concentration in
blood and thus a deficiency in the oxygen supply to the eye. The procedures used to treat this
condition are focal and panretinal laser therapy. Focal laser therapy is targeted at a specific
dangerous structure or process, with one focal point on the retina. When diabetic retinopathy
progresses into its pre- proliferative stage, panretinal photocoagulation is used instead , By
destroying a substantial part of the periphery and mid- periphery of the retina using thermal
laser therapy, it is possible to spare the central retina and extend its viability for up to 10 years.
Retinal detachment laser treatment
Retinal detachment begins when an opening develops in the superficial layers of the retina. This
part of the retina subsequently detaches and a black curtain can be seen to move across the
centre of the visual field. In cases of dubious retinal degeneration or if tears are present, a laser
thermal barrage is used to block the lesion, surrounding it with three to five lines of blocking
burns.
Age- related macular degeneration laser treatment
Age- related macular degeneration (ARMD) is a disease acquired at an advanced age. The
incidence of this condition is rising, and it is the most common cause of irreversible blindness in
developed countries. Ninety percent of ARMD patients have dry (atrophic) macular
degeneration and ten percent have wet(exudative or neovascular) macular degeneration.
Patients can be classified using fluorescein angiography into ‘classic’ if they can see clearly and
‘occult’ if they cannot. Wet macular degeneration progresses quickly and the loss of
vision is severe.
Central chorioretinopathy laser treatment

This disease attacks the central retinal region of the retina. When viewed in cross- section, the
central region looks like an Artesian well, the volume of which is supplied from the damaged
vessel wall. The damaged locus is
diagnosed using fluorescein angiography and focal thermal laser therapy is used to close it.
Diabetic macular oedema laser treatment
Diabetic macular oedema is another complication of diabetes, and is characterized by the
sponge- like appearance of the affected retina in cross- section. Laser thermal intervention is
used to dehydrate this region and improve the
central vision.
Retinal and choroid cancer laser treatment
Transpupillary thermotherapy may be used for primary or adjuvant treatment of small pigmented
choroidal melanomas, especially those near the fovea and optic disc. The ocular side effects of
this treatment can decrease the vision. It is preferable to use beta or gamma irradiation to treat
retinal and choroidal tumours.

4
physical concepts
When an electron is excited from a lower to a higher energy level, it will not stay that
way forever. An electron in an excited state may decay to a lower energy state which is
not occupied, according to a particular time constant characterizing that transition.
When such an electron decays without external influence, emitting a photon, that is
called "spontaneous emission". The phase associated with the photon that is emitted is
random. A material with many atoms in such an excited state may thus result
in radiation which is very spectrally limited (centered around one wavelength of light),
but the individual photons would have no common phase relationship and would
emanate in random directions. This is the mechanism of fluorescence and thermal
emission.
An external electromagnetic field at a frequency associated with a transition can affect
the quantum mechanical state of the atom. As the electron in the atom makes a
transition between two stationary states (neither of which shows a dipole field), it enters
a transition state which does have a dipole field, and which acts like a small
electric dipole, and this dipole oscillates at a characteristic frequency. In response to the
external electric field at this frequency, the probability of the atom entering this transition
state is greatly increased. Thus, the rate of transitions between two stationary states is
enhanced beyond that due to spontaneous emission. Such a transition to the higher
state is called absorption, and it destroys an incident photon (the photon's energy goes
into powering the increased energy of the higher state). A transition from the higher to a
lower energy state, however, produces an additional photon; this is the process
of stimulated emission.

5
system and block diagram
Different types of lasers emit specific wavelengths of light and are used to treat specific eye
problems. Lasers are commonly named according to the active material used. For instance, an
argon laser contains argon gas as its active material, whereas the YAG laser contains a solid
material made up of yttrium, aluminium, and garnet. The effects that lasers have on eye tissues
are both a function of the molecular composition of the tissue and of the wavelength and power
of the laser light. Lasers essentially destroy tissue in order to have a beneficial effect on the eye.
The argon laser emits blue-green wavelengths, which are absorbed by the cells under the retina
and by the red haemoglobin in blood. These blue-green wavelengths can pass through the fluid
inside the eye without causing damage. For this reason, the argon laser is used extensively in the
treatment of diabetic retinopathy. The argon laser can burn and seal the leaking blood vessels,
also known as photocoagulation. Retinal detachment is another serious eye problem that can be
treated using an argon laser. The laser is used to weld the detached retina to the underlying
choroid layer of the eye. Some forms of glaucoma may also be treated with argon lasers. For
instance, angle-closure glaucoma can be treated by using an argon laser to create a tiny hole in
the iris (a capsulotomy), which allows excess fluid inside the eye to drain to reduce
pressure.Macular degeneration is sometimes treated with an argon or krypton laser. In this
treatment, the laser is used to destroy abnormal blood vessels so that haemorrhage or scarring
will not damage central vision.The YAG 1064 nm infrared laser generates short-pulsed, high-
energy light beams to cut, perforate, or fragment tissue. For patients that develop posterior
capsular opacification after receiving cataract surgery, the YAG laser is commonly used to
vaporise a portion of the capsule, allowing light to fully reach the retina. A frequency-doubled
YAG green laser (wavelength 532 nm) can also be used to create a capsulotomy to treat angle-
closure glaucoma, producing similar results to that of an argon laser.