Joel Hunter, MD Refractive Surgeon, Hunter Vision Updated 10/31/18 12:33 PM
It’s probably best to start by saying that I wouldn’t have guessed right on lasers existing in the first place. Taken back to a time before laser tech was invented, if someone said, “Hey, do you think we’ll be able to create coherence at a specific wavelengths of light so it’ll be able to travel hundreds of feet and remain a tight, perfect beam? Think we’ll probably be able to put that into a peanut-sized keychain and have them available at 7-Eleven for three bucks?” I would’ve definitely, 100% guessed wrong. But I don’t want to be too hard on myself. I would’ve guessed right on Slurpees. Those were just waiting to happen.
What won’t change about lasers?
That said, since lasers do exist and I work with them every day, I can make a few educated guesses on where laser technology might be headed. There is definitely technological evolution happening in the field still, and the lasers we have available today are different than the ones that are coming. How are they different? It may be easiest to start with what probably won’t change.
The current excimer laser, with its 193 nanometer wavelength of invisible ultraviolet light, is the same excimer laser that’s been around for three decades. It is still the same wavelength created by the same mechanism with the same reactive and noble gases. People have come along — very smart people! — and said, “how about a solid state laser instead? Say, something in the 213 nanometer arena? That arena is wide open!” But those new lasers turn out to be like fad diets. A bunch of people gather around at a conference to hear about it, become disillusioned, and go back to something they know works.
So the laser itself very likely won’t change. It’s just super, super good at what it does. Namely, ablating (i.e. “disappearing”) collagen so precisely that it could spell out the Gettysburg Address on a strand of hair. Disclaimer: that’s never been done because the market for that type of thing is very small/non-existent. But it could be done, and that is spectacular.
What’s the future of laser technology?
The future of laser will likely be the same as the last couple decades of the history of laser. The computer driving the laser will continue to evolve and improve. Here are three examples: the ability to center directly on the visual axis in cases where the axis might be more off center, the ability to register an iris pattern quickly and use it to track torsional movements of the eye, the ability to measure topographic changes in real-time during laser treatment. None of these ideas are new, and all of them are being done to some degree currently. But they will improve.
What’s interesting about surmising on the future of laser and laser eye surgery is that it almost certainly will involve widening the net for who is a candidate. It’s not likely that there will be too much appreciable improvement (if there’s any at all) in results for people that are already candidates for LASIK. To say that differently, the future of LASIK likely looks very similar to today’s LASIK for people who are good candidates. But for those who aren’t candidates today, the future of LASIK is much brighter because it probably is a real option that exists out there in the future — even if it doesn’t yet today.