Understanding Clinical Laser Selection and Laser-Tissue Interactions in Glaucoma

Importance: It is critical for the ophthalmic surgeon to understand lasers and their interactions with biological tissue in order to best select the device and technique specific to the treatments’ goals.

Objective: To describe the various types of lasers and how they differ in their mechanisms of action and interaction and subsequent clinical utility.

Methods: This review addresses lasers historical development, optical properties, laser-tissue interactions, diagnostic advantages, clinical applications, post-operative results and complications which are associated with each of the various lasers.

Findings: Light therapy in ophthalmology has enabled remarkable advances in the therapeutics of many conditions including refractive surgery, diabetic retinopathy, cataract and glaucoma. Due to their specific laser-tissue interactions each laser enables specific therapeutic interventions with some lasers created for application requiring scarring (retinal repair), some to move tissue physically (Nd:YAG capsulotomy), and some to non-thermally break chemical bonds to sculpt tissue without creating scar (PRK, LASIK, and ELT). They have proven increasingly useful in their application in ophthalmic surgery by providing safer and more effective surgical outcomes.

Conclusion and Relevance: This historical review demonstrates the evolution of our understanding of lasers which has stimulated the development of laser technologies enabling new surgical procedures with improved safety and efficacy. This evolution and the various applications of lasers and laser techniques have redefined glaucoma therapy to the benefit of patients.