Lasers

LASER is an acronym for Light Amplification by the Stimulated Emission of Radiation.

* Laser light is coherent: all photons have the same wavelength and are in phase. * A
laser beam is also collimated: the waves of light are parallel.

Production of Laser Energy

Ground state: Lowest energy state of atoms (Fig. 15.1).

Pumping: Process of delivering energy to atoms in a laser active medium.

Elevates electrons from ground state to a higher energy level.

Upper laser energy level: Allows excited atoms to accumulate.

Population inversion: Occurs when there are more atoms in the excited state
than in the lower energy level.

Spontaneous emission: Excited atoms are unstable and spontaneously return to

ground state by emitting light energy.
This light is incoherent and travels in all directions.

Stimulated emission: An atom at a higher energy level is stimulated by a photon

of the same wavelength it would naturally emit.
Resulting emission is coherent with the stimulating photon.

Atom drops to a lower energy level.

Most energy released by active medium is incoherent spontaneous emission;

small amount from stimulated emission can be amplified.

Laser tube: Houses the active laser medium, with a mirror at each end (Fig. 15.2).
Distance between mirrors must equal a multiple of the emitted wavelengths
for resonance.

Photon encounters excited electron, stimulated emission occurs, light

travels down tube, reflected and rereflected.

Light reinforces itself, remaining exactly in phase (coherent).

Other stimulated emissions occur, making the light stronger and stronger.

Continuous-wave (CW) mode: Achieved when one mirror is partially

transparent, allowing some light to leave the tube continuously.
Emitted light is coherent, monochromatic (one wavelength), and
collimated.

Luminous flux: Relatively small, as lasers are inefficient.

However, luminous flux is concentrated in a fine parallel beam, making it
exceedingly bright.

Example: 5 lumens laser may have 500 million candela luminous intensity.

Example: 1 watt laser produces retinal irradiance 100 million times greater
than a 100 watt incandescent bulb. 🔥 HIGH-YIELD
Laser naming: Named after their active medium.
Active medium: Contains atoms/molecules for stimulated emission.
Gas: Argon, Krypton, Carbon Dioxide.

Liquid: Dye.

Solid: Neodymium supported by Yttrium Aluminium Garnet crystal

(Nd:YAG).

Energy source (pump): Electrical discharge, second laser, or incoherent

light.

Laser Modes

Laser light is not perfectly parallel; it is slightly divergent.

Transverse electromagnetic modes: Points of more intense light within the

beam.
Less important for diffuse energy delivery (e.g., retinal photocoagulation).

Important for photodisruption (e.g., YAG capsulotomy) for precise focused

energy.

Fundamental mode: Point along the laser beam path where it is least divergent.
Energy is most concentrated at the center, diminishing peripherally
(Gaussian curve distribution, Fig. 15.3).
Newer YAG laser designs increase central energy distribution for smaller
focus with less energy.

Non-fundamental modes (divergent waves) can be cancelled by an aperture

inside the laser cavity.

Mode Locking, Q-Switching

Power increase: Achieved by delivering same energy over a shorter time (Power
= Energy/Time).

Continuous wave ophthalmic laser (e.g., argon):

Constant power output.

Energy output depends on shutter speed.

Measured in watts.

Pulsed laser (e.g., Nd:YAG):

Has a peak of power.

Measured in joules.

Q-switching: Mechanism to produce a brief pulse.

A shutter is placed in front of one of the two mirrors in the laser tube (Fig.
15.4).

Maximises energy state of laser medium by limiting energy loss to

spontaneous emission.

Opening shutter allows oscillation, producing a single pulsed surge of

stimulated emission.

Duration: 2–30 nanoseconds (30 × 10⁻⁹s). 🔥 HIGH-YIELD

Shutters: Rotating mirrors, dyes, electro-optic switches.

Laser light purity: Less than pure due to multiple wavelengths.

Reasons for impurity:
Tube length: Multiples of several different wavelengths can 'fit' into
the tube length.

Solid state lasers: Heat causes expansion of crystal, altering mirror

distance.
Gas lasers: Doppler effect (random motion of gas molecules affects
emitted wavelength).

Free running mode: Various 'sub-wavelengths' are not in phase.

Mode locking: Refinement of Q-switching.

Synchronises various wavelengths so they periodically are in phase and
summate (Fig. 15.5).

Produces a train of very high energy pulses.

Pulse duration: about 30 picoseconds (30 × 10⁻¹²s). 🔥 HIGH-YIELD

Produces up to 100 times more power for the same energy compared to Q-
switching.

Effects of Laser Energy on Tissue

Radiation wavelengths from 400 to 1400 nm can enter the eye and reach the
retina.

Effects depend on:

Wavelength and pulse duration of laser light.

Absorption characteristics of the tissue (largely determined by pigments).

When laser energy exceeds damage threshold, mechanism of damage depends

on exposure duration.

Effects can be: ionising, thermal, or photochemical.

Ionisation

Mechanism: Photon energy delivered in nanosecond or less strips electrons

from molecules to form a plasma.
Plasma has very high temperature and rapidly expands, causing a
mechanical shock wave.

Sufficient to displace tissue.

Energy released as photons may produce a flash.

Lasers: Nd–YAG and argon–fluoride excimer lasers.

Thermal Effects

Mechanism: Light energy converted into heat energy.

Occurs if wavelength coincides with absorption spectrum of tissue pigment.

Pulse duration between a few microseconds and 10 seconds.

Important ocular pigments:

Melanin: Located in retinal pigment epithelium and choroid; absorbs most
of the visible spectrum.

Xanthophyll: At the macula; strongly absorbs blue light (green is safer).

Haemoglobin: Absorbs blue, green, and yellow wavelengths.

Retinal heat transfer: Heat transferred to adjacent retinal layers, causing a 10–
20°C rise in tissue temperature.
Result: photocoagulation and a localised burn.

Vaporisation: Occurs when visible or infrared light raises tissue temperature to

100°C.
Water vaporises, causing tissue disruption.

Carbon dioxide (CO₂) lasers: 90% of energy absorbed within 200 µm of

surface.

Can also be produced by argon retinal photocoagulation if too intense.

Photochemical Effects

Mechanism: Pulse duration of 10 seconds or more required to cause damage.

Formation of free radical ions (highly reactive and toxic to cells).

Wavelengths: Shorter wavelengths (blue, ultraviolet) cause damage at lower

irradiance levels, thus more harmful.

Argon lasers for retinal photocoagulation: Incorporate a filter to protect

operator from photochemical effects of reflected light.

Lasers Used in Ophthalmology

New lasers developed annually; those below have accepted place.

Laser light can be delivered via fibre optic cable to:
Slit lamp.

Indirect ophthalmoscope.

Intraocular endolaser probe.

The Argon Blue-Green Gas Laser

Emits a mixture of 70% 488 nm (blue) and 30% 514 nm (green) light.

Most commonly used for retinal photocoagulation.

Older models: Large, required water cooling.

Newer lasers: Smaller, air cooled, limit emission to green light.

Photocoagulation aim: Treat outer retina, spare inner retina (avoid damaging
nerve fibre layer).

Argon green (blue screened out) photocoagulation of macula: Does not cause
direct retinal damage.

Absorption: Well absorbed by melanin and haemoglobin.

Xanthophyll: In inner layer of macula, absorbs blue light (not green).

Use of blue light at macula is contraindicated to avoid direct retinal
damage. 🔥 HIGH-YIELD
Crystalline lens scattering: In older individuals, affects beam focus, necessitates
higher power settings.

The He–Ne Laser

Helium-neon (He–Ne) laser: Low power gas laser.

Emission: Visible red 632.8 nm.

Use: Aiming beam for lasers with invisible output (e.g., Nd–YAG, diode).

Diode Lasers

Emission: 810 nm infrared in continuous wave mode.

Energy generation: Semiconductor diode chip.

Characteristics: Efficient, generate little excess heat, portable.

Absorption in eye: Only by melanin.

Primary use: Retinal photocoagulation.

Penetration: Low scattering ensures good penetration of ocular media and

oedematous retina.

Scleral penetration: 810 nm wavelength penetrates the sclera.

Allows photocoagulation even if retina is obscured (by placing probe on eye
surface).

Allows photocycloablation of ciliary body in 'end stage' glaucoma.

Enhanced photocoagulation: Of vascular structures (neovascular membranes,

tumours) enhanced by intravenous indocyanine green dye (absorption peak
800–810 nm).

Other use: Used endoscopically to create a dacryocystorhinostomy (DCR).

The Nd–YAG Laser

Emission: 1064 nm infrared radiation.

Type: Powerful continuous wave (CW) laser, usually Q-switched for ocular
treatment.

Common uses:
Disrupt posterior capsule of lens after cataract surgery.

Disrupt iris in narrow angle glaucoma.

Energy source: Neodymium molecules suspended in a clear YAG crystal.

Achieves higher concentration of Nd ions than gas laser medium.

Aiming beam: 1064 nm is invisible, requires a He–Ne laser red aiming beam.
Operator must ensure laser beam and aiming beam are focused at the same
point.

The Frequency-Doubled Nd-YAG Laser

Emission: 532 nm radiation.

Production: Passing 1064 nm radiation from a YAG crystal through a potassium

titinyl phosphate (KTP) crystal.
Converts some energy to 532 nm radiation.
Pumping: YAG crystal may be pumped by arc light or a diode laser.

Effect: Photocoagulation effect similar to continuous wave argon green laser.

The Excimer Laser

Name origin: 'Excited dimer' (two atoms forming a molecule in excited state,
dissociate in ground state).

Clinical use: Argon–fluorine (Ar–F) dimer laser medium.

Emission: 193 nm ultraviolet (UV) radiation.

Corneal absorption: High absorption of UV by the cornea limits its penetration.

Photon energy: Each photon has 6.4 eV, sufficient to break intramolecular
bonds.

Tissue removal (ablation): High energy delivered to small tissue volume causes
precise tissue removal.
Ablation depth can be precisely determined.

Very small amount of heat produced; no significant temperature rise in

adjacent tissue.

Ideal for: Photorefractive keratectomy (PRK) and laser intrastromal

keratomileusis (LASIK) to reshape corneal surface.