Nikolai Pisny: The Fear of Surgery Is Linked to a Lack of Information

SMILE provides minimal invasive impact; however, compared to LASIK, it has a number of significant limitations, notes Nikolai Pisny, consultant in cataract and refractive surgery, as well as the creator of the LASIK_calculator software. This tool helps make precise calculations for laser operation and assess potential surgical risks.
According to Nikolai, the choice of laser correction method depends on several factors: the degree of refractive error, the need for further enhancement, and the professional activity of the patient.
In an interview with Discover Health, the expert discussed the advantages of personalized femto-LASIK, contraindications for laser vision correction, and cataract surgery in young patients.

— Nikolai, you have developed business launch plans for laser vision correction, consult clients on equipment selection, and provide training for medical staff and surgeons. Could you tell us about the key changes that have occurred in the field of vision correction in recent years?

— The latest technique in laser vision correction is lenticular extraction. The femtosecond laser forms a thin lens (lenticule) in the deeper layers of the cornea, and then the lens is extracted through a small incision. The main advantages of the SMILE technique are its minimal invasiveness, quick healing after surgery, and low risk of dry eye syndrome. However, this method also has its drawbacks: limited correction for high degrees of myopia and astigmatism, and an inability to compensate for hyperopia. If necessary, it will not be possible to perform an enhancement procedure using this same method. Additionally, the lenticular extraction method is not suited for compensating higher-order aberrations.

— Recently, you published a scientific article on the study of corneal microstructure and laser correction calculations. In your opinion, which method is preferable — SMILE or femto LASIK?

— The best method in terms of visual quality achieved after surgery, in my opinion, is personalized femto LASIK. The application of femto LASIK is divided into two categories — standardized and customized. By standardized procedure, we mean the necessary optical correction in terms of dioptric value. This method has long been considered the most reliable, but it increases the number of higher-order aberrations. Simply put, these aberrations become noticeable when we look at a light source at night, and halos or light rays appear around it.
In the customized procedure, a special device called an aberrometer is used, which helps program the correction procedure without introducing additional higher-order aberrations.
With the lenticular extraction method, SMILE, it is physically impossible to achieve compensation for aberrations.

— You developed the LASIK_calculator software, which helps with calculations during laser vision correction procedures. What feedback have you received from the professional community? What results have been noted from using the program?

— The software has been in use for about a year now. It is used by surgeons in Almaty, Shymkent, and Karaganda. Feedback from specialists has been very positive: the program not only saves surgeons’ time by eliminating the need for manual calculations but also provides sufficient analytics for decision-making, warning about contraindications or high risks. Moreover, LASIK_calculator can be run on a smartphone, which frees ophthalmologists from the need to use stationary computers.

— Nikolai, you have trained at leading ophthalmological centers in Barcelona and Germany, and you consult surgeons on refractive surgery. From what age can a person undergo laser vision correction with modern equipment? And what are the contraindications?

— It is generally accepted that laser correction can be performed on individuals from the age of 18, when the body’s growth stops. However, practice shows that it can be done as early as 16 years old, for example, when a patient needs to enroll in a school with high requirements for good vision, but with the possibility of enhancement in the future.

Contraindications for eye surgery are divided into two types. Absolute contraindications include any diseases of the cornea and retina: thin cornea, progressive myopia, autoimmune diseases. Relative contraindications are cases where treatment is required before surgery, such as unstable vision, dry eye syndrome, and acute inflammatory eye diseases.
Pregnancy is also a contraindication due to the unstable hormonal background of the patient, so it is necessary to wait for stability before performing the surgery.

— What happens to vision in the long term after correction? Can the condition return?

— There is no definite answer to this question. Changes in the curvature of the cornea occur in the deeper layers and are considered permanent. However, due to the individual characteristics of the patient, myopia can return over time. It all depends solely on the patient and their lifestyle.

— Among your publications, there is a scientific article dedicated to calculations for artificial lenses after vision correction using radial keratotomy, a method developed by Academician Fyodorov. At that time, it was a groundbreaking method in vision correction. What difficulties do surgeons face when working with young patients nowadays?

— When it comes to cataract surgery in young patients, it’s usually about selecting an artificial lens that suits the patient’s occupation. Currently, there is no ideal artificial lens that can fully replace the human one. Choosing a lens is always a compromise between independence from glasses and visual quality, especially in scotopic conditions. In laser vision correction, the main task of the doctor is to prevent those who are contraindicated from undergoing the surgery, and there are quite a few contraindications.

I can also point out a feature of the younger generation — a fear of surgery, which is often linked to a lack of information about the procedures and influenced by rumors and cinema. Therefore, doctors need to talk about modern eye surgery methods as frequently as possible.

— You consult surgeons on calculations for both laser and intraocular vision correction. What other ophthalmic issues, besides vision correction, can be addressed using a laser?

— Laser technologies are widely used in ophthalmology not only for vision correction but also for treating various eye diseases. Laser retinal coagulation, treatment of diabetic retinopathy, YAG laser capsulotomy, YAG laser iridotomy, corneal cross-linking (CXL), laser trabeculoplasty (SLT, ALT), and many other treatment methods are only possible thanks to laser technologies.