The 2014 Bowman lecture - Bowman's and Bruch's: A tale of two membranes during the laser revolution

Abstract

To describe the historical evolution of the role of lasers in effecting therapeutic changes in the four acellular membranes of the eye. Over the past 50 years, iterative developments have been instituted in lasers used for various forms of eye surgery predominately on the basis of data generated in early experiments in the 1960s to determine thresholds for damage and their incorporation in codes of practice for laser safety. The evolutionary steps are described. Excimer laser technology resulted in the generation of the new field of laser refractive surgery with over 40 million individuals now having undergone procedures such as photorefractive keratectomy and LASIK. Developments in lasers used for various forms of retinal surgery have undergone changes involving shorter and shorter pulse durations together with changes in beam energy distribution with implications for potential intervention in AMD prophylactically. Lasers have made a major impact on surgical treatment on all four acellular membranes of the eye but particularly Bowman's membrane in refractive surgery, where it has been demonstrated that it can be removed without significant consequences for eye health or vision.