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为什么要用激光照进眼球?

Why We Started Shooting Lasers Into People’s Eyeballs

《科学秀》
Eyes are amazing!
眼睛是神奇的!
Think about it: People with sight rely on two balls of clear jelly
想想看 人们通过两颗透明胶状球
to focus light on some special cells and create the whole experience of vision.
将光线集中到特殊细胞上并创造完整的视觉体验
And for two balls of jelly, eyes are surprisingly robust—
也是因为这两颗胶状球使得眼睛出奇地坚固
you get one set of them, and they generally last your whole life.
一双眼睛通常伴随你一生
But sometimes, they don’t work perfectly,
但有时它们不那么好使
so these days, many people turn to laser eye surgery—
所以近期很多人选择做眼睛激光手术
like Lasik and cataract removal—to repair their vision.
比如LASIK和白内障摘除手术来恢复视力
I mean, I’ve done it!
嗯…我也做了
And if it’s ever struck you as bizarre that millions of people have signed up
有数百万的人报名接受手术 让激光照进眼球
to have a surgeon shoot lasers into their eyeballs—well, yes.
这是不是让你感到奇怪 但事实确实如此
But, it’s all thanks to the history behind these procedures
但是 它们能像今天这样的成功和普遍
that they’re as successful and common as they are today.
这都要感谢这些手术背后的历史
When eyes fail, it’s often because something about the shape of the eye
眼睛看不清时 很多时候是因为眼球的形状
is preventing light from focusing perfectly.
使光线无法精准聚焦
Like, if your eye is too long or too short, or if the curve of the cornea—
例如 如果你的眼球太长或太短 亦或是角膜曲率异常——
that clear part at the front of your eye—isn’t just right,
角膜是指位于眼球前面的透明部分
light can get focused onto the wrong spot.
在以上情况 光线就会聚到其他地方
That makes people nearsighted or farsighted—or causes astigmatism.
进而导致近视 远视或散光
These are often problems glasses can fix—but eventually,
虽然戴眼镜能解决这些问题 但最终
doctors began looking for more permanent solutions.
医生们开始着手找寻更永久性解决的方法
And that’s how lasers entered the game.
激光就这样开始应用于这个领域
Back in the 1970s and ’80s,
在上世纪七八十年代
lasers were improving dramatically and transforming all sorts of science.
激光技术得到了极大的发展并改变了各种科学
One of the really big inventions of the time was something called the excimer laser,
当时最伟大的发明之一是准分子激光
a really precise type of laser that was originally used for physics and chemistry research.
这是一种非常精确的激光 最初用于物理和化学研究
But eventually, ophthalmologists realized that maybe they could use this laser, too…
但最终眼科专家们发现或许他们也可以利用这种激光
to perfect people’s vision.
来改善视力
At the time, many of them were using a technique called radial keratotomy
当时 他们中的许多人正在使用一种叫做放射状角膜切开术的技术
to surgically improve the vision of nearsighted people.
来改善近视患者的视力
The modern form of this surgery had been refined and made popular
苏联眼科医生斯维亚托斯拉夫·费奥多罗夫对这种手术进行了改进
by the Soviet ophthalmologist Svyatoslav Fyodorov,
并使其流行起来
who would cut slices in the cornea that looked like the spokes of a wheel.
他在角膜上切割 看起来像车轮的轮辐
This flattened the cornea, which moved back the focal point of light and corrected nearsightedness.
这使角膜变平 使光的焦点向后移动 从而矫正了近视
And for many patients, that worked pretty well!
这对许多近视眼都很管用
But there were also some issues.
但也有些问题
Like, often, the cornea would keep getting flatter over time,
通常情况下 角膜会随着时间的推移变得越来越平
so people who started out nearsighted would end up farsighted after a few years…
所以一开始近视的人几年后会变成远视
and then need glasses again.
然后又得戴眼镜了
Plus, using a blade on such delicate tissue was risky
而且 用刀片割这么脆弱的组织是很危险的
and depended heavily on the skill of the surgeon.
也高度依赖于医生的技术
But excimer lasers are extremely precise and controllable.
但是准分子激光是非常精准和可控的
So, the idea behind the surgery was this:
这个手术背后的想法是这样的
You’d first carefully cut a flap in the top layer of the cornea,
你首先要小心地在角膜的顶层切一个瓣
top layer of the cornea, then lift it back, revealing the inner part.
然后把它提起来 露出里面的部分
Next, using the laser, you’d vaporize parts of the cornea to achieve the desired shape.
接下来 使用激光 气化部分角膜 以达到预期的形状
Once that was done, you’d just put the flap of cornea back on top, let it heal,
做完那些再把最外层角膜瓣放下 等它愈合
and end up with a new and improved eye.
最后就会得到一个全新的 改良过后的眼睛
Today, that’s known as Lasik eye surgery,
如今 这种称为LASIK的眼部手术
a process that hundreds of thousands of people still get every year!
每年仍有成千上万的人做
Compared to older methods, the laser was easier to standardize, and the results were much more stable,
比起老方法 激光更易标准化 效果要稳定得多
so it became the procedure of choice for ophthalmologists everywhere.
因此 成了各地眼科医生的首选
But this wasn’t the end-all solution for blurry vision—
但这用于治疗视力模糊也不是万能的
especially because, no matter how well you can shape the cornea,
特别是因为 如果眼角膜下面的晶状体模糊
that doesn’t help if the lens beneath it is cloudy.
那么不管眼角膜塑造得多好 也无济于事
As we age, proteins in the lens of our eyes naturally start to clump up
我们眼中晶状体的蛋白质随年龄自然聚集
and create cataracts, which cloud the lens.
形成白内障 使晶状体混浊
They’re entirely normal, but they can make it hard to see
这很正常 但会让人看不清
and cause blindness if they go untreated.
不治疗还会导致失明
Scientists did have a way of breaking up cataracts at the time—
当时科学家确实有一种治疗白内障的方法
they’d use a tiny needle with a vibrating tip to break up the lens
他们用一根带振动尖的小针来分解晶状体
before sucking it out of the eye.
然后把它从眼睛里吸出来
But unfortunately, the constant, rapid in-and-out motion built up heat quickly,
但不幸的是 这种持续快速的移动
and sometimes it burned the cornea.
有时会使热量飙升并灼烧角膜
So surgeons had to—and still have to—
因此 医生们过去和现在都不得不
be very careful with this method.
非常谨慎地采用这种方式
Then, around the same time that people began putting their eyes under the laser for Lasik-type surgeries
差不多就在人们开始接受像LASIK这类激光手术的同时
the ophthalmologist and inventor Patricia Bath wondered if excimer lasers could
发明该手术的眼科医生帕特丽夏·巴斯思考
if excimer lasers could also be applied to cataracts.
准分子激光是否也适用于白内障
The light from these lasers is so high-energy
这些激光发出的光具有极高的能量
that it vaporizes tissue without heating it up,
可以在不加热的情况下使组织气化
and Bath thought it could potentially break up cataracts
巴斯认为它可能有治疗白内障的潜力
without the risk of burning surrounding tissues.
却没有灼伤周围组织的风险
Over five years, she developed a device called the Laserphaco Probe,
在五年多的时间里 她开发了一种叫做激光探针的设备
which became an extremely safe and effective tool for breaking up cataracts in the lens.
它成为了一种非常安全有效地打碎晶状体白内障的工具
The method involves pushing a small needle embedded with a fiber-optic cable
这种方法需要将一根嵌有光纤电缆
and a tiny vacuum through the side of the eye.
和一个微型真空的小针穿过眼睛的一侧
Then, surgeons shoot an excimer laser through the cable directly onto the lens
然后 外科医生通过电缆向晶状体直接发射准分子激光
to break it up, before sucking it out with the vacuum.
将其打碎 再用真空吸出
Finally, they insert a new, artificial lens made of durable, clear plastic.
最后 他们植入一个新的 耐用透明塑料制成的人造镜片
When Bath patented the probe in 1988,
她在1988年取得激光探头的专利权
she became the first Black woman to hold a patent for a medical device.
成为首个获医用设备专利的黑人女性
Her invention significantly lowered the risk of complications,
她的发明明显降低了并发症风险
and it was adopted around the world.
并且在全世界范围内被广泛采用
Since then, technology has continued to advance.
从那时起 技术不断进步
Some surgeons have refined an older practice of using ultrasound to break up cataracts,
一些外科医生改进了用超声波分解白内障的老方法
while others have begun using the smaller femtosecond laser in place of the excimer laser.
其他人则开始用飞秒激光代替准分子激光
Still, the general concept—of using a laser to break up cataracts—
尽管如此 人们普遍接受的观点 即用激光分解白内障
remains one of the most widely-used technologies for extracting cataracts around the world.
仍然是世界上摘除白内障最广泛使用的技术之一
Since their invention, lasers have remained a major player in medicine
自从激光发明以来 它一直是医学界的一个重要角色
as scientists try to keep up with the challenge of keeping our eyes clear, healthy, and focusing.
科学家们试图迎接挑战 保持眼睛干净 健康和精准聚焦
And with hordes of people putting their eyes under surgeons’ lasers every year,
由于每年都有大批人去做眼睛激光手术
laser eye procedures are some of the most common
激光眼科手术成为现代世界最常见
and successful surgeries in the modern world.
和最成功的手术之一
Thanks for watching this episode of SciShow!
感谢收看本期科学秀
If you liked it, and if you’re curious about what exactly surgeons are shooting lasers
如果感兴趣或对激光手术的细节好奇的话
into, you might enjoy our episode about what eyes are made of.
可以欣赏频道中“眼睛的构成”的那期
You can watch that right after this!
你可以看完本期视频之后就去看!
[♪ OUTRO]
[终]

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视频概述

本视频详细描述了眼部激光手术的由来、发展和原理

听录译者

收集自网络

翻译译者

pixie

审核员

审核员LJ

视频来源

https://www.youtube.com/watch?v=oAd6iqq0nYY

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