Written by Bill Mylius
Even after four decades as a physician—including 35 years as a pioneering and groundbreaking ophthalmologist—Dr. Marc Michelson, M.D, has difficulty containing his excitement when discussing his latest patient technology for laser vision correction. “It’s one millionth of one billionth of a second,” he says, his tone attempting to convey his own amazement with the speed of the laser knife he now uses as part of the laser vision procedures he performs at Michelson Laser Vision, Inc., and Alabama Eye & Cataract Center PC, both located at UAB Highlands in Birmingham.
To appreciate that laser speed, we should go back to the fall of 1988, when Michelson became only the fifth U.S. physician to be granted clinical investigator status by Summit Technology, the first company to receive Food and Drug Administration approval to use an excimer laser for vision correction surgery. As Michelson explains, excimer is a specific laser light that draws its name from the term “excited dimer,” a dimer being two molecules—in this case argon and fluoride—that, when placed into an excited state through electrical stimulation and pressure, produce a laser light in the ultraviolet range.
In the winter of 1989, shortly after being named a clinical investigator, Michelson traveled to Germany to participate in the world’s first excimer laser course, held at the Free University of Berlin. There he trained in the use of the new laser technology for vision correction and rubbed elbows with pioneering ophthalmologic surgeons, including German physician Theo Seiler, M.D., who is revered in the world of laser vision correction. Seiler performed the very first laser surgeries on human eyes: Photo Therapeutic Keratectomy (PTK), the initial type of laser surgery which is used to treat medical conditions such as corneal dystrophy, in 1985; then Photo Refractive Keratectomy (PRK), the next generation of the surgery, which is used to correct refractive errors, in 1987. Completing this intensive medical training, Michelson returned to his Birmingham practice at Carraway Methodist Medical Center and initiated his first U.S. clinical trials in laser vision correction.
“Dr. Ben Carraway, a visionary, was instrumental in acquiring the equipment and establishing Alabama’s very first laser center—The Carraway Laser Center,” Michelson says. There, in 1989, Michelson performed the very first excimer laser treatment in Alabama using the laser to treat a glaucoma patient. He also hosted the first refractive surgery course in the U.S. with none other than his friend Dr. Seiler as featured instructor. In 1991 Michelson performed the state’s first myopic (near-sightedness) vision correction procedure using PRK. Michelson and his staff continued to conduct numerous clinical trials, including some of the initial LASIK studies, beginning in 1995. The LASIK procedure eventually replaced PRK as a more popular treatment for nearsightedness. It’s similar to PRK and corrects refractive errors such as near-sightedness, far-sightedness, and astigmatism. A primary difference is that PRK is performed on the surface of the cornea, while LASIK is performed under a thin flap created on the cornea’s surface and requires less time to heal and to achieve optimum vision. As a testament to the need for such surgery, some of Michelson’s early patients were professional photographers, pilots, and others whose livelihoods were dependent on the accuracy of their vision. “In the beginning, we could only do one eye at a time, and then wait six months to ensure full healing before we did the other eye,” Michelson says. “It was new and groundbreaking and exciting, but compared to today, it was somewhat tedious, especially for the patients.”
The initial clinical trials concluded when the FDA approved the excimer laser for PRK in 1994 and LASIK in 1999. At that point, Michelson and his staff were already on the forefront of innovation in laser vision correction. With hundreds of successful surgeries under his belt, Michelson had come to view the laser technology and the procedures performed with it as not only a very sophisticated and incredibly accurate clinical tool, but as a highly marketable consumer service as well. After a decade at the Carraway Laser Center, he left to open Michelson Laser Vision, Inc., a retail medical outpatient facility at Birmingham’s newest retail center, The Summit.
It was a bold move. At the time there were only a few free standing LASIK facilities in the U.S. and none in Alabama. Plus, LASIK was in its infancy and developing a laser center required significant capitalization and marketing. Risky? Sure, but Michelson’s entrepreneurial vision trumped any doubts he might have had. “My goal was to provide high patient satisfaction and high quality outcomes through a premium experience, all in a convenient and easily accessible location. That’s why we chose The Summit,” he says, then added with a slight grin, “And it worked.”
As if bringing laser vision correction to Alabama wasn’t time-consuming enough, Michelson also had a full ophthalmology medical practice, Alabama Eye & Cataract Center, PC, at a Birmingham Southside medical facility that eventually became UAB Highlands. Last year, anticipating future changes in healthcare delivery, he consolidated both operations into a 4,000-square-foot space at UAB Highlands. Alabama Eye & Cataract Center offers ophthalmic services for patients in need of routine eye exams, consultation for cataract surgery, complex anterior segment surgery, and corneal surgery.
Which brings us back to the “millionth of a billionth of a second” and his ongoing admiration for the technology he commands. Since starting with first-generation laser technology over a quarter-century ago, Michelson has been through a lot of technology upgrades—five new and more advanced lasers for LASIK since 2000 alone. “What’s critical is that Michelson Laser Vision, Inc. has maintained the most sophisticated technology in order to provide our patients with the absolute best in laser vision correction,” he says with obvious excitement in the scientific aspects of the technology, as well as its benefits for his patients. “Lasers are extremely fast and extremely precise. Our newest laser is the EX500 Allegretto…it’s unique in Alabama. It’s called a ‘flying spot’ laser because the (laser) beams are incredibly tiny and they literally dance around the eye directed by a complex computer algorithm that is very precise, very accurate, and very smooth. The ‘500’ refers to the 500 times per second that it shoots the laser. Five hundred times!” he emphasizes. “Per second!”
The original lasers, Michelson explains, fired a mere 60 to 80 times per second, so his newest laser is almost 10 times faster. This is not only impressive, but also critical for patient outcomes. Because the cornea has a very high water content, slower treatments can result in corneal dehydration that can adversely impact the desired outcome. The longer the treatment takes to perform, the greater chance for dehydration. Originally, optimum patient outcomes of 20/20 vision were “maybe 80 to 85 percent, resulting in 15 to 20 percent of patients needing retreatments.” Today, with a computer algorithm driven laser firing 500 hundred times per second, there’s much less dehydration and outcomes have reached more than 99 percent.
But what about that “millionth of a billionth” comment? Well, in order for the laser correction surgery to take place, Michelson has to access the cornea, which requires cutting a tiny flap in the eye. He used to use a microkeratome with an oscillating blade—basically a mechanical process—to make the flap; now he uses a femtosecond laser. A femtosecond is one quadrillionth of a second, or 10 to the minus 15th, or one millionth of one billionth of a second. Again, more precision, less time, less dehydration, better outcomes.
With the technology and the outcomes improving each step of the way, Michelson muses about the future of his art. It’s important to him for a variety of reasons. One, he’s an Associate Clinical Professor of Ophthalmology at the UAB School of Medicine and staying abreast of new developments allows him to share that with young colleagues. Another important reason is that, as part of his medical practice, he often addresses a variety of clinical problems for patients who have had laser surgery or lens implants at other facilities and have experienced poor outcomes. Also, he’s an in-demand lecturer and has presented to such groups as the Russian Ophthalmological Society in Moscow, the Asian Ophthalmological Group in Singapore, and the Japanese Ophthalmological Society in Tokyo. At the same time, he has been an invited speaker performing grand rounds at such notable hospitals as the Albert Einstein Medical Center, NYU in New York, and the University of Utah. Michelson carries out significant clinical research and publishes in a variety of medical journals. And finally, he’s considered a go-to expert with his decades of skill, experience, and teaching in the field of laser vision correction surgery affording him both national and international recognition.
“I have upgraded our technology at least five times in the past 15 years,” he says. “That’s an average of once every three years. I anticipate a new custom treatment software later this year. With all the work and research that’s continually being carried out in the field, I’ll probably be talking about a new laser that’s even faster, even more precise, with even shorter healing times and maybe…just maybe…outcomes approaching 100 percent.”