Why Choose Intralase - the All Laser LASIK Method

The ability to restore clear natural vision for millions of patients has propelled LASIK to its current position as the single most commonly performed elective surgical procedure in the world.  At Will Vision and Laser Centers we are committed to making laser vision correction the absolute safest and most precise procedure possible for our patients. Accomplishing that goal requires that we use only the latest and most safe precise technology available.  For that reason, at Will Vision and Laser Centers, we only use the “All-laser LASIK” Intralase Method.

LASIK is actually a two-step procedure that requires the surgeon to first create a thin flap of tissue on the surface of the patients cornea and then secondly, to alter the shape of the cornea.  It would likely surprise many people to learn that this first step is NOT always performed using a laser even though we call this “laser vision correction”.  In the past, and at many seemingly reputable LASIK centers even today, the surgeon relies upon a mechanical cutting device known as a microkeratome to create that flap.  However, since 2002, with the Intralase laser system, the entire LASIK surgery can be performed using a precise laser technology making the procedure much safer and more accurate.

All-laser LASIK using the Intralase Method provides patients with many scientifically proven advantages including:

1.     Better vision

2.     Superior quality of vision and contrast sensitivity

3.     Higher degree of safety

4.     Higher degree of accuracy and precision

5.     Fewer adverse side effects like dry eye

6.     Individualized and customized flaps

7.     Better patient acceptance with less stress during surgery

8.     Fewer retreatments

9.     Increased accuracy allows more patients to undergo LASIK that were not candidates with a mechanical microkeratome

LASIK using the advanced IntraLase Method has been shown clinically to deliver better visual outcomes in both standard and Custom LASIK procedures with more patients achieving visual acuity of 20/20, 20/15 and even 20/12.5. These remarkable results are the product of the optimized corneal surface prepared by the IntraLase FS laser in creating the corneal flap. The precision of the laser reduces the microscopic inconsistencies on the corneal bed, providing an optimal surface for the vision correction performed by the excimer laser in step two of the LASIK procedure.

Robert Montés-Micó, PhD, of University of Valencia, Spain, and colleagues compared LASIK outcomes side by side in patients evenly randomized to undergo flap creation with the IntraLase femtosecond laser or the Moria Carriazo-Barraquer microkeratome.  Better contrast sensitivity was observed in the femtosecond flaps compared to the microkeratome LASIK flaps.  Better results in high-spatial-frequency contrast sensitivity with the femtosecond laser results in more clarity and definition of even faint targets.

This increased accuracy in producing predictable refractive endpoints also translates into fewer patients required retreatments or enhancement surgeries to refine their vision.  Given the choice, great vision after only one surgery is always the most desirable course.  With the Intralase Method, more patients obtain their desired quality of vision after only one surgery than when a mechanical microkeratome is used.

It may also be surprising to learn is that side effects such as the degree of dryness experienced by a patient is markedly affected by the methods used to create the flap.   In our experience, as well as in many carefully controlled clinical studies, use of the mechanical bladed microkeratome is responsible for a significant amount of dry eye symptoms.  With the microkeratome, not only do a high percentage of patients experience dry eye, many of those patients experience severe dry eye.  Severe dry eye can require the doctor to physically insert tiny plugs into the patients tear duct system to block the exit of tears from the eye or even necessitate the use of expensive prescription eye drops or oral supplements designed to stimulate tear production. 

Fortunately, Intralase technology has truly revolutionized the manner that the eye responds to LASIK surgery.  With the Intralase method, severe dry eye appears to be a thing of the past.  In addition, very few patients experience any symptoms of dry eye at all after the first several weeks postop.  Most importantly, with the Intralase method, very few patients require the insertion of plugs or the use of prescription eye drops and oral medications.  The ultrathin Intralase flaps markedly reduce nerve injury and allow for rapid nerve regeneration compared to old microkeratome methodology.

Unfortunately, the majority of risks and complications associated with conventional LASIK surgery are related to the use of that mechanical microkeratome blade method to create the flap.  Your vision is too precious to expose it to even the remotest of risks if that risk can be avoided.   Using an “All-laser Intralase Method” alternative has been proven in numerous peer reviewed clinical studies to markedly reduce the risks associated with creating that flap compared to the older mechanical microkeratome.  You should recognize that an adverse event that occurs even as infrequently as one in a million would be potentially devastating if it happened to you.  As a result, at Will Vision we only use the newest, safest, and most accurate Intralase method to create your flaps.  We are not willing to risk your vision and our professional reputation on outdated microkeratome technology.  We are delighted to provide this extraordinary advance to all of our patients and we would like to explain its benefits.

The Intralase has truly revolutionized laser vision correction with respect to surgical precision and predictability, and it has an incomparable safety record.  Specifically, it allows the surgeon to eliminate mechanical error from the surgical procedure and make it a true “all-laser” technique.  As a result, the surgeon can decisively control all the parameters that go into creating the perfect flap for each individual case. This is due to the ultra-high-speed infrared laser that operates in the femtosecond range, freeing you and your surgeon from the unpredictable nature of the microkeratome blade.  With the high-speed computer, we can program and control nearly every variable of the creation of the flap.  In addition, we can be assured that the thickness of the flap will be within a few microns of expected, making the procedure much safer for those with high corrections, thinner corneas, or very large pupils. 

To illustrate why “All-laser LASIK” is so much safer and precise than at microkeratome, it is helpful to understand exactly how the Intralase works.  The Intralase laser focuses its energy at a precise depth and plane just below the surface of the cornea.  The energy is delivered in a back and forth raster pattern.  Each laser pulse creates a microscopic bubble, and these, when added together results in a perfect surgical incision.  Then, the energy is directed around the perimeter of the flap to create a vertical sidewall incision, leaving a hinge. 

In stark contrast to the Intralase, the mechanical microkeratome’s performance is dependent on a number of variables, all of which can adversely affect the outcome of the flap.  These include: proper assembly of the device by the surgical assistant, strict adherence to care and maintenance protocols, quality control in blade production, the ability to obtain and maintain adequate suction throughout the microkeratome pass, as well as significant skill and experience on the part of the Lasik surgeon.  However, even in the best hands, the microkeratome is not as predictable as we would like.  The thickness of the flap can vary as much as 15% from expected.  This is of particular concern in cases where the corneas are thin, the prescription is high, or the pupils are very large.  In addition, it’s not always possible to achieve the desired flap diameter and architecture.  There is also the potential for partial flaps, button-hole flaps, flaps that are too thick or too thin, flaps that are cut completely off of the eye or exhibit large abrasions to the eye surface. Our vision is so precious that, when it comes to your eyes, there is no such thing as a benign complication.  While most of these microkeratome complications are rarely threatening to sight, they frequently make healing or outcomes less predictable and in some cases cause long-term irreversible visual distortions. 

If you compare the safety record in the scientific literature of the Intralase side by side with the microkeratome, you will see that almost all of the serious complications that can occur with the microkeratome have never been seen with the Intralase.  When it comes to surgical quality, safety and precision there is no room for compromise.  That is why Intralase and the All-laser Intralase Method is recognized world-wide as the most advanced LASIK methodology available and the method that we use at Will Vision and Laser Centers for every patient.

To help you appreciate the critical differences between the more advanced Intralase All-laser Method and the older out-dated Microkeratome blade technique, we’ve prepared this table to summarize a few of the most important factors. 



 

Intralase Femtosecond Laser System

Microkeratome

Computerized control of corneal flap thickness

Yes - Surgeon able to control to within 10 microns

No computer control - Surgeon must rely on manufacturing tolerances on steel blades with typical tolerance of 20 to 30 microns at best

Computerized control of flap diameter

Yes - Surgeon able to control within 100 microns

No - Surgeon must hope that flap diameter is adequate for the planned ablation

Computer adjustment of flap centration

Yes - Surgeon able to control centration using software controls

No - Centration is dependent on surgeon and variability of vacuum positioning of suction ring on the eye. Can result in decentered flap that will compromise the visual result

Flap Characteristics

Planar flap induces few if any new optical aberrations

Meniscus flap architecture induces new visually significant optical aberrations

Surface Characteristics of Stromal Bed

Very smooth on scanning electron micrographs

Blade chatter creates irregular surface characteristics on scanning electron micrographs

Sidewall architecture

Vertical sidewall promotes better healing and less flap slippage

Meniscus edge heals less aggressively with increased risk for flap slippage and dislocation

Flap healing and adhesion to the eye

Extremely good adhesion - Many flaps are difficult to relift within months making the eye more structurally sound

Poor healing and adhesion - flap can be easily lifted many years after the primary procedure

Risk for epithelial ingrowth

Extremely rare if not non-existent

Common - occurs in 1 to 2% of primary cases and more common in retreatments - can be difficult to eradicate - causes pain, dryness and can compromise vision

Risk for free flap

Highly remote - never reported in over 1 million procedures

Yes - if occurs can have severe visual results

Risk for "button hole" flap (flap with a hole in the middle)

No

Yes - occurs 1/1000 - requires surgery be aborted and recut in 3 months or otherwise undergo a complex PRK procedure

Risk to patient if vacuum is lost during surgery

No problem - vacuum ring is reinserted and procedure is immediately repeated without incident or sequelae

Yes - may cause a defective flap. Treatment must be aborted for at least 3 months and patient may have permanent injury in rare cases

Risk for partial flap or short flap

No problem - vacuum ring is reinserted and procedure can be repeated immediately without incident or sequelae

Yes - occurs 1/2000 - requires that surgery be aborted and recut in 3 months or otherwise undergo complex PRK procedure

Risk for epithelial defect or sloughing

Extremely rare

Common - occurs in 1 to 2% of primary cases.  Results in slow visual recovery, unpredictable refractive endpoints and predisposes to epithelial ingrowth

Risk for Diffuse Lamellar Keratitis (DLK)

Rare

Rare

Risk for Transient Light Sensitivity (TLS)

Transient sensitivity to light - easily treated with eye drops - Extremely rare with new 60 KHz system - Does not cause problems with vision, is not permanent and has no long term sequelae

Never reported