Advances in microkeratome and femtosecond laser technology are making LASIK safer and more predictable than ever.
And while femtosecond lasers continue to gain popularity, offering patients an all-laser LASIK experience, new premium microkeratomes are making surgeons' decision about whether to switch from using a highly effective microkeratome to a much more costly femtosecond laser a difficult one.
In the March 1, 2009 issue of Ocular Surgery News (Europe/Asia-Pacific Edition), several European and American LASIK surgeons weigh in with their opinions about both instruments.
Choice of femtosecond laser or microkeratome depends on the LASIK patient
Some LASIK surgeons, recognizing the advantages of both devices, opt to choose a femtosecond laser or a microkeratome on a case-by-case basis, depending on the needs of each patient.
Lucio Buratto, MD, in private practice in Milan, Italy, was one of the pioneers of LASIK in Europe. In addition to developing innovative LASIK surgical techniques, Dr. Buratto helped develop the Hansatome microkeratome (Bausch & Lomb) and was the first European LASIK surgeon to use the IntraLase femtosecond laser (Abbott Medical Optics).
Dr. Burrato uses both microkeratomes and femtosecond lasers in his refractive surgery practice. He believes both types of instruments produce excellent results in expert hands, noting that each has specific advantages and drawbacks. For example, some microkeratomes may be extremely accurate and patient-friendly for most cases, but they may not perform as well for small, deep-set eyes. For these cases, a femtosecond laser or a different microkeratome may have a distinct advantage.
“Generally speaking, for the average, uncomplicated cases, I still prefer microkeratomes," says Dr. Burrato. "They are very good, perfectly safe and reliable instruments."
"The femtosecond laser is heavier on the eye and requires a slightly longer suction time, as well as some waiting time for bubble dissipation, which may cause some discomfort and anxiety in the patient,” he adds.
The IntraLase femtosecond laser is Dr. Buratto’s first choice for small eyes, for eyes with large pupils and when preoperative aberrations need to be treated during LASIK.
Femtosecond laser preferred
Michael C. Knorz, MD, medical director of the FreeVis LASIK Center and a professor at Medical Faculty Mannheim of the University of Heidelberg, Germany, has switched from using a microkeratome to using an IntraLase femtosecond laser for 100 percent of his LASIK cases.
According to Dr. Knorz, when he compared the surgical results of his patients who had flaps created with a microkeratome to those who had femtosecond laser flaps, visual outcomes were slightly better in the IntraLase laser group. The laser group also had fewer flap complications, and the IntraLase flaps healed better than the microkeratome flaps, he says.
Dr. Knorz also conducted studies on rabbit eyes to compare the adhesion strength of microkeratome flaps to that of flaps created with the latest-generation IntraLase, the iFS. At 2.5 months after surgery, the laser flaps had twice the adhesion strength of the microkeratome flaps, indicating better healing.
Femtosecond laser flaps also may have additional advantages over microkeratome flaps after LASIK, according to Dr. Knorz. “The IntraLase femtosecond laser can produce thin, planar flaps that, compared with the meniscus-shaped flaps of microkeratomes, minimize corneal weakening and induction of spherical aberration,” he says.
Jérôme C. Vryghem, MD, who works in the Brussels Eye Doctors private practice in Belgium, also is a firm believer in using femtosecond lasers to create LASIK flaps.
Dr. Vryghem typically uses the Ziemer LDV (formerly the Da Vinci, Ziemer Group) femtosecond laser. He has conducted studies to determine the optimum flap thickness for LASIK and found that the Ziemer LDV laser is capable of creating thinner, more predictable flaps than many microkeratomes.
In a study of over 1,500 eyes, Dr. Vryghem found he could create flaps that had a mean thickness of approximately 100 microns (little more than the thickness of the corneal epithelium) with the Ziemer LDV laser, achieving successful outcomes with no clinically relevant complications.
Based on these results, Dr. Vryghem says he now performs all-laser LASIK on nearly 100 percent of his patients, using a microkeratome only when patients are not ready to pay the extra costs involved when a femtosecond laser is used.
Advanced microkeratomes popular among many surgeons
But don't write off microkeratomes too quickly. Other surgeons point to new microkeratome technology that can produce similar outcomes as those produced with the latest-generation femtosecond lasers, and at a fraction of the costs.
Richard A. Norden, MD, of Ridgewood, New Jersey, says laser-style thin flaps with a planar architecture can be achieved with the new Moria One Use-Plus SBK microkeratome.
According to Dr. Norden, the Moria SBK microkeratome can produce 100-micron flaps like those created with a femtosecond laser and can create flaps quicker than those produced with a laser. Also, there may be less risk of inflammation and discomfort after surgery when the microkeratome is used, he says.
Dr. Norden also says flap thickness is extremely predictable with the Moria SBK microkeratome, and, unlike most microkeratomes, it produces a laser-style planar flap which may heal better than traditional meniscus-shaped flaps created by other microkeratomes. (Planar flaps have an equal thickness throughout and a blunt edge, whereas meniscus-shaped flaps vary in thickness from center to periphery and have a knife-edge.)
Microkeratomes and femtosecond lasers will likely coexist
Most surgeons agree that advances in microkeratome and femtosecond laser technology have made both instruments very viable for the important first step of creating consistent, predictable flaps in LASIK surgery. In the hands of experienced LASIK surgeons, both devices are safe, causing few LASIK risks.
“I think that wherever surgeons have a free choice, femtosecond LASIK will become the standard of LASIK surgery,” says Jorge L. Alió, MD, PhD, of the Vissum Eye Institute in Alicante, Spain. “However, if price is an issue—and indeed it is—we can still rely on microkeratome LASIK as a very safe and effective alternative.”
SOURCE: "Femtosecond lasers continue to gain ground as improvements are made to microkeratomes" Ocular Surgery News - Europe/Asia-Pacific Edition. March 1, 2009.
Check out this "Thinking About Lasik Video"
Hi all,
If you have been considering Lasik please click on this link and watch this informational video.
Thinking About Lasik?
If you have any further questions about Lasik please visit us at Lasik University
LasikCounselor
If you have been considering Lasik please click on this link and watch this informational video.
Thinking About Lasik?
If you have any further questions about Lasik please visit us at Lasik University
LasikCounselor
PRK, LASIK show equal long-term results
Wear Glasses or Contacts? Click Here!
LASIK is the most popular laser vision correction surgery worldwide — due largely because it involves little or no discomfort and many patients have excellent visual acuity within 24 to 48 hours after surgery.
PRK is preferred by some eye surgeons and patients because it eliminates the risk of flap complications during and after surgery. PRK is far less popular than LASIK, however, because vision recovery is slower and postoperative discomfort can be significant the first few days after surgery.
But how do the long-term visual outcomes of the two procedures compare?
PRK vs. LASIK over a 4-year period
In a recent Japanese study, researchers compared the visual acuity results of PRK and LASIK over a 4-year period.
PRK was performed on 22 eyes of 22 patients and LASIK was performed on 18 eyes of 18 patients. All patients were examined over a 4-year follow-up period.
The following criteria were evaluated for both groups throughout the 4-year study period:
Uncorrected visual acuity (UCVA)
Best spectacle-corrected visual acuity (BSCVA)
Percentage of eyes within +/-0.50 diopter (D) of the intended target refraction
Results
The data gathered during the course of the study yielded these results:
The average UCVA was significantly better in the LASIK group at 6 and 12 months after surgery, but there was no difference in the average UCVA between the two groups two years after surgery.
The average BSCVA was significantly better in the LASIK group at 6, 12 and 24 months after surgery, but there was no difference in the average BSCVA between the LASIK and PRK groups three and four years after surgery.
The percentage of eyes within ±0.5 D of the targeted refraction was not significantly different between the LASIK and PRK groups at any time.
Conclusions
The researchers concluded that though LASIK has short-term visual acuity advantages over PRK, these advantages were not retained four years after surgery.
They attributed this to a mild regression of myopia and corresponding decline in uncorrected visual acuity over time among the eyes treated with LASIK, while the visual results among the PRK showed no comparable degradation over time.
SOURCE: "Comparison of laser in situ keratomileusis and photorefractive keratectomy results: Long-term follow-up." Journal of Cataract & Refractive Surgery. Volume 34, Issue 9, September 2008.
LASIK is the most popular laser vision correction surgery worldwide — due largely because it involves little or no discomfort and many patients have excellent visual acuity within 24 to 48 hours after surgery.
PRK is preferred by some eye surgeons and patients because it eliminates the risk of flap complications during and after surgery. PRK is far less popular than LASIK, however, because vision recovery is slower and postoperative discomfort can be significant the first few days after surgery.
But how do the long-term visual outcomes of the two procedures compare?
PRK vs. LASIK over a 4-year period
In a recent Japanese study, researchers compared the visual acuity results of PRK and LASIK over a 4-year period.
PRK was performed on 22 eyes of 22 patients and LASIK was performed on 18 eyes of 18 patients. All patients were examined over a 4-year follow-up period.
The following criteria were evaluated for both groups throughout the 4-year study period:
Uncorrected visual acuity (UCVA)
Best spectacle-corrected visual acuity (BSCVA)
Percentage of eyes within +/-0.50 diopter (D) of the intended target refraction
Results
The data gathered during the course of the study yielded these results:
The average UCVA was significantly better in the LASIK group at 6 and 12 months after surgery, but there was no difference in the average UCVA between the two groups two years after surgery.
The average BSCVA was significantly better in the LASIK group at 6, 12 and 24 months after surgery, but there was no difference in the average BSCVA between the LASIK and PRK groups three and four years after surgery.
The percentage of eyes within ±0.5 D of the targeted refraction was not significantly different between the LASIK and PRK groups at any time.
Conclusions
The researchers concluded that though LASIK has short-term visual acuity advantages over PRK, these advantages were not retained four years after surgery.
They attributed this to a mild regression of myopia and corresponding decline in uncorrected visual acuity over time among the eyes treated with LASIK, while the visual results among the PRK showed no comparable degradation over time.
SOURCE: "Comparison of laser in situ keratomileusis and photorefractive keratectomy results: Long-term follow-up." Journal of Cataract & Refractive Surgery. Volume 34, Issue 9, September 2008.
Do Drugs And LASIK Mix?
Do drugs and LASIK mix? You decide. There are not many direct studies that link the use of some drugs with LASIK surgery. Many researchers of late have taken in interest in the link between marijuana and LASIK. Specifically, surgeons have an interest in learning whether cannabinoids, THC and other chemicals in marijuana may have an impact on patients undergoing LASIK, IntraLasik, PRK and other types of refractive surgery.
It is important to know whether these drugs mix with surgery, as many patients are unwilling to report their drug use.
Cannabis (Also known as Weed, Pot, Marijuana, etc. etc.)
Humankind has long used cannabis as a medicinal agent throughout the world. For thousands of years, cultures used it for various illnesses. In the U.S., the government restricts the use of cannabis chiefly resulting from the its recreational use, which grew tremendously during the 1960s.
Research reveals roughly 72 controlled studies evaluating the therapeutic benefits of cannabinoids. Clinical trials show that cannabis may act as an appetite stimulant, as an agent to combat Tourette's syndrome, as an antiepileptic agent and may be helpful for glaucoma.
Many studies suggest concurrent use of cannabis with refractive surgery poses no real risk. There are no records of direct studies of cannabis and refractive surgery, therefore it seems sensible one might decide to refrain from use before surgery.
Bottom line? Don't smoke a bowl right before (or after) any refractive surgery.
Herbs and Surgery
There is even less information about use of herbs and their effects on refractive surgery. If you routinely use herbs to help bolster your health, you should talk with your surgeon before surgery to find out whether you should stop taking them and when. Most of the time, taking herbs or supplements will not pose a problem, however certain natural herbs or therapeutic agents may have effects that raise or lower your blood pressure or thin your blood. This may prove troublesome if you experience complications during surgery. This is not just true of refractive surgery, but any surgery.
Some herbs may not have a direct effect on your surgery, but if you experience complications and are given drugs for them, these herbs may interact with the medicines intended to help resolve your problem.
Remember it is always important you are 100 percent honest with your doctor about any over-the-counter supplements or herbs and prescriptions you may be taking. This will help your doctor treat you best in the event you do experience a complication.
It is important to know whether these drugs mix with surgery, as many patients are unwilling to report their drug use.
Cannabis (Also known as Weed, Pot, Marijuana, etc. etc.)
Humankind has long used cannabis as a medicinal agent throughout the world. For thousands of years, cultures used it for various illnesses. In the U.S., the government restricts the use of cannabis chiefly resulting from the its recreational use, which grew tremendously during the 1960s.
Research reveals roughly 72 controlled studies evaluating the therapeutic benefits of cannabinoids. Clinical trials show that cannabis may act as an appetite stimulant, as an agent to combat Tourette's syndrome, as an antiepileptic agent and may be helpful for glaucoma.
Many studies suggest concurrent use of cannabis with refractive surgery poses no real risk. There are no records of direct studies of cannabis and refractive surgery, therefore it seems sensible one might decide to refrain from use before surgery.
Bottom line? Don't smoke a bowl right before (or after) any refractive surgery.
Herbs and Surgery
There is even less information about use of herbs and their effects on refractive surgery. If you routinely use herbs to help bolster your health, you should talk with your surgeon before surgery to find out whether you should stop taking them and when. Most of the time, taking herbs or supplements will not pose a problem, however certain natural herbs or therapeutic agents may have effects that raise or lower your blood pressure or thin your blood. This may prove troublesome if you experience complications during surgery. This is not just true of refractive surgery, but any surgery.
Some herbs may not have a direct effect on your surgery, but if you experience complications and are given drugs for them, these herbs may interact with the medicines intended to help resolve your problem.
Remember it is always important you are 100 percent honest with your doctor about any over-the-counter supplements or herbs and prescriptions you may be taking. This will help your doctor treat you best in the event you do experience a complication.
Dr. Ashraf of the Atlanta Vision Institute
Hi all,
For anyone interested in having their vision corrected by having the Lasik procedure done I wanted to recommend a great Lasik Doctor here in the Atlanta area.
At one time I worked for The Lasik Vision Institute wich is now formerly the World's Largest Provider of Lasik. Dr. Ashraf was one of LVI's Lasik Surgeons. Over the 4 year period I worked for Lasik Vision Institute I never heard a complaint aimed towards Dr. Ashraf. All of his patients gave me superb feedback in regards to his professionalism and bed side manner. If I needed to have Lasik done I would certainly have Dr. Ashraf conduct my Lasik procedure.
He is now the top Lasik Surgeon at Atlanta Vision Institute. He uses the most state of the art Lasik Excimer Lasers as well. He has the German Allegretto Wavelight Laser wich yields phenomenal results.
Dr. Ashraf has completed over 35,000 Lasik surgeries with great results. He is definitely one of the most experienced Lasik Doctors in the world. You can check out his impressive academic background on his website at www.atlanta2020.com .
If you have any Lasik questions or concerns you can contact me at Lasik University .
Lasik Counselor
For anyone interested in having their vision corrected by having the Lasik procedure done I wanted to recommend a great Lasik Doctor here in the Atlanta area.
At one time I worked for The Lasik Vision Institute wich is now formerly the World's Largest Provider of Lasik. Dr. Ashraf was one of LVI's Lasik Surgeons. Over the 4 year period I worked for Lasik Vision Institute I never heard a complaint aimed towards Dr. Ashraf. All of his patients gave me superb feedback in regards to his professionalism and bed side manner. If I needed to have Lasik done I would certainly have Dr. Ashraf conduct my Lasik procedure.
He is now the top Lasik Surgeon at Atlanta Vision Institute. He uses the most state of the art Lasik Excimer Lasers as well. He has the German Allegretto Wavelight Laser wich yields phenomenal results.
Dr. Ashraf has completed over 35,000 Lasik surgeries with great results. He is definitely one of the most experienced Lasik Doctors in the world. You can check out his impressive academic background on his website at www.atlanta2020.com .
If you have any Lasik questions or concerns you can contact me at Lasik University .
Lasik Counselor
FDA Approves New-Generation Laser for Corneal Flap Creation
The Food and Drug Administration has cleared the way for Advanced Medical Optics to begin selling its new-generation femtosecond laser. This laser is used to create a thin corneal flap on the eye's surface in preparation for the Lasik procedure.
In a Lasik Surgery, the laser will create a flap and it is then hinged back and then a different type of laser called an excimer laser is then used to reshape the cornea to achieve better vision.
Advanced Medical Optics newly approved laser that is known as the IFS Advanced Femtosecond Laser has advanced capabilities like the ability to complete a corneal flap in under ten seconds. This is phenomenal!
Some of the other exiting features is that it can create elliptiacal form flaps which will increase the options Lasik Eye Surgeons have to address individual vision concerns. It is really a boost in continuing the customization of the Lasik Procedure.
Lasik Counselor
In a Lasik Surgery, the laser will create a flap and it is then hinged back and then a different type of laser called an excimer laser is then used to reshape the cornea to achieve better vision.
Advanced Medical Optics newly approved laser that is known as the IFS Advanced Femtosecond Laser has advanced capabilities like the ability to complete a corneal flap in under ten seconds. This is phenomenal!
Some of the other exiting features is that it can create elliptiacal form flaps which will increase the options Lasik Eye Surgeons have to address individual vision concerns. It is really a boost in continuing the customization of the Lasik Procedure.
Lasik Counselor
FDA responds to Lasik Advisory Board
If you have already had Lasik or are interested in having Lasik you should be aware that the US Food and Drug Administration has now finally responded to a public advisory panel of outside Lasik industry professionals who have taken the time to hear about the experiences of Lasik patients. Together this public Lasik advisory panel is considering how to drastically improve the availability of good information for potential Lasik patients and Lasik physicians about Lasik.
The Food and Drug Administration has responded to public and Lasik expert feedback and is now implementing multiple improvements in communications with the public in regards to Lasik related safety concerns and issues.
Some of these improvements include keeping the FDA’s website more up to date to make it easier to report any Lasik problems to MedWatch, the government’s platform to receive complaints in regards to FDA approved medical instruments. Within the updated public information you will now see more of a focus on any reports of patients experiencing halos, glare, night vision problems and dry eye syndrome. These issues are very well known side-effects of Lasik Eye Surgery. To learn more about Lasik side-effects please visit Lasik911 .
Patient information cards are now being constructed with full partnership of the American Academy of Ophthalmology that Lasik Doctors can fill out with the patient’s exact eye measurements before their Lasik Procedure. Lasik Patients will be able to retain this information card to assist their Doctor in calculating the lens implant power in the event they require future cataract surgery.
It is great to see that the FDA is finally addressing some of the existing concerns about Lasik side-effects and the lack of good Lasik educational information.
To learn more about Lasik you can register for Lasik University for FREE!
Lasik Counselor
The Food and Drug Administration has responded to public and Lasik expert feedback and is now implementing multiple improvements in communications with the public in regards to Lasik related safety concerns and issues.
Some of these improvements include keeping the FDA’s website more up to date to make it easier to report any Lasik problems to MedWatch, the government’s platform to receive complaints in regards to FDA approved medical instruments. Within the updated public information you will now see more of a focus on any reports of patients experiencing halos, glare, night vision problems and dry eye syndrome. These issues are very well known side-effects of Lasik Eye Surgery. To learn more about Lasik side-effects please visit Lasik911 .
Patient information cards are now being constructed with full partnership of the American Academy of Ophthalmology that Lasik Doctors can fill out with the patient’s exact eye measurements before their Lasik Procedure. Lasik Patients will be able to retain this information card to assist their Doctor in calculating the lens implant power in the event they require future cataract surgery.
It is great to see that the FDA is finally addressing some of the existing concerns about Lasik side-effects and the lack of good Lasik educational information.
To learn more about Lasik you can register for Lasik University for FREE!
Lasik Counselor
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