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All-Laser LASIK (IntraLASIK)
by Craig S. Bindi, MD

In the first step of LASIK, either a mechanical microkeratome OR an Intralase femtosecond laser
(All-laser LASIK) is used to prepare the cornea for laser vision correction. Next, an excimer laser
reshapes the underlying cornea to the desired optical correction. All-laser LASIK may be combined
with either wavefront or standard laser vision correction. On this page, I explain about All-laser
IntraLASIK and when it is especially useful to use the most modern version, the 5th generation
iFS 150 Intralase laser.

All-laser LASIK is a further refinement of the LASIK procedure, without the inherent risk of the
microkeratome’s surgical blade. Several scientific studies have compared the performance between
various microkeratomes and the Intralase femtosecond laser (See references 1-18). Since modern
microkeratomes are automated and quite safe, there is not a large statistical difference between
these two types of equipment for the majority of procedures. Nevertheless, in my assessment of all
the pertinent data, the All-laser IntraLASIK procedure does offer several distinct advantages
(listed below), in terms of vision results and safety profile. In my personal experience, I have found
that the Intralase laser is especially advantageous in certain patients with thin, flat or steep corneas
or dry eyes. Also, the blade-free All-laser LASIK method may provide additional peace of mind for
patients that are apprehensive about their procedure. Since upgrading to the 5th generation
iFS Intralase laser, we have also been impressed with the rapid visual recovery, shorter surgical times,
less dry eye symptoms compared to the 4th generation Intralase laser.

Intralase has been the “name brand” of femtosecond lasers since the introduction of All-laser LASIK
in 2001. More Intralase All-laser LASIK procedures have been performed compared to all other brands
of femtosecond lasers combined. We have been using Intralase femtosecond lasers since 2003, and
recently upgraded to the most modern version of Intralase femtosecond laser, the “iFS 150″.

Only the 5th generation iFS 150 Intralase laser can create:
1. Inverted bevel flap edge architecture, which has been proven to promote stronger flap adhesion
and help prevent epithelial ingrowth from its patented inverted “manhole” flap edge deign.

2. Elliptically-shaped (oval) flaps to better treat astigmatism

3. Surgical time lasts 8 seconds (2.5 times shorter than the 4th generation femtosecond laser)

What’s the downside to All-Laser LASIK?
Since the laser manufacturer charges an additional royalty fee per procedure, All-laser LASIK costs
a few hundred bucks extra. While the majority of our patients prefer All-laser LASIK, in certain
patients, the added expense of All-laser IntraLASIK may not be as necessary as for others. During
your consultation, we will help determine whether All-laser LASIK is especially beneficial for you.

Recent studies have confirmed certain benefits of All-Laser IntraLASIK:

Vision Results
• Better visual acuity outcomes vs. microkeratome 1,18

• Rapid visual recovery & slightly faster healing times 2,3

• Intralase flaps induce less visual aberrations than microkeratomes 4

• Better early visual outcomes vs. microkeratomes 2

• Better early contrast acuity recovery vs. microkeratomes 3

• Lower retreatment rates with Intralase than microkeratomes 5

Safety Profile
• Prevents ALL microkeratome blade-related flap complications 6,7, 17

• Stronger flap adhesion strength helps avoid shifted flap 8

• Customized flap dimensions and architecture 9,10, 16

• Lower rate of healing problems (Epithelial ingrowth) from inverted bevel edge flap design11

• Less Dry Eye symptoms after IntraLASIK 12

• Ability to make elliptically-shaped flaps to better treat astigmatism

• Better flap predictability and control 13

Better Patient Comfort: Less Anxiety About “The Blade”
• It just seems better to use a laser instead of a blade!

**These published studies were performed with the Intralase™ brand laser, and may or may not
be applicable to other promising types of femtosecond lasers, such as Ziemer LDV, FemTec,
Alcon FS200 or VisuMax, which are still maturing.

Types of Intralase femtosecond lasers:
5th generation 150 kHz iFS (Current)
4th generation 60 kHz (2007)
3rd generation 30 kHz (2005)
2nd generation 15 kHz (2003)
1st generation 10 kHz (2001)

Other types of femtosecond lasers (Not Intralase brand):
Ziemer LDV femtosecond laser
Technolas Femtec femtosecond laser
Zeiss Visumax femtosecond laser
Alcon 200FS femtosecond laser

References:

1. Durrie DS, Kezerian GM. Femtosecond laser versus mechanical microkeratome flaps in wavefront-guided LASIK: prospective
contralateral eye study. Journal of Cataract & Refractive Surgery. 2005 Jan;31(1):120-6.
2. Tanzer DJ, Schallhorn S. Comparison of femtosecond vs. mechanical keratome in wavefront-guided LASIK, 2005. Data presented
at American Academy of Ophthalmology 2004; New Orleans, LA; 2005; Chicago, IL.
3. Durrie D. A randomized, prospective clinical study of LASIK performed with the IntraLase FS laser vs. mechanical microkeratome, 2004.
4. Tran DB. Randomized prospective clinical study comparing induced aberrations with IntraLase and Hansatome flap creation in fellow eyes: potential impact on wavefront-guided laser in situ keratomileusis. Journal of Cataract & Refractive Surgery. 2005 Jan;31(1):97-105.
5. Manger C. Enhancement Rates of IntraLase Laser and microkeratome-assisted LASIK. Presented at American Society of Cataract
& Refractive Surgery; 2004; San Diego, Calif.
6. Sutton G, Accuracy and precision of LASIK flap thickness using the IntraLase femtosecond laser in 1000 consecutive cases.
Journal of Refractive Surgery. 2008 Oct;24(8):802-6.
7. Will B, Kurtz RM. IntraLase is best. In: Probst LE, ed. LASIK: Advances, Controversies, and Custom. SLACK; 2004:397-402.
8. Knorz MC. Comparison of flap adhesion strength using the Amadeus microkeratome and the IntraLase femtosecond laser.
Journal of Refractive Surgery. 2008 Nov;24(9):875-8.
9. Binder PS. Flap dimensions created with the IntraLase FS Laser. Journal of Cataract & Refractive Surgery. 2004;30(1):26-32.
10. Kezirian GM, Stonecipher KG. Comparison of the IntraLase femtosecond laser and mechanical microkeratomes for laser in situ
keratomileusis. Journal of Cataract Refractive Surgery. 2004;30(4):804-811.
11. Kamburoglu G. Epithelial ingrowth after femtosecond laser-assisted in situ keratomileusis. Cornea. 2008 Dec;27(10):1122-5.
12. Shamie N. Post-LASIK Corneal Hypoesthesia and Dry Eye. Presented at American Society of Cataract & Refractive
Surgery; 2003; San Francisco, CA.
13. Alió JL, Flap biomechanics with femtosecond and mechanical microkeratomes. Presented at: European Society of Cataract
and Refractive Surgeons; 2005; Portugal.
14. Marketscope Study 2008
15. Panday VA. Refractive Surgery in the U.S. Air Force. Current Opinions Ophthalmology. 2009
16. Lee J. Microkeratome Complications. Current Opinions in Ophthalmology. April 2009
17. Schallhorn SC. Comparison of night driving performance after wavefront-guided and conventional LASIK for moderate myopia.
Ophthalmology. 2009 Apr:116(4): 702-709
18. Von Jagow B. Corneal architecture of femtosecond laser and microkeratome flaps imaged by anterior segment optical
coherence tomography. Journal of Cataract and Refractive Surgery. 2009 Jan: 35-41