All-Laser LASIK

All-Laser LASIK
by Craig Bindi, MD

In the first step of All-Laser LASIK, a femtosecond laser is used to prepare the cornea for laser vision correction. Next, an wavefront excimer laser reshapes the underlying cornea to the desired optical correction. All-laser LASIK is blade-free procedure that is a refinement of the original LASIK procedure, which included the use of a microkeratome blade. Several scientific studies have compared the performance between various microkeratomes and the Intralase femtosecond laser (see references below).  Though modern microkeratome blades were automated and quite safe, the All-laser LASIK procedure does offer several distinct advantages (listed below), in terms of vision results and safety profile. In my personal experience, I have found that femtosecond lasers are 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. We have also been impressed with the rapid visual recovery, shorter surgical times, less dry eye symptoms compared to the initial prototypes of the femtosecond laser.

Modern femtosecond lasers can:

  1. Create 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. Create Elliptically-shaped (oval) flaps to better treat astigmatism
  3. Surgical time lasts only 8-20 seconds!

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

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 re-treatment rates with All-Laser LASIK compared to 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 All-Laser LASIK 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!

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. 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