Advances in LASIK safety: femtosecond all-laser LASIK

Have you wondered how safe LASIK eye surgery is? The safety of this procedure is determined by the skill of the surgeon, the accuracy and rigor of preoperative screening, and the technology used in the procedure. 

Three major technology advances in laser vision correction:

• Excimer laser – Since the Excimer laser was FDA approved in 1995, millions of procedures have been performed to reshape the cornea (front surface of the eye) so it can focus images better on the retina (the back of the eye that acts like a film in the camera). The Excimer laser is called a nanosecond laser because it pulses light with a frequency of one pulse every

10^-9 seconds. The precision of this laser allows the cornea to be reshaped more accurately than by any other methods, correcting nearsightedness, farsightedness, and astigmatism.

• Wavefront aberrometry mapping –This is the mapping of the eye’s optical system; the cornea and the lens. The map includes all the imperfections; major ones, called lower order aberrations, like nearsightedness, farsightedness, and astigmatism, and smaller ones, called higher order aberrations. By using the map to guide the Excimer laser beam, an accurate removal of imperfections can be accomplished, allowing for better day and night-vision for most patients.

• Femtosecond laser – Femtosecond lasers are ultrafast lasers, pulsing light with a frequency of one pulse every  ]]> */ 10^-15 seconds. Used in laser vision correction, this ultrafast pulsing allows for extremely precise energy delivery to the cornea and results in safe and gentle creation of the corneal flap. After the reshaping is complete, the flap is replaced and the healing begins immediately. Prior to the invention of femtosecond lasers, a mechanical device, called microkeratome was used to create the flap. This process was not as precise and could sometimes result in complications.

How the femtosecond laser improves LASIK safety:

• Reduces procedure complications – Unlike the hand-held mechanical blades that can result in an imperfect corneal flap, the precision of the femtosecond laser allows for a predictable and safe procedure.

• Creates thin LASIK flap safely – The precision of femtosecond laser allows for a safe creation of a thin flap for patients with thin corneas.

• Reduces dry eyes – Studies have shown that the incidence of dry eye is less after LASIK done with a femtosecond laser.

Do’s and Don’ts of selecting a femtosecond LASIK surgeon:

• Do ask for surgeon specific results – As with any surgery, the results are surgeon-dependent. Surgeons using identical technology may get different results. Ask your surgeon to clearly describe their results. Laser vision correction centers with multiple surgeons or with multiple locations may not quote specific results, rather an average of results for their center or for the chain of centers.

• Do look for a busy surgeon who has done at least 1,000 procedures – Studies have shown that a Surgeons learning curve evens out after 1,000 procedures, which translates to increased safety for the patients.

• Do select a surgeon who works with a strong surgical team – Knowledgeable staff insures accurate calibration and monitoring that keeps technology functioning at its peak condition. All lasers are complex and delicate machinery, which require testing, calibration, and technical know-how.

• Don’t compromise on quality – Laser vision correction is surgery, and you never want to compromise the safety of your eyes. It is tempting to think that “laser does all the work” and that one can simply pick the least expensive surgeon who uses a particular technology. Surgery, however, is an art as much as a science and the laser is simply a tool of an artist. The best surgeons often charge higher fees. Chose the best.

Pacific Vision Institute

American Academy of Ophthalmology

American Society of Cataract and Refractive Surgery

Intralase/AMO