The IntraLase technology provides a less invasive, computer-controlled approach to the important first step in LASIK surgery - making the flap.

Before the LASIK surgeon can utilize the Excimer laser to reshape the cornea and correct refractive errors (nearsightedness, farsightedness and/or astigmatism), the upper layer of the corneal tissue has to be opened.

Traditionally, a hand-held mechanical device with a blade called a microkeratome passes across this layer and leaves a hinge - after which the surgeon lifts the flap and begins using the Excimer laser. Without a great flap, you may not get optimal results.

This little-publicized start to LASIK accentuates that laser vision correction is a procedure that requires the skill and precision of the surgeon - whether a traditional microkeratome or the new IntraLase laser is involved.

Previously, I have used the Amadeus microkeratome and achieved excellent results. Although the percentages are not great, some surgeons have experienced problems with lesser-quality flaps while using microkeratomes.

When a blade microkeratome is used, the side cut and dissection must be completed before the surgeon can recognize that there may be problem with flap. For example, if a flap is created and the patient moves, a borderline flap may occur. Also, although the initial suction with a blade microkeratome may be good, suction may diminish as the blade moves across the eye, resulting in a poor flap which in turn produces irregular astigmatism.

One of the top post-LASIK complaints is dry eye following surgery. In a comparison of 300 cases performed with IntraLase and 300 cases performed with a traditional microkeratome, only 15 percent of IntraLase patients reported this condition compared to 55 percent of those who flaps were made with the microkeratome.

An explanation may be that the IntraLase laser allows the surgeon to create a flap more like a postage stamp whereas the microkeratome makes a straight cut that may vary in thickness because of the curvature of the cornea. That is why microkeratome flaps are sometimes thinner in the middle than the edges.

With IntraLase, problems such as tight eyelids or deep-set eyes go away because the surgeon does not need a lid speculum to keep the eye open. IntraLase uses a small suction device that fits on most everyone's eyes. In fact, with IntraLase, we are now able to potentially create an even larger treatment zone which has benefits in reducing night-time glare and halos.

HOW THE FEMTOLASER WORKS

A ray of light that could go around the globe 7.5 times in one second would barely cross the diameter of a hair in about 100 femtoseconds. The femtosecond laser emits 10,000 pulses per second of 1,053-nm infrared light with an extremely small spot size. One of the major advantages of this laser is that it avoids collateral tissue damage.

With the harnessing of this power, the IntraLase FS femtosecond laser's low energy can pass through the outer layer of the cornea unabsorbed, except at the point of its focus. This allows the surgeon to customize the flap by choosing the most appropriate flap diameter, flap thickness and hinge placement.

At the point of the laser's focus, a microplasma occurs, creating an expanding air bubble of gas and water. I will use the IntraLase and thousands of its laser pulses to create a connecting spiral pattern that makes a more precise flap plane.

These "micro pulses" can be lined up in different directions to create the flap, side cut and hinge with computer-controlled accuracy. Incisions can be made at different angles allowing for greater precision.

In other words, the hinge is made last, thus, the flap is essentially developed internally and lifted instead of the harsh blade cut of the microkeratome. Also, with a mechanical microkeratome, fluid is needed on the eye to lubricate and lessen friction that could slow the blade's passage or let it get too hot. Unfortunately, the introduction of fluid during the procedure can produce a complication called edema. The IntraLase FS laser eliminates this problem.

Despite the best efforts of the surgeon, because of the many external variables using the microkeratome, the flap size can naturally alter. With the IntraLase, this potential deviation has been substantially reduced - in microns.

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