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.
CLICK HERE to schedule your FREE CONSULTATION