I am going to be getting the Intralase with wave-guided Lasik with the Visx Star4 laser. The astigmatism is at a cylinder 3.75 and 2.75 in the other my SPH numbers are moderate at 3.25 and 3.50. My glasses prescription has been stable for about 6 years. Should I be concerned that the surgeon will be able to correct the astigmatism?
Correcting Astigmatism with Intralase with Lasik?
Doctor Answers (5)
The Visx Laser and is FDA approved for up to 5 diopters of astigmatism
The amount of astigmatism that you have currently should not be an issue with the VISX laser as it is now FDA approved for up to 5 diopters of astigmatism. Your surgeon will mark your eye carefully and you should be able to have a good refractive result. With either the intralase laser or PRK the shape of your cornea should not cause an issue.
Most likely they will be doing wavefront measurements and any higher order aberrations will also be fixed during your corrective procedure.
Lasik is great for astigmatism
Years ago, astigmatism was difficult to treat using any excimer laser. Now, however, with the advent of bladeless flap creation(Intralase) and wavefront software for the lasers, the treatment of astigmatism is routine and accurate. Many many patients feel their astigmatism is the worst on the planet and could not possibly be treatable. This could not be further from the truth. Astigmatism treatment has become a very fun part of what I do everyday! So get a good laser workup by a very reliable provider, then get yourself excited for a great result!
Intralase has no effect on amount of astigmatism treated
The laser you describe should be able to treat both the astigmatism and the spherical portion of your prescription, and using the Intralase to make the flap should not have any effect of the potential results of your treatment. As another doctor mentions we have found for high astigmatism corrections that the Wavelight laser, now marketed by Alcon, does a superb job in correcting higher amount of astigmatism up to 6 diopters. With your treatment I would expect the VISX should perform well. Sometimes in high astigmatism cases, especially with large optical zones there can be laser "spillover" beyond the area of the flap bed but this does not usually have any significant consequences.
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The latest version of the Visx is FDA approved to treat up to 5 diopters of astigmatism, so you are well within the bounds. I've treated up to 8 diopters with other lasers, with generally very good results. This is considered "off-label"--the lasers were never tested in the FDA studies for this, but if in the opinion of your treating doctor it would work and be beneficial, it can be done.
High levels of astigmatism correction with ANY laser are associated with a higher than normal risk of needing retreatment (an "enhancement"), and MAY be associated with a higher than normal risk of night glare and halos.
It is good to hear you are choosing to have your flap created with the Intralase laser. Highly astigmatic corneas such as yours have a higher risk of flap creation complications when a mechanical blade-based microkeratome is used.
Treating Astigmatism with LASIK
The VISX S4 laser for LASIK can easily treat 3.75 d of astigmatism, though I find the Wavelight laser does a better job with astigmatic treatments.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.