I recently had a consultation with experienced Lasik surgeon in Manhattan. When I inquired as to whether he uses wavefront with his VISX S4 IR, he explained that he used it at one point but no longer typically uses it -He said that with wavefront, the computer does much of the programming and he felt gave him less input and control (he seems very detail oriented/ meticulous about his lasers). He also mentioned that he felt it was an unnecessary additional cost that he had to pass on the patient.
Does it Seem Strange or Reasonable for a Doctor to Not Use WaveFront in his Office?
Doctor Answers 5
Customized Wavefront Lasik
There are only two reasons I can come up with for a surgeon not using the latest technology(Custom Wavefront Lasik). Either he is inexperienced(bad) or he is trying to cut corners on cost(worse). I would seek another opinion rather than pursue surgery with this surgeon.
Wavefront vs Conventional
It seems unreasonable that a LASIK surgeon would never use wavefront LASIK in his/her treatments. I use wavefront LASIK on the majority of my patients. Wavefront LASIK is one tool that has been very beneficial in treating many patients and clinical studies have shown it to be more effective on average than conventional LASIK. I would say that it would be foolish not to take advantage of the advances in LASIK treatment that came with the improved wavefront ablation profiles in most of your patients. At the same time, there are certainly cases where a conventional treatment (without wavefront) can provide better results. It is most important that surgeons consider each patient as a unique individual and weigh all the possible treatment options (as well as the option to not treat a patient). Some patients should receive wavefront treatment. Some should not. LASIK surgeons who treat all patients with the same method are limiting their patients from receiving the best possible individual treatment.
Wavefront LASIK is a very useful tool and when it was introduced several years ago (approx 7 or 8), it significantly improved outcomes, especially relating to night vision and post operative aberrations. Since that time, several companies have tried to improve on this technique. One company in particular, Alcon/Allegretto, has maintained over the years that their approach to vision correction, one that does not use the wavefront guided approach, is a better way to go. It is quite controversial actually amongst us LASIK surgeons, which way provides better outcomes. It is true that Allegretto may be less expensive and easier to use for the surgeon, but that is never (and should never be) a consideration in something as serious as vision correction. We aren't selling a product here, we are permanently changing patient's lives, hopefully with the most advanced and perfected technique possible. In our center, I am proud to say we have both Lasers and are thus able to tailor the best possible surgery for each patient in particular. I feel that some patients do better with Wavefront VISx S4 and some do better on the Wavelight Allegretto. It is a major benefit for us to be able to measure wavefront aberrations and decide which will benefit the patient best, without worrying about cost or other non-medical issues. Look for a surgeon that has both and uses both, it makes the most sense-- that surgeon won't be burdened by company tie-ins and loyalty programs to one or the other.
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Wave-front-guided procedures take more time, effort and cost more than conventional LASIK procedures. In general the outcomes are slightly better with wavefront- guided procedures but not all patients will experience or notice the benefit. Some doctors do not believe the benefits justify the extra effort and cost. Consider consulting with someone who offers wavefront, ask them if they think there would be a significant benefit in your case, then decide how to proceed.
Wavefront Custom LASIK
The answer depends on what brand laser the surgeon uses. If they are using the VISX laser (the most popular), than I would say yes you should use the wavefront data and perform a custom wavefront based treatment. There are several ways for surgeons to fine tune the wavefront to further customize the treatment for the patient. Most importantly, using a custom treatment over a standard treatment affords a larger treatment zone, especially for astigmatism and far sightedness. This is very important in obtaining best outcomes. IR (iris registration) definitely helps in patients who have astigmatism as well and is only available with waverfront/custom treatments.