My friend just underwent lasic eye surgery but using a new technique called Intralase. She told me that intralase was better than lasik. She really couldn't explain why other than saying that intralase makes thinner cuts into the cornea. I imagine thinner the better, but can someone help explain why this is better than lasik?
IntraLase Lasik Vs Traditional Lasik
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We have both the microkeratome and Intralase at our office. Before we began using the Intralase laser, we had a higher rate of complication with the corneal flaps. I now have control over how thick a specific patients flap should be instead of one-size-fits-all with the microkeratome. The other reason I love the Intralase is that when the flap is placed back on the cornea, it fits in like a man-hole cover as opposed to just resting back in place. There is a greater likelihood that the flap will move around after the microkeratome is used when compared to the Intralase. At our practice, we charge the same for both technologies, making the decision easy for our patients. Go with the better technology. -Dr. Clinch
Intralase vs mechanical flaps
About 8-10 years ago, when all a surgeon had was a mechanical method of creating corneal flaps, the discussion with the patient of this part of the surgical process universally gave the patient the creeps. Over the past 8 years, with the advent of a laser device(Intralase) to create the corneal flap, all of those gitters have gone away. Not only is the Intralase safer, the corneal flaps are better, they heal better and there are far far fewer scenarios where "unexpected" things could happen.
All laser lasik, using the Intralase laser, has, essentially become the standard of care for LASIK surgery. I have not used a mechanical device in 7 years and, frankly, I would have to search deep in one of my office closets for the device! There are still some surgeons who use a mechanical keratome, though I am not sure why. Perhaps, they are just comfortable with it. Hopefully, they are not trying to save some pennys by using it. Remember to ask these questions!
Is Intralase better?
Let me begin by saying I've been using blade-based mechanical microkeratomes for 16 years (began with ALK, the precursor of LASIK), and the Intralase for over 5 years. I've done tens of thousands of cases using each.
For some patients, the Intralase is hands-down much better (safer). This would include patients with very steeply curved corneas (blades tend to cut thin flaps here), very flat corneas (blades tend to cut thicker, smaller diameter flaps with a risk of a free cap), and thin corneas (Intralase is more precise and better able to accurately deliver a thin flap). I also prefer Intralase for very nervous patients, as well as patients with severe dry eye, or at particular risk for dry eye. In my experience, Intralase seems to have a lower incidence of dry eye postop than the keratome blade does.
For many patients with normal corneal curvature and thickness, the difference in safety between the blade and the Intralase is nominal. Both work well, though there may be a slight safety advantage with the Intralase. I quote patients a risk of flap complication of 1 in 1,000 with a blade, and 1 in 10,000 with Intralase.
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Intralase is more precise
Intralase Custom LASIK, known as iLASIK, is the newest most advance procedure. It combines the all laser method using the Intralase laser with the personalized CustomVue LASIK tailored to treat the unique characteristics of your eyes. iLASIK was approved in September of 2007 to treat the eyes of astronauts and about one year ago, to treat the military. It is now safer and more precise than ever before.
AS one of the first centers to use the Intralase and provide some of the early data there is not question that it is a safer, more precise, more accurate way to do Lasik. Simply it uses a Femto Second Laser to create the flap vs. a blade in traditional Lasik. Almost all studies have shown increased safety, less dry eye, more accurate flap thickness with less variability, and less enhancements.
Intralase is better for most patients
We were the third site in the United States to introduce Intralase, and completed 900 of the first 1000 Intralase cases ever performed, so there is some bias perhaps in my answer. If you look at the statistics, there is an increasing percentage of eyes that are treated with the Intralase as compared to the microkeratome, which is now over 50%.
There are many benefits to Intralase, which I believe is clearlly safer than the microkeratome, and this is coming from someone who had previously performed tens of thousands of microkeratome cases. It is the achilles heal of LASIK surgery in that most complications of the procedure are microkeratome related.
As to effectiveness, it is probably slightly better than microkeratome but the differences are less substantial than the safety aspect.
There are even newer femtosecond lasers available and we are one of the few sites, but there are others, using the new Zeiss VisuMax laser which is even better than the Intralase in my opinion. It is more accurate, uses a lower suction pressure, and cuts a more precise flap in our experience.
You should not have to pay much more for a femtosecond (this is the technology behind the Intralase and other laser cutting lasers) than for the blade, and the small extra cost is definitely worth it. We only do all laser lasik, and like other centers to not add a premium charge for this better technology which all of our patients deserve.
Rarely, there is a case such as a corneal scar where we do need to use the microkeratome, but only about once a year.
The IntraLase Difference
IntraLase is a laser that is used specifically to create the corneal flap in the first part of LASIK, or other corneal procedures. In traditional LASIK, a handheld oscillating blade is used in the first step to create the corneal flap.
In general IntraLase is:
- More precise
- Creates a smoother LASIK corneal bed, thus better vision
- Virtually eliminates flap complications (99% of LASIK complications, which are rare, are flap complications)
- Reduces incidence and severity of dry eyes after LASIK
- Quicker recovery
- Most importantly when compared head to head to handheld blades, it yields better vision
IntraLase uses a computer guided laser, which greatly reduces the uncertainty and risks associated with the oscillating blade and and makes LASIK a truly precise all laser procedure. Since most LASIK complications may be traced back to the flap, it is believed that flap creation is one of the most important steps, and requires the high technology solution of the IntraLase method.
A corneal flap created with IntraLase is customized as to shape, diameter, thickness, depending on each eye's unique curvature, corneal thickness, diameter and shape.
When a LASIK flap is created with IntraLase, the resulting surface of the underlying stroma is much smoother when compared to the surface after the mechanical blade.
Intralase (Intra-LASIK) vs. Traditional/Conventional LASIK
Intralasik utilizes a femtosecond laser instead of a metal blade to form the LASIK flap. The laser is the more technologically advanced approach, but what does that mean for you, as the patient?
Basically, it means that using the Intralase is safer for you and your eyes because it gives the surgeon more control.
With both tools the ophthalmologist is the one programming the laser for your flap based on your eyes meaning the flap is customized based on the surface of your cornea. Each person's cornea is different similar to a fingerprint and the Intralase creates a custom flap. Additionally, with the Intralase the ophthalmologist can watch as the laser creates the flap and can interfere if needed. The traditional or conventional approach to laser eye surgery with the blade doesn't allow this feature. Once the keratome (device with the blade) is programmed and started, there is nothing the ophthalmologist can do to stop it. He/she cannot see what the blade is doing after he/she programs it and will only know if something is wrong after the flap is made.
90% of LASIK complications are flap related, so giving the ophthalmologist more control and more visibility dramatically reduces the likelihood of these complications.
I performed the first IntraLASIK procedure on the East Coast in early 2002. This is the laser that creates the LASIK flap rather than a mechanical device called a "keratome". I have exclusively used the Intralase technique - All Laser LASIK for 10 years because it is safer, more accurate, and provides better visual outcomes.
Microkeratome vs Intralase
The objective in LASIK is to make a flap. Traditionally, this was performed with a microkeratome which uses a specially designed blade to make a smooth cut. The problem with the microkeratome is that it takes a great deal of skill. As more surgeons have started performing LASIK, they have gone to using a laser to make the flap. The Intralase and other "femtosecond lasers" work by making thousands of tiny explosions. The risk of significant complications is probably smaller with the Intralase, but the rate of smaller complications is much higher. In my mind, the two balance each other out. It matters little which way your surgeon wants to make the flap. the big difference is in the laser used for the treatment. I believe that results are much better with a Customized Treatment rather than a standard treatment.
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.
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