LASIK has it’s roots in a procedure first performed over 50 years ago. A Columbian ophthalmologist described performing a procedure termed “keratomileusis” or corneal reshaping procedure to correct extreme amounts of nearsightedness using a bladed microkeratome and a lathe. Others began performing the procedure and refined it with better instrumentation and techniques to yield better results and improved safety. Eventually the excimer laser was introduced to replace the lathe in the reshaping part of the procedure and the term LASIK (laser assisted in-situ keratomilieusis) was applied to the “new” procedure. With the improved precision brought about by the excimer laser came wider acceptance of the procedure and eventual FDA approval.
As with most things in medicine, continued improvements and refinements have taken place. Two of the bigger refinements were the addition of wavefront technology to improve the final optics of the reshaped cornea and the introduction of a second laser: the femtosecond laser (IntraLase). Today’s LASIK procedure is far advanced from earlier generation procedures. Outcomes are improved with higher levels of 20/20 vision, lower levels of side-effects such as night vision difficulties and a safety profile that surpasses that of contact lens wear.
If you are contemplating LASIK or any other vision correction procedure, you should not presume that you will automatically benefit from all the refinements that have taken place. Upgrading and replacing equipment is an expensive proposition and some doctors and LASIK centers may not be willing to invest in new technology. That puts the responsibility on you, the patient, to investigate and determine if you are comfortable with the technology to be used in your procedure. If you have made the decision that improvements in the LASIK procedure have now made it a viable option for you, it is up to you to determine whether you, in fact, will be receiving this better procedure.
Posts Tagged ‘intralase’
LASIK: A Good Procedure Gets Better
Tuesday, August 2nd, 2011New iFS Laser Minimizes Dry Eye from LASIK
Sunday, July 24th, 2011Most patients appreciate the improved safety afforded by the IntraLase laser in creating the flap during the LASIK procedure. An additional benefit of the latest model of IntraLase laser is the reduction in both severity and duration of dry eyes after LASIK.
Our last blog post discussed the mechanism of dry eye production from LASIK. Dry eye symptoms result from the severing of corneal nerves during the procedure. So how can the iFS minimize dry eye? By limiting the number of severed nerves and promoting quicker healing of the cut nerve fibers.
An Oval LASIK flap with a wider hinge will help to minimize dry eyes from LASIK
Like all lasers used to create corneal flaps, the iFS has the ability to create very thin flaps which helps to limit the number of cut corneal nerves. The IFS, in addition, has a unique surgical planning dashboard and customization features not available on other lasers. Surgeons using the iFS have the capability to create oval shaped flaps with wider hinges that are just large enough to cover the dilated pupil. This insures that an unnnecessarily large number of nerve fibers are not cut thus minimizing dry eye symptoms.
In additon, the iFS has the ability to create an inverse beveled flap edge assuring near-perfect alignment of the flap. Because the two ends of the cut nerve are apposed closely to each other, the nerve has only a short distance to grow before healing back together.
Thinner smaller flaps and wider hinges minimizes the invasiveness of the LASIK procedure which in turn minimizes the severity and duration of dry eye symptoms from LASIK. Dry eyes often last several weeks after a LASIK procedure and are an almost universal side-effect. If you are concerned about dry eyes and wish to limit its severity choose thin-flap LASIK with the iFS laser. And if you live anywhere near Raleigh NC there’s only one place to get this procedure: the Laser Eye Center of Carolina.
New Laser! New Laser!
Thursday, June 9th, 2011
An inverted bevel can only be created by the iFS laser. It is the most secure flap for LASIK.
This is a BIG deal! We’re proud to announce that we are the proud owners of the first iFS femtosecond laser in North Carolina. The iFS laser is a fifth generation IntraLase laser. IntraLase lasers are now commonly used in LASIK eye surgery. The iFS model of IntraLase laser has some unique capabilities applicable to LASIK but also to other types of eye surgery.
IntraLase lasers have revolutionized LASIK eye surgery by replacing an oscillating metal blade with a laser to create the corneal flap: the first step in the LASIK procedure. Use of the IntraLase laser has dramatically reduced the incidence of LASIK complications. Clinical studies performed by the Department of Defense using the IntraLase laser has led to the acceptance of the LASIK procedure by the military for combat troops, pilots and even astronauts. The IntraLase method is now the dominant method for performing refractive surgery by US physicians making up an estimated 61.1 percent of all U.S. LASIK procedures.
The iFS laser is a significant upgrade to its predecessors with more advanced capabilities. It is faster with the ability to cut complex shapes. We will be using the iFS to perform LASIK as well as other eye surgeries including corneal transplants. A unique capability of this laser is the ability to create matching incisions that form ‘lock-tight’ or ‘zipper’ closures. This ultimately leads to a safer procedure and better results.
Of course we’re no strangers to innovation. Our medical director, Dr. Dean Dornic, has been performing LASIK eye surgery and corneal transplants in the Raleigh-Durham NC area since 1998. He has been performing IntraLase all-laser LASIK procedures since 2005 and is acknowledged as the first Raleigh area ophthalmologist to perform IntraLase. Dr. Dornic has adopted newer technology as soon as clinical benefits were demonstrated. In the case of the iFS clinical studies prove that this technology leads to maximum flap stability and a lower incidence of certain side-effects such as dry eye. Patients also demonstrate better outcomes and quicker vision recovery.
Maximizing Safety in LASIK
Sunday, May 1st, 2011 There is no such thing as any medical procedure that is completely risk free. If you are considering vision correction, obviously your number one concern is safety. But how do you make sure you have done everything possible to minimize the risk of LASIK? And why do some patients suffer from complications?
The first thing to understand is that the risks of LASIK are not the same for every patient. Some patients may inherently have a higher risk of certain complications such as infection, flap complications, healing problems, dry eye and night time driving difficulties. It is important that you have a preoperative evaluation by a qualified physician experienced with the LASIK procedure to insure that pre-existing conditions that increase the risk of a LASIK procedure be identified. For some patients, the risks can be minimized with preoperative measures such as initiating Restasis therapy before the procedure. For other patients, the risks associated with the procedure may just be too great. There are several alternative procedures, such as implantable lenses or refractive lens exchange that may be a better fit.
The other thing to know is that not all LASIK surgeons and LASIK technology are equal. Optimizing your chance of success requires choosing an experienced surgeon and choosing the technology associated with the lowest risk. There are two steps to the LASIK procedure and there now exists technology designed to improve the safety of both steps. The IntraLase laser to make the LASIK flap is the safest way to achieve this step. The IntraLase laser decreases the risk associated with flap creation and in addition decreases the risks after flap creation (such as flap displacement and dry eye). CustomVue technology by AMO is the cornea reshaping technology designed to maximize vision quality and decrease the risk of night time glare and halos. When IntraLase is combined with CustomVue, the resulting LASIK procedure is termed “iLASIK”. Potential LASIK patients can therefore minimize the risks associated with a LASIK procedure by 1. Insuring they are evaluated by an experienced surgeon who performs alternative procedures to LASIK and 2. Looking for a surgeon who performs “iLASIK”. Looking for someone in the Raleigh area that meets these requirements? See Dr. Dean Dornic at the Laser Eye Center of Carolina. iLASIK Procedure on YouTube
I’m Afraid to Have LASIK
Saturday, March 5th, 2011One of the most common phrases we hear is “I’d like to have my vision corrected but I’m afraid to have LASIK”. Patients verbalize a fear of having an eye procedure because they are afraid of the risk of vision loss. There is not much worse fate one can imagine than to have to go through life blind or with greatly diminished vision. Some patients may even relate the story of “a friend of an acquaintance” that they ‘heard’ had vision loss from a LASIK procedure but yes, everyone that they know who had LASIK seems to be doing just fine. Just like many urban legends, the details of this alleged vision loss are not really known by the reporter.
Yes, there are cases of patients who have lost vision from LASIK; but those cases are exceedingly rare, and, with advances in technology, becoming rarer. Most patients are surprised to hear that the risk of vision loss is actually greater from contact lens wear than from LASIK. You mean you can lose vision from contact lenses? Yes, and every year patients, some of who were afraid to have LASIK, lose their vision from contact lens associated corneal infections.
So, if you don’t want to wear glasses or find they interfere with your ability to function in your job or leisure activities, making the transition from contact lenses from LASIK really does not increase your risk of vision loss. And, as numerous studies bear out, actually saves you money in the long run.
How then do you maximize your chance and minimize your chance of vision loss from a LASIK procedure? Well, first make sure you actually are a good LASIK candidate. Go to a surgeon who can offer more than just LASIK. If you are not an excellent LASIK candidate,just don’t have it: do something else like implantable contact lenses or advanced surface ablation. If you are a good candidate, make sure you are being offered the best and safest technology. IntraLase LASIK has been shown to be the safest LASIK technology for the great majority of patients so insist on this. The decision to have vision correction is one of the most important decisions you will make in your lifetime so why would you go to someone who offers only LASIK and worse yet, why would you choose someone because they offered the lowest price? Over the years, thousands of Raleigh are patients have chosen Dr. Dean Dornic of the Laser Eye Center of Carolina. His opinion can be trusted because he can offer more than just LASIK. To make an appointment for a free, no obligation consultation just call 1-888-376-EYES and we’ll get you started on the road to visual freedom.
The LASIK Flap
Monday, February 7th, 2011The first step of the LASIK procedure is to create a “flap”. The flap can be created by several different instruments including a microkeratome which is an instrument with a blade to cut a thin sheet of the cornea or a femtosecond laser which creates a flap through photodisruption and tissue separation. The creation of a flap does not contribute to the correction of refractive error. The LASIK flap simply serves as a lid under which the reshaping of the cornea takes place. Although the creation of a flap with a microkeratome (blade) is generally safe and for many years was the only way a LASIK flap was made, if a complication occurred during a LASIK procedure, it almost always was related to this first step of flap creation.
The IntraLase femtosecond laser was introduced as a safer way to create a flap several years ago. It offers unparalleled safety because it offers more precise thickness settings, is more customizable, is unaffected by the shape of the patients cornea, allows the surgeon to visualize flap creation and offers a “second chance feature” In addition the flap parameters can be adjusted to create a “manhole” configuration that causes the flap to fit snug decreasing the risk of flap slippage.
Raleigh LASIK patients may be confused by “cut-rate” LASIK centers offering blade-free or All-Laser Z-LASIK assuming this is the same as IntraLase. While Z-LASIK is indeed blade-free and does offer precise thickness settings like IntraLase, it offers none of the other safety features ie customization, lack of variability related to an individual patients starting cornea shape, the surgeon can not watch the flap being created and there is no second chance feature: basically you have only one chance to get it right.
Another important difference between the two types of flap-making lasers used in the greater Raleigh area is that a Z-LASIK flap is a single plane cut just like that created by a microkeratome blade whereas the IntraLase has a customizable side cut by which the surgeon can create a “lock-top”. This means the IntraLase flap is more secure against displacement from eye rubbing, squinting and squeezing during the first several hours after the procedure. The flap is also more secure from trauma in the months and years after the LASIK procedure.
So don’t be fooled into thinking all LASIK procedures are the same or that all Blade-Free LASIK procedures are the same. Many patients seek out our services over cheaper providers because they took the time to study the difference in technology and value their safety over a couple hundred dollars in savings.
The Intralase flap fits more securely.
The Evolution of LASIK
Sunday, January 23rd, 2011Like many medical procedures, LASIK eye surgery has evolved and improved with time. Many patients are surprised to find out just how long LASIK has been around.
In 1949 a Columbian ophthalmologist by the name Barraquer performed a corneal procedure to correct refractive error termed automated lamellar keratoplasty (ALK). ALK involved the use of a microkeratome to create a flap and remove a disc of corneal tissue in order to decrease nearsightedness.
With the introduction of the excimer laser to the ALK procedure the name of the procedure was changed to LASIK. The excimer laser made the procedure more precise and resulted in more widespread acceptance but this was, by no means, the only important advance in vision correction technology. Over the years, a number of innovations such as eyetrackers, iris registration, wavefront technology and introduction of the IntraLase laser have improved safety and outcomes.
Today, the safety of LASIK exceeds that of contact lens wear and the risk of such side-effects as night halos is reduced to such a low level that most patients will actually experience an improvement in night vision.
Of course, patients should be aware that there are different technologies available all with different safety profiles and success rates. Some of the more important innovations: IntraLase and CustomVue are associated with increased costs but if you’ve been holding off on LASIK waiting for the procedure to get better, the increased costs may well be worth it.
Are You Guilty of LASIK Stereotyping?
Monday, January 3rd, 2011LASIK refers to a group of diverse procedures that involves reshaping the cornea under a flap. Over the years, LASIK has evolved with the introduction of many advances in instrumentation and techniques that have made vision correction safer and more successful. Now we can offer conventional LASIK but also Z-LASIK, CustomVue wavefront-guided LASIK , and IntraLase LASIK. All too often, however, I hear patients and even investigative or consumer reporters attempt to generalize, inappropriately, on the merits and/or risks of the LASIK procedure. I will hear statistics quoted on side-effects, for instance, that may be from studies performed years ago using old, and now outdated, technology.
Two of the more important factors that effect risk of a LASIK procedure are the exact technologies involved in performing the procedure and the particular characteristics of the patient themselves. For instance, the risk of a patient with high myopia and astigmatism needing an enhancement (or “touch-up”) procedure might be double that of a patient with low myopia and no astigmatism. The risk of a flap complication is 6 times lower with IntraLase versus Z-LASIK. The risk of night time vision problems is up to 20 times lower with CustomVue technology compared to other technologies. The statistical spread is so wide, that discussions about the ‘risk of LASIK’ can be virtually meaningless without knowledge of the patient and the exact technique utilized.
Patients can be severely misled about the side-effect profile of LASIK if they rely on old data or make the mistake in assuming that all LASIK procedures are equivalent. Raleigh area patients should be aware that in our area there are several different providers offering different LASIK technologies. Patients can minimize their risk by insuring that they use the safest available technology (iLASIK) and, when individual risk rises to an unacceptable level, choosing an alternative vision correction procedure such as implantable contacts or PRK that may yield a higher chance of success.
What Matters is Results
Tuesday, December 7th, 2010The prospective LASIK patient may be confused about what to ask about before choosing a Refractive surgeon. Most commonly, they make the assumption that LASIK is LASIK, that all technology and providers are more or less equivalent . They then set about choosing their LASIK provider by calling various offices asking about price.
Often the unwary patient may be swayed by claims such as “newest” “most advanced” or “most precise” LASIK technology. But such claims should be taken only for what they are: subjective opinion with little true meaning.
Over the years, LASIK technology has changed and evolved and several large medical corporations manufacture the various lasers and other equipment. Each of these corporations have found their niche. Some appeal to the LASIK surgeon because of their improved safety, higher success rate, ease of use or reduced cost. Obviously if there was a laser manufacturer that offered LASIK equipment that was the lowest price to purchase and operate and also offered the best result and safety profile, that manufacturer would soon dominate the industry and every LASIK surgeon would gravitate toward that manufacturer.
In the Raleigh market area, there are two main competing LASIK technologies: IntraLase LASIK and Z-LASIK. There also exists a few older and still effective technologies. The main advantage of the Z-LASIK technology is cost and ease of use. The advantage of IntraLase LASIK is superior safety and outcomes.
So there you have it. If you are looking for the cheapest LASIK, Z-LASIK is a possible choice. If you are mainly concerned with safety and want to maximize your chance of achieving 20/20 vision with excellent night vision you will choose IntraLase or iLASIK. Raleigh area patients looking for true value choose iLASIK and when looking for a provider with the longest history of using IntraLase technology, they choose Dr. Dean Dornic of the Laser Eye Center of Carolina.
Does the Type of “Blade-Free” LASIK Really Matter?
Sunday, August 8th, 2010In the United States there are two main manufacurers of lasers to create LASIK flaps. Consumers may recognize the terms “iLASIK” and “Z-LASIK” as descriptors of a blade-free LASIK procedure and wonder what the difference is. Both lasers boast improvements in flap thickness precision but only the IntraLase has certain safety features that prevent certain flap complications.
Some of the safety features that the i-LASIK procedure has that the Z-LASIK procedure does not have include:
1. True customization of flap parameters
2. Ability to adjust the diameter and centration of the flap on a presurgical treatment planning screen before the flap is made.
3. Ability to create a “manhole” configuration to the flap to enable a snugger fit and less likelihood of flap displacement.
4. Visualization of the flap as it is being created to allow for surgeon intervention.
5. Ability to resume or restart the procedure if there is an interruption for any reason.
The manufacturers of the laser that is used in the Z-LASIK procedure tout their laser as the “most advanced” laser: presumably a reference to the fact that it is more portable. Of course, the patient doesn’t really care that the laser is easily moved from room to room, they are more interested in safety. The iLASIK procedure, for the reasons stated above, is the LASIK procedure most likely to result in a complication free procedure and achieve an excellent level of vision.
LASIK consumers are advised to do their homework before choosing a particular technology and understand what is really behind the “catch phrases” used in advertising. For the safest LASIK procedure, iLASIK is indisputably superior. For LASIK patients in the Raleigh area, the Laser Eye Center of Carolina should be your destination for genuine iLASIK.