Intra-Lasik For Better Flaps

Written by John Taylor

While the complication rate for laser-assisted refractive surgery is incredibly low, there's always room for improvement, and all-laser LASIK is one of the ways laser-assisted refractive surgery is continuing to be refined to provide better results for patients.

In LASIK, the surgeon uses a blade to cut a flap in the cornea before using an excimer laser to resculpt the tissue beneath (called the stroma) to enable better refraction of light, which improves the vision. The flap is important, because it can be repositioned over the stroma, thus allowing for quicker healing and a faster improvement curve in the patient's vision.

All-Laser LASIK, which is also commonly referred to as IntraLASIK, differs from traditional LASIK in that instead of using a tool called a microkeratome, your surgeon will create the corneal flap with a special device called a femtosecond laser. The procedure gets its IntraLASIK moniker from one of the manufacturers of the femtosecond laser, Intralase, and LASIK.

The FDA approved the very first femtosecond laser for LASIK surgery in 2001. Since then, the leading femtosecond manufacturer, Intralase, has continually upgraded the device, and since Introlase was bought out in 2007 by what is now Abbott Medical Optics, the device has been used in Abbott's CustomVue excimer laser platform.

There are a number of reasons why Intra-LASIK may be more desirable than LASIK or other laser-assisted refractive surgeries, but this form of the procedure does have its own cons which may make it inappropriate for some patients. Careful consultation with your eye doctor is essential to choosing the laser-assisted refractive surgery that is right for you.

In general, All-Laser LASIK is better than traditional LASIK at providing patients with improved contrast sensitivity in their vision. Contrast sensitivity is the ability to discern objects from backgrounds that are similarly colored. Other advantages include a more accurate positioning of the corneal flap, which allows for fewer complications with the flap. Because of the greater level of accuracy in All-Laser LASIK, the surgeon can provide a more uniform thickness in the corneal flap, as well, which reduces the chance of complications that may be caused by uneven flaps. Also, patients who undergo All-Laser LASIK can expect a markedly reduced chance of developing a complication known as buttonhole flaps.

A buttonhole flap is a complication that can be created in LASIK if a hole develops in the corneal flap. If this happens during the beginning of LASIK surgery, the procedure is halted and the patient must wait for the hole to heal before the procedure can be attempted again. During this time, the patient must also be monitored for epithelial ingrowth, a very uncomfortable potential side effect of laser-assisted refractive surgery.

All -Laser LASIK is a good option for just about everyone eligible to have laser-assisted refractive surgery involving a flap, but it may actually be required for patients with conditions such as big pupils, poor contrast sensitivity, thin corneas or pre-existing defects of the epithelium.

While there are many benefits to All-Laser LASIK, there are some drawbacks. A small minority of patients who undergo the procedure may experience a brief episode of greater corneal edema. Corneal edema is a swelling of the cornea that often occurs after eye surgery, or can be caused by inflammation or infection.

Another potential side effect of All-Laser LASIK is an uncomfortable level of photosensitivity following the surgery. This can be easily treated with anti-inflammatory eye drops and will usually resolve itself within a few weeks of the surgery. Yet another potential side effect of the procedure is the "rainbow effect" in which the patient will see multi-colors around lights.

While eye surgeons are, in general, offering standardized prices for all laser-refractive surgeries now, some doctors who have yet to jump on the bandwagon will likely charge an additional $300 per eye on top of the $2,000 per eye cost of laser-refractive eye surgery.

As surgeons become more accustomed to All-Laser LASIK surgery, the procedure is becoming more popular. According to the International Society of Refractive Surgery of the American Academy of Ophthalmology, 40 percent of all eye surgeons prefer procedures using a femtosecond laser over the traditional method of LASIK surgery.

American Society of Cataract and Refractive Surgery (ASCRS) found that 34 percent of LASIK surgeons preferred bladeless LASIK, and a separate survey by the International Society of Refractive Surgery of the American Academy of Ophthalmology found that 40 percent of surgeons preferred using a femtosecond laser to a bladed microkeratome for LASIK flaps.

All-Laser LASIK can be a great option for many LASIK patients, especially ones who may have problems with traditional flap surgery. Interested patients should shop around and find a surgeon specializing in the procedure and arrange a consultation to see if the procedure is appropriate for them.