Vision correction surgery involves techniques that correct or reduce nearsightedness, farsightedness, astigmatism and presbyopia by reshaping the surface of the cornea. To correct nearsightedness, the curvature of the cornea is flattened; to correct farsightedness and presbyopia, the curvature is increased. LASIK & Advanced Surface Ablation (PRK) are the most common vision correction surgery techniques used today.

Laser Vision Correction Surgery

There are many lasers used in eye care today, but only one particular laser, the excimer laser, is used for vision correction surgery. Unlike other lasers that produce heat and tend to damage surrounding tissue, the excimer laser mixes gases together to produce a cool, non-thermal beam of light. Guided by a sophisticated computer, this cool laser beam can reshape the curvature of the cornea by removing molecules of tissue without damaging or affecting surrounding tissue. The excimer laser is so precise that each pulse can remove 39 millionths of an inch of tissue in 12 billionths of a second. It would take 200 excimer laser pulses to cut through a human strand of hair.

There are two primary procedures currently used for laser vision correction:

Custom LASIK & PRK (also known as Advanced Surface Ablation)

Custom LASIK (Laser Assisted Insitu Keratomileusis) can be used to treat low to high levels of nearsightedness and astigmatism and low to moderate levels of farsightedness. LASIK combines the precision of the excimer laser with a proven
procedure that has been performed manually for over 30 years.

LASIK treats the inner tissue of the cornea. Using an instrument called a microkeratome, a small cap is partially lifted from the very top surface of the cornea and hinged to the side, leaving the inner portion of the cornea exposed.

For nearsightedness and astigmatism, the central portion of the exposed cornea is reshaped with the excimer laser, and for farsightedness, the peripheral portion of the exposed cornea is reshaped with the laser. The cap is then placed back in the original position and due to the cornea's extraordinary natural bonding qualities, the cap remains in position without stitches or sutures.

Until recently, doctors treated patients based on their optical prescription despite the fact that their eyes each have a unique set of naturally occurring optical imperfections. This is known as conventional LASIK.

Today, with the advent of wavefront diagnostic technology, wavefront-guided excimer lasers can now treat patients according to the uniqueness of their entire optical system, not just their prescription.

Wavefront technology compares distorted waves of light exiting the eye to flat waves of light that would have returned in a perfect optical system. This information is converted to a 3D map that then serves a guide for the excimer laser while reshaping the cornea.

Results have shown that Custom LASIK can reduce some of the unwanted visual effects associated with conventional LASIK, especially those associated with night vision such as glare and possibly even help with halos. Custom LASIK has the potential to improve the quality of vision and possibly help patients see even better than they could with glasses or contact lenses.

Intralase

There are two important steps to LASIK eye surgery. In step one, the doctor creates a micro-thin flap of tissue on the outer layer of your eye, also known as the cornea. The flap is important for rapid healing and greater comfort after surgery. If it is too thick, too thin, or irregular, it could affect the quality of your vision. Although complications with LASIK surgery are rare, they are usually treatable.

In step two, the doctor folds open the flap so that an excimer laser can be used on the inner cornea to correct your vision. Your flap is then returned to its original position where it seals without stitches.

In a traditional Custom LASIK procedure, the flap is usually created with a
handheld mechanical microkeratome which uses an oscillating surgical blade. The IntraLase laser is a newer technology for a truly all-laser, blade-free LASIK procedure, replacing the hand-held microkeratome. The IntraLase is a computer-guided ultrafast laser that is used to cut the flap in the first step of the LASIK procedure.

Once the flap is created, the surgeon folds back the flap and, in the second step of the procedure, applies the excimer laser correction treatment to the inner portion of the cornea to reshape the cornea. After the laser treatment, the flap is repositioned and self seals without stitches. The procedure is now complete.

Traditional microkeratomes are safe and provide good results in LASIK eye surgery. However, studies show that the INTRALASE laser provides a more accurate and safer first step in flap creation technology. INTRALASE can reduce many of the complications seen with the microkeratome by improving safety, predictability and dependability by creating a flap of precise size, shape and depth.

IntraLase Frequently Asked Questions (FAQs)

A lot of patients have LASIK eye surgery for the same reasons. They want to be able to do as many things as possible without their glasses or contacts. Most people who have already had LASIK had many of the same questions you do.


Q:  Why IntraLase?

A: LASIK (Laser Assisted In-Situ Keratomileusis) has proven to be a very successful procedure, freeing millions of the daily dependence on glasses and contact lenses. Yet, while LASIK complications are rare, all surgery carries some degree of risk. Now, advances in laser technology have made it possible to significantly reduce the majority of LASIK complications. This advancement is known as IntraLase.
IntraLase is the first blade-free laser technology for performing the critical first step in the LASIK procedure: creating the corneal flap. Prior to IntraLase, this first step was done manually using a hand-held device with an oscillating metal razor blade, called a microkeratome.
IntraLase virtually eliminates the severe sight threatening complications seen with the microkeratome, improving safety and precision while providing predictably better visual results for the patient. IntraLase is the most sophisticated and accurate technology for corneal flap creation available today and has given many patients greater confidence and assurance in choosing laser vision correction.


Q: How does IntraLase change the LASIK procedure?

A: LASIK is actually a two-step process. In the first step, the surgeon creates a flap of corneal tissue and folds it back to prepare the eye for the second step, where an excimer laser is used on the inner cornea to correct vision. This two-step process allows for rapid visual recovery with little or no patient discomfort.
Traditionally, the corneal flap was created with a hand-held microkeratome blade. While this method has worked well over the years, the performance of these devices can be unpredictable and is frequently the source of a majority of LASIK complications.
With IntraLase, the surgeon uses the precision of a computer-guided laser to create the corneal flap. IntraLase delivers micron-level accuracy 100 percent greater than that of a microkeratome, giving the surgeon more control during the procedure and the ability to establish precise dimensions and thickness of the corneal flap, factors which are critical to a successful LASIK outcome.  
This level of precision is unparalleled by any other technology in vision correction surgery. IntraLase allows surgeons to tailor the corneal flap for each individual patient, and each individual eye. Because of its consistent accuracy, IntraLase may make LASIK a viable option even for patients who previously didn’t qualify, such as those with thin corneas.

Q: Is IntraLase safer?

A: Yes. IntraLase improves the safety, precision and visual results of LASIK, whether you choose to have a standard or custom procedure.
This is a result of the superior precision provided by the computer-guided IntraLase laser, as compared to that of a hand-held microkeratome, which houses a metal blade that cuts across the cornea to create the flap. In comparison, IntraLase uses the precision of a beam of light to create a laser flap without traveling across the cornea, virtually eliminating severe sight-threatening complications as a result.
Its precision is the source of its safety. Accuracy of flap thickness has been demonstrated at +/- 10 microns.* Precise flap thickness is critical to a successful LASIK outcome, and IntraLase flaps feature a consistent thickness from edge to edge. This degree of accuracy is unprecedented in flap creation technology to date.
Flap stability is also an important factor, as the consequences of flap slippage can be quite problematic. IntraLase flaps provide added assurance and peace of mind for many patients.

Q: Is traditional LASIK unsafe?

A: No, but IntraLase reduces the risk of complications reported with the microkeratome and has given many patients more confidence in choosing laser vision correction.

Q: Is this the same as the customized procedure I have heard so much about?

A: No. Custom LASIK generally refers to an individualized visual diagnosis using technology called “wavefront,” which allows for customized treatment with the excimer laser. There has never been a combination of technologies that have allowed for this type of personalized vision correction. The most exciting part is that while the patient has the opportunity for an optimized visual result, it can be done with unprecedented safety and precision.
Every patient’s eyes are different and therefore need to be evaluated independently and treated uniquely. Now all steps of the laser vision correction procedure may be personalized to the individual: custom diagnosis with wavefront, personalized flap creation with IntraLase, and custom laser vision correction with custom ablation.

Q: How do the visual outcomes using IntraLase compare with those of traditional LASIK with a microkeratome?

A: Clinical studies confirm that patients see better following IntraLase-initiated LASIK than with the hand-held microkeratome blade.
More patients achieve 20/20 or better vision with IntraLase-initiated LASIK.
Patients stating a preference preferred the post-operative vision of their IntraLase-treated eye 3 to 1 over their blade-treated eye.
IntraLase creates fewer high and low order aberrations, frequently associated with glare and halos at night.
IntraLase patients have a reduced incidence of post-operative dry eye symptoms.
IntraLase patients required fewer enhancement procedures following LASIK.
The precision of the IntraLase flap significantly reduces the incidence of post-operative induced astigmatism as compared with a microkeratome-created flap.


Q: I have seen several advertisements for “All-Laser LASIK.” Is this IntraLase?

A: Maybe. Contrary to popular belief, LASIK is not an “all-laser” procedure, due to the use of the microkeratome blade. Only LASIK procedures that use IntraLase can be considered “all-laser.”
Your doctor can explain the difference between other procedures that may be advertised as “all laser,” such as LASEK, PRK or epi-LASIK – all of which are surface ablation procedures. Because they are performed without creating a corneal flap, these procedures generally require longer healing time and frequently involve more discomfort and a delay in visual recovery.

Q: Is IntraLase more expensive?

A: Yes. Most patients agree that the added level of safety, assurance and predictably better vision offered by IntraLase is worth the incremental cost. IntraLase surgeons are leaders in the field of ophthalmology who continually evaluate advances in technology. They’ve determined that the IntraLase is the most sophisticated and accurate system available today for flap creation and have invested in the technology to sustain their leadership in patient care.

Click for more information on Intralase

Custom PRK (Advanced Surface Ablation)

The technique of Advanced Surface Ablation or PRK, involves removing the surface "skin" of the eye in order to expose the sturdy tissue underneath which gives the eye its shape.  This is a painless procedure done using a local anesthetic eye drop. This is different from LASIK in which a flap is created in the cornea to expose the tissue underneath. The laser is then used to shape the underlying cornea in a procedure that usually takes one minute or less.   After the PRK procedure is completed, a protective contact lens is placed on the eye which allows the surface of the eye to re-heal over a period of several days, and prevents most of the discomfort that might be associated with the recovery period.
Following PRK, vision gradually improves over the first week. Once the protective contact lens is removed several days after surgery, vision continues to improve and may be at its best level within approximately two weeks to one month after the surgery.  Eye drops are used on a frequent basis during the first 4-5 days to lubricate the eye, prevent infection and decrease any inflammation resulting from the surgery.  Eye drops are decreased rapidly over the upcoming weeks, though in some cases patients may use eye drops for several months after surgery.