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Medical Forum / General / Vision / April 2005

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Opinions about IntraLase

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Pauli Soininen - 16 Apr 2005 12:49 GMT
What is this and does it revolutionize LASIK? Opinions?

http://biz.yahoo.com/bw/050415/155080.html?.v=1

http://www.intralase.com/patient/faq/index.php
Dr. Leukoma - 16 Apr 2005 13:32 GMT
The Intralase uses a femtosecond pulsed YAG laser to cleave the corneal
stroma at a predetermined depth.  It does this by creating tiny
contiguous bursts of energy in a plane.  The claims are for greater
accuracy and precision in flap thickness resulting in improved safety.

Ophthalmic conferences are often used by the manufacturers to showcase
new technology, be it new lasers or new contact lenses.  Although the
studies purport improved visual results over standard
microkeratome-created flaps, I would want to know how many of those
referenced studies were sponsored by the manufacturer, and how many of
the authors were paid consultants.  I have heard that visual recovery
following Intralase-created flaps takes longer, presumably because of
the effects of the gaseous by-products created in the process.

We will probably hear a volley from the microkeratome manufacturers.

DrG
RM - 17 Apr 2005 03:05 GMT
I work part-time in a practice that does refractive surgery.  Both intralase
and the traditional ablations.

Although I don't know of any studies, my opinion is that many of the
difficulties patients have with LASIK are due to imperfect mechanical
microkeratome cuts-- button holes, off center ablations, etc.  I believe,
based solely upon my personal experience, that intralase is a definite
incremental improvement in the LASIK procedure.  If I were going to get
LASIK, I would prefer it.
Pauli Soininen - 17 Apr 2005 10:44 GMT
> my opinion is that many of the difficulties patients have
> with LASIK are due to imperfect mechanical
> microkeratome cuts-- button holes, off center ablations, etc.

As I'm interested in the very details about all that is related to the
subject; what do you mean by button holes? And why do you think the flap has
something to do with off center ablations (actually I don't know if the
centration is measured from the flap cut but I would imagine it's not)? The
flap cut radius is about 1mm or so bigger than the treated area (at least in
my case).
Dr. Leukoma - 17 Apr 2005 13:18 GMT
You're probably right about some of the advantages...although one of my
current cases is a decentered Intralasik.

DrG
Pauli Soininen - 17 Apr 2005 15:13 GMT
> You're probably right about some of the advantages...although one of
> my current cases is a decentered Intralasik.

Does a patient with decentered LASIK have often (or always) a starburst/halo
pattern that is correspondingly "decentered" as in not equally around a
bright object? Or does decentration symptoms have anything to do with the
shape of starburst/halo?
Dr. Leukoma - 17 Apr 2005 15:23 GMT
Yes.  The tail of the comet is typically opposite to the direction of
decentration.  This may not always be the case, since other aberrations
may be superimposed.

DrG
Pauli Soininen - 17 Apr 2005 15:55 GMT
> Yes.  The tail of the comet is typically opposite to the direction of
> decentration.  This may not always be the case, since other
> aberrations may be superimposed.

Thank you. And when the decentration is fixed by making another, corrective
ablation, what kind of improvement in sight can be expected? I would imagine
there would not necessarily be other improvement than reshaping/reducing the
halo (and thus maybe slightly improving acuity) unless a larger optical zone
of full refractive correction is made.

Is the flap openable in the same way months after surgery with both
IntraLase and non-IntraLase cases?
Dr. Leukoma - 17 Apr 2005 22:39 GMT
> > Yes.  The tail of the comet is typically opposite to the direction of
> > decentration.  This may not always be the case, since other
[quoted text clipped - 8 lines]
> Is the flap openable in the same way months after surgery with both
> IntraLase and non-IntraLase cases?

Most surgeons refer to Intralase flaps as velcro flaps.  They probably
are not as easy to lift as microkeratome flaps months after surgery.

Don't assume that any decentration can be fixed with another surgery.
It's not so easy and not so predictable.

DrG
 
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