IntraLase Femtosecond Laser- All Laser LASIK – Bladeless LASIK
In 1999, IntraLase Corp. (Irvine, CA) developed the first femtosecond laser designed to create the corneal flap in LASIK surgery. Though this laser gained FDA approval for use in the United States, the company chose to improve the design prior to commercial release.
In 2001, the company gained FDA approval for a faster, more advanced version of the laser and introduced it to the U.S. eyecare market later that year, marking the advent of all-laser LASIK in the United States.
Since the introduction of the first IntraLase FS laser, a number of names for all-laser LASIK employing IntraLase technology have been popularized. These include IntraLase LASIK, IntraLASIK, the IntraLase Method and, most recently, iLASIK.
Advantages of IntraLase LASIK
The use of a high-tech laser instead of a mechanical bladed instrument to create the corneal flap in LASIK surgery relieves a good deal of anxiety many people have about the procedure.
One recent study found that, when given the choice, 81 percent of LASIK candidates chose IntraLase all-laser LASIK over conventional LASIK with the flap created with a bladed microkeratome.1
And other clinical studies have identified a number of advantages of IntraLase flaps over those created with a bladed microkeratome. These advantages include:
- A higher percentage of patients attaining 20/20 or better visual acuity after IntraLase LASIK.2
- Surgeons are able to create more predictable and precise flaps with the IntraLase laser, compared to a microkeratome.3
- Flaps created with an IntraLase laser adhere better to the underlying cornea than flaps created with a microkeratome.4
The IntraLase LASIK Procedure
Like conventional LASIK, IntraLase LASIK is a two-step procedure:
Step 1: Flap Creation
A thin flap of corneal tissue is created prior to the laser reshaping of the eye. Once it's created, the flap is folded back, and then replaced after the laser treatment.
Anesthetic (numbing) eye drops are applied to the eye to decrease the sensitivity of the cornea and make the process pain-free. The IntraLase femtosecond (FS) laser is attached to the eye with a suction device and then is activated to create a thin flap of corneal tissue.
The flap remains attached to the cornea at one end via a small portion of uncut tissue. The flap is folded back on this "hinge," exposing the underlying cornea for reshaping with a second type of laser (called an excimer laser).
Step 2: Laser Re-Shaping
With the underlying cornea is exposed, the LASIK surgeon positions the excimer laser close to the eye and begins the corneal re-shaping process.
The excimer laser delivers a series of computer-programmed pulses of high-energy ultraviolet (UV) light to the cornea. These energy pulses vaporize (or "ablate") microscopic amounts of corneal tissue to reshape the front of the eye, enabling it to focus light more accurately.
The excimer laser treatment usually takes less than a minute. When it is finished, the surgeon repositions the corneal flap and gently presses it into place over the treatment area. The flap bonds to the underlying cornea relatively quickly, with no need for stitches.
After surgery, you will be given medicated eye drops to use for several days to reduce swelling and decrease the risk of infection.
Who is a Good Candidate for IntraLase LASIK?
Like conventional LASIK, IntraLase LASIK can correct a wide range of nearsightedness, farsightedness and astigmatism. In some cases, because the IntraLase laser can create thinner flaps than a bladed microkeratome, a person whose corneal thickness is “borderline” for conventional LASIK may be an excellent candidate for IntraLase LASIK.
The ideal IntraLase LASIK candidate is over age 21, with healthy eyes and stable vision. Good candidates must also have realistic expectations about their vision after surgery and should fully understand and accept the risks of post-operative complications.
To be certain you are a good candidate for IntraLase LASIK, schedule a pre-operative consultation and eye exam by a qualified eye doctor or refractive surgeon.
Will IntraLase LASIK Eliminate My Need for Reading Glasses?
The need for bifocals or reading glasses is due to a normal age-related vision change called presbyopia. The underlying cause of presbyopia is a loss of flexibility in the lens inside the eye.
IntraLase LASIK cannot treat the underlying cause of presbyopia, but it can reduce the need for bifocals or reading glasses in the same way contact lenses can—through the use of multifocal LASIK or monovision LASIK.
Risks and Complications of IntraLase LASIK
Though there is no government agency or clearinghouse that gathers data on LASIK risks and complications, recent research suggests that less than one percent of LASIK patients experience serious vision problems after surgery.
IntraLase LASIK reduces the risk of several potential complications related to flap creation, and therefore may be safer than conventional LASIK.
Still, no surgery, including IntraLase LASIK, is risk-free. The following complications have been reported after LASIK:
- Dry eye
- Blurred vision
- Fluctuating vision
- Glare or halos around lights
- Overcorrection or undercorrection
- Decreased quality of vision
- Infection
Most LASIK complications are temporary and decrease in severity with time. Permanent visual complications can often be resolved with a second LASIK procedure, called an "enhancement."
How Much Does IntraLase LASIK Cost?
Expect to pay approximately $400 more per eye for IntraLase all-laser LASIK than conventional LASIK that uses a bladed microkeratome to create the corneal flap.
According to industry sources, the average price for all types of LASIK surgery in 2008 was approximately $2,100 per eye.
Conventional LASIK with a corneal flap created with a bladed microkeratome is the least costly LASIK, with an average price of approximately $1,650 per eye in 2008.
Custom LASIK (or wavefront LASIK) with the flap created with an IntraLase laser or other femtosecond lasers is the most costly type of LASIK surgery, with an average price of roughly $2,350 per eye in 2008.
Increase in Popularity of IntraLase All-Laser LASIK
As LASIK surgeons have become more familiar and comfortable with IntraLase femtosecond laser technology and have recognized the advantages all-laser LASIK offers, popularity of IntraLase LASIK has grown rapidly.
By the summer of 2005, approximately three and a half years after the first FDA-approved IntraLase laser was commercially available in the United States, nearly 300 IntraLase FS lasers had been installed in refractive surgery practices worldwide and approximately 18 percent of LASIK procedures in the United States were all-laser, IntraLase procedures, according to the company.
As of October 2008, more than 900 IntraLase FS lasers were in service worldwide and LASIK surgeons had used IntraLase laser technology in more than two million surgical procedures (data on file, Advanced Medical Optics, Inc.)
iLASIK: Integration of IntraLase and VISX Technologies
In May 2005, Advanced Medical Optics, Inc. (AMO) based in Santa Ana, California, acquired VISX, Inc., the largest excimer laser platform for LASIK surgery worldwide. In addition to offering conventional LASIK ablations, the VISX platform also gives surgeons the capability of performing the company's proprietary CustomVue wavefront LASIK procedure.
Soon after its acquisition of VISX, AMO acquired IntraLase Corp (in April 2007), and work soon began on creating a new, integrated all-laser LASIK procedure that combined the VISX excimer laser platform and the IntraLase femtosecond laser.
In January 2008, AMO introduced iLASIK—"the first vision correction procedure to be 100 percent custom-fit from beginning to end," according to the press release issued by the company to launch the product.
The iLASIK procedure is a customized, wavefront LASIK procedure that employs VISX's 3-dimensional WaveScan mapping technology to develop an excimer laser ablation pattern that is 100 percent customized for each patient's eyes.
It also includes VISX's iris registration technology that compensates for any rotation of the patient's eyes when they are in a supine position during surgery (compared to sitting upright when the WaveScan wavefront measurements are taken).
The IntraLase FS femtosecond laser is combined into the iLASIK platform for seamless integration of flap creation and laser reshaping during the LASIK procedure. When Intralase is added to the procedure, it can affect the LASIK eye surgery cost.
SOURCE: 1IntraLase: Coming of age. Cataract Refract Surg Today. 2005:117-120.
2Tanzer DJ, Schallhorn SC, Brown MC, et al. Data on file, IntraLase Corp. 2005.
3Durrie DS. How IntraLase raised the bar in refractive surgery. Cataract Refract Surg Today. 2003:(suppl):1-2.
4Comparison of Flap Adhesion Strength Using the Amadeus Microkeratome and the IntraLase iFS Femtosecond Laser in Rabbits. Journal of Refractive Surgery. Vol 24, No 9, November 2008.
Last updated: February, 2010
