A recent clinical study suggests a new type of laser being tested for LASIK surgery is safe and effective in treating high astigmatism.

The LASIK laser of the future?
LASIK is currently performed using a special type of refractive surgery laser called an excimer laser. Excimer lasers are extremely precise, but they are also costly and expensive to maintain, which is one of the reasons LASIK costs as much as it does.

For this reason, there is interest in developing a new laser for LASIK surgery that is less costly with equal or greater accuracy and effectiveness in treating vision problems. One such laser is a solid-state refractive laser called the Pulzar Z1, developed by CustomVis (Perth, Australia).

The Pulzar solid-state laser uses a slightly different wavelength of light to reshape the cornea, compared to the excimer laser (213 nm vs 193 nm). Because these longer wavelength beams are closer to the peak absorption of corneal collagen, it's possible the solid state laser may be more efficient at ablating corneal tissue than the excimer laser and may be able to created smoother ablations. The ablations performed by the solid-state laser also appear to be less affected by the amount of water in and on the cornea during surgery.

The solid-state instrument does not require toxic gases to operate, it's more energy efficient than an excimer laser, and it requires less maintenance.

Effective and safe in the treatment of high and mixed astigmatism

Excimer lasers are very accurate in treating nearsightedness and farsightedness. But the correction of astigmatism is more challenging, and often requires a follow-up laser treatment.

To test the safety and effectiveness of the Pulzar solid-state laser, CustomVis recently commissioned a small-scale study of the instrument.

LASIK procedures were performed on 10 eyes that had high astigmatism (ranging from -4.00 to -6.50 D). Nine of the eyes had mixed astigmatism and one eye had myopic astigmatism. (In mixed astigmatism, the meridian of the eye with the greatest curvature is nearsighted and the meridian of the eye with the flattest curve is farsighted.)

After a minimum follow-up of 8 weeks after surgery, the uncorrected visual acuity (UCVA) of the eyes were measured, revealing the following results:

• 100% of the eyes were 20/30 or better
• 80% of the eyes were 20/25 or better
• 30% of the eyes were 20/20

"There were no complications, and patient satisfaction was very high," reported CustomVis clinical manager Tarak A. Pujara, M.D.

The Pulzar Z1 solid-state laser is not yet approved by the U.S. Food and Drug Administration (FDA) for use by LASIK surgeons in the U.S., but CustomVis may start the FDA approval process by the end of this year or in early 2008, according to Dr. Pujara.


SOURCE: Solid-state laser can achieve excellent results for high, mixed astigmatism. Ophthalmology Times; Vol 32, No 19, Oct 1, 2007.

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