In an article published in the November 2007 issue of Refractive Eyecare, prominent Canadian refractive surgeon Raymond Stein, M.D. explains why he has used an IntraLase femtosecond (FS) laser to create the corneal flap in over 99% of his LASIK surgeries since January 2006.

Dr. Stein was one of the first surgeons to perform laser vision correction surgery in North America and is currently the medical director of the Bochner Eye Institute in Toronto and chief of ophthalmology at Scarborough General Hospital in Toronto.

Reasons for preferring femtosecond laser over microkeratome

Among the reasons Dr. Stein gives for his decision to change from a mechanical microkeratome to an IntraLase femtosecond laser for creating the corneal flap in LASIK procedures:

1. A quicker return of vision and faster corneal healing after LASIK.
   Dr. Stein says many patients attain visual acuity of 20/20 or better as early as 10 minutes after the all-laser LASIK procedure.


2. Increased patient comfort. Dr. Stein reports that after he tells patients the femtosecond laser is safer for their eyes, most of them have greater peace of mind during the procedure.


3. Greater safety. Femtosecond lasers create more uniform and predictable flaps, decreasing the risk of flap complications during LASIK procedures.


4. Ability to create larger flaps. The IntraLase femtosecond laser allows refractive surgeons to create larger diameter flaps for patients with flat corneas. With mechanical microkeratomes, corneal flaps on these eyes must be made smaller, which can contribute to glare and halos at night.


5. Smoother corneal "bed". The latest IntraLase FS laser creates a smoother corneal "bed" under the flap than mechanical microkeratomes. Generally, a smoother corneal bed helps create better visual outcomes after LASIK surgery.

Because of the added expense of the femtosecond laser (including fees refractive surgeons have to pay to AMO/IntraLase each time they use the laser), all-laser LASIK procedures are priced higher than standard LASIK procedures that use a mechanical microkeratome to create flaps. But Dr. Stein says patients are willing to pay more for the advanced laser technology, and the higher price has not decreased the number of LASIK procedures he and his colleagues perform.

"On the contrary, patient excitement generated by the new technology boosted word-of-mouth referrals and actually increased our procedure volume," says Dr. Stein.


SOURCE: Experience with the femtosecond laser allays common concerns. Refractive Eyecare. Vol 11, No 11, November 2007. pp 10-12.

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