New Vision Surgery Techniques

by Franklin W. Lusby, M.D., Scripps Memorial Hospital La Jolla

If you’re one of the millions of Americans who need their glasses to find their glasses, you’ve probably wondered more than once what it would be like to wake up in the morning and be able to see the alarm clock or your spouse’s face clearly. Perhaps you’ve even thought about having laser vision correction and throwing your glasses or contacts away forever – but the risks of vision surgery have held you back.

Well, thanks to the newest advances in laser vision correction, the risks are now smaller than ever – and the benefits greater. The IntraLase femtosecond laser has revolutionized traditional laser vision correction surgery, commonly known as LASIK (Laser-Assisted In-Situ Keratomileusis) by both reducing the risk and producing exceptional results.

What’s the Flap About?
LASIK has been performed in this country for about ten years. In a nutshell, here’s how it works: The first step of the procedure is to create a flap on the cornea. The flap is laid aside, and the surgeon then uses an excimer laser to reshape the layers of the cornea immediately under the flap. Each pulse of the laser vaporizes a tiny area of the cornea, working in a controlled pattern until the desired shape is achieved. When the flap is placed back into position, the new corneal shape is transferred to the surface, and the patient’s vision adjusts accordingly. Recovery is rapid and virtually painless.

Until about two years ago, the only way to make a corneal flap was with a microkeratome, a hand-held mechanical device with a blade and a motor. Although this technology has been very reliable, it has not been totally free of difficulties. The equipment requires a lot of care in cleaning, assembly, and the like. Occasionally, the flap made by a microkeratome can be irregularly shaped, and the procedure will have to be completed on another day. In addition, flap irregularities cause many of the vision and comfort complications associated with traditional LASIK.

Because the IntraLase laser operates in a completely different manner, many of these types of complications are impossible. The laser is guided by computer rather than by hand, so there is more control over the size, shape and thickness of the corneal flap. With traditional LASIK, the flap is about 30 to 35 percent of the thickness of the cornea, whereas an IntraLase flap is much thinner. Because the IntraLase flap can be thinner, more people with higher prescriptions can be considered for surgery (traditional LASIK is limited to people within a certain prescription range). Moreover, because IntraLase uses a laser to create the flap, it is more acceptable for people who cannot tolerate the idea of a blade cutting into their eye.

IntraLase surgery carries few risks. Occasionally, an air bubble may form under the cornea during the procedure, and it will have to be completed on another day. However, there is no negative effect on the patient’s vision.

Better Than 20/20
Advancements in laser vision surgery also have resulted in even better vision correction. In fact, some patients report better than 20/20 vision.

That’s because new techniques enable surgeons to customize the laser correction to each patient’s unique needs. Custom LASIK uses computerized “Wavefront” technology to map individual vision problems. Wavefront measurements determine how much the patient’s vision deviates from a perfect optical system and detects even subtle visual abnormalities that cannot be found or treated in traditional LASIK. The laser treatment is then customized to the specific Wavefront diagnosis, enabling the surgeon to treat conventional vision errors such as nearsightedness or farsightedness as well as unique irregularities.

In addition to excellent vision, Custom LASIK patients have much better night vision and are less likely to need additional treatments than traditional LASIK patients. What’s more, with the introduction of the IntraLase, the procedure can now be done with unprecedented safety and precision.

Franklin W. Lusby, M.D., has performed more than 16,000 LASIK procedures and recently performed the first IntraLase procedure at Mericos Eye Institute at Scripps Memorial Hospital La Jolla. For more information, please call 1-800-SCRIPPS (1-800-727-4777).