Trying to decide between 2 LASIK doctors (Laser versus Blade?)

Discussion in 'Laser Eye Surgery' started by artvandelay, Apr 8, 2004.

  1. artvandelay

    artvandelay Guest

    Both are highly skilled surgeons in San Francisco (and quite expensive
    I might add, but I'm willing to pay for the skill). One is my
    opthamalogist who I've been seeing for a few years. Great reputation
    in general, very good LASIK guy.

    #2 I went to just for a second opinion, but now I'm kind of sold on
    her I think. Outstanding medical credentials, and her practice is 90%
    focused solely on refractive surgery and cornea surgery. Here's the
    thing. #2 uses the new IntraLase, which is a laser to cut the flap.
    She is the only doc in San Francisco who has the equipment and
    knowledge to use IntraLase as it is so new. She's only been using the
    IntraLase instead of the blade for 3-4 months (LASIK and other
    procedures for years). When she started using the Intralase, she only
    used it on about a third of her patients. Now she uses it on almost
    all of her patients because she feels it offers much more precision
    and good results over blade.

    Whats the general consensus out there about IntraLase laser versus
    blade for the initial flap step of LASIK?

    (p.s. I'm only interested in knowledgeable opinions from folks who
    aren't of the "lasik is evil" stripe. I won't even read those kinds of
    posts, and I've been lurking long enough to get a sense of who posts
    like that and I ingore those posters.)

    Thank you!!!!

    artvandelay, Apr 8, 2004
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  2. artvandelay

    Ragnar Suomi Guest

    On paper, the intralase sounds wonderful. It's debatable if it is
    more of a marketing tool than a better device.
    If a surgeon has an intralase laser, they might as well use it. That
    saves them $50/blade for the microkeratome.
    Ragnar Suomi, Apr 8, 2004
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  3. artvandelay

    serebel Guest

    I think it's too soon to tell which way is better. Intralase lasik is
    a relatively new technique. I think which ever flap you choose,
    surgeon skill is of profound importance.

    serebel, Apr 9, 2004
  4. artvandelay

    artvandelay Guest

    Thanks Ragnar. Interestingly I found this posting of yours which makes
    me a little nervous. My doc who is the first and only to use INtralase
    in San Francisco (also she has a great rep and corneal
    issues/refractive surgery is her entire practice) says that she finds
    the benefits of IntraLase to be better than the blade (better, more
    comfortable, quicker healing, less complications).

    Whats a guy to do?

    From: Ragnar Suomi ()
    Subject: Intralase
    View: Complete Thread (2 articles)
    Original Format
    Newsgroups: alt.lasik-eyes
    Date: 2003-05-26 10:48:06 PST

    This is slightly off topic, but the intralase method takes much longer
    to do, is more irritating to the eyes, takes longer to heal, results
    in some haze, and costs more than using a microkeratome.

    Someone needs to tell me what the benefit of an intralase flap is.
    artvandelay, Apr 10, 2004
  5. artvandelay

    RT Guest

    Get more advice from a more reliable source.
    Ask to speak to some of your doc's patients who've had intralase.
    Get a second opinion from another lasik surgeon.

    I wouldn't base a decision on advice from Ragnar. His "lasik book" (ie.
    what he knows about lasik) was written before intralase was invented.
    He has no medical or experiential credentials to give anyone advice on

    Good luck. Let us know what you decide.
    RT, Apr 10, 2004
  6. artvandelay

    Ragnar Suomi Guest

    I posted that about a year ago, when Intralase was brand new. At the
    time, it was completely valid. Although it's a good idea to take
    advantage of improved technology, I wouldn't dare be the guinea pig
    that tried out a NEW technology like Intralase until it's efficacy was
    well established.
    Ragnar Suomi, Apr 10, 2004
  7. artvandelay

    Dr. Leukoma Guest

    Well, mercy. I must say that I find myself in the Ragnar camp on this one.
    One very prominent surgeon around here referred to Intralase flaps as
    Velcro flaps, which speaks - I think - to the sometimes inconsistent
    interface created by the femtosecond laser and the minute craters it
    causes. The cleavage plane is undoubtedly very precisely and repeatably
    located in three dimensional space, and this creates some definite
    advantages. I have heard that it can take longer for visual recovery with
    this technique, possibly as a result of the stromal absorption of gaseous
    products. There's just not enough published yet in the literature.

    Dr. Leukoma, Apr 10, 2004
  8. Hello Art. I hope I can be of assistance.

    Like nearly all new technology, there are advantages and
    disadvantages. What one must do is determine if the advantages
    outweigh the disadvantages. It is my opinion that the advantages of
    the Intralase femtosecond laser for creation of the LASIK flap
    (IntraLASIK) outweigh the disadvantages, but you must come to your own

    The primary advantage of IntraLASIK is accuracy of flap depth and
    safety. The primary disadvantage of IntraLASIK is short-term swelling
    and a higher probability of a longer healing time before good visual
    acuity (weeks instead of days). IntraLASIK is also usually more

    IntraLASIK is accurate within about 10 microns. A mechanical
    microkeratome is usually accurate within 30-50 microns, but there are
    case studies of mechanical microkeratomes being off by 150 microns and
    more. This is important because at least 250 microns of cornea must
    remain untouched to provide stability after surgery, and the average
    cornea is around 500 microns thick. Unless you have 150 microns to
    spare, there is a slightly higher element of risk with a mechanical
    microkeratome. I want to be quick to add that these large variables
    are very, very rare, but do occur.

    It is virtually impossible to create a buttonhole flap with
    IntraLASIK. That is when the microkeratome pass is too shallow and
    the blade breaks through the surface in the middle of the flap.
    Buttonhole flaps are normally not very problematic. The doctor
    repositions the flap, waits about three months, then does the
    procedure again. Of course, nobody wants a buttonhole flap, no matter
    how well they heal.

    If for any reason the IntraLASIK flap is aborted during the process,
    such as suction loss, it can be continued later at exactly the same
    depth without causing vision problems. If a mechanical microkeratome
    aborts during flap creation, there is a risk of ridge formation and a
    second flap would need to be created at a different depth. It is
    nearly impossible to complete later an aborted LASIK flap made with a
    mechanical microkeratome.

    The IntraLASIK flap is an even thickness throughout. Think of it like
    a man-hole cover with edges that go straight up. A flap created with
    a mechanical microkeratome is meniscus shaped with thin edges, thick
    mid-periphery, and a slightly thinner center. It is believed, but not
    really proven, that the uniform flap provides uniform internal
    stresses and therefor is less likely to create the tiny crinkles in
    the flap called micro-striaie. With all microkeratomes, micro-striae
    is quite rare, but can occur and is difficult to resolve through means
    other than healing.

    Intralase causes a series of "explosions" along a predetermined plane
    within the cornea. These explosions create tiny pockets of gas. With
    enough explosions close enough together, a flap is created. Because
    the flap is created by a series of bubbles, the IntraLASIK flap is not
    quite as smooth as a flap made with a mechanical blade. A smoother
    flap is a better flap.

    It is surmised that these explosions cause slight swelling that takes
    several days to a few weeks to settle down. During this time, the
    patient will have less than clear vision. Also, it is surmised that
    the relative roughness of the IntraLASIK flap provides less clear
    vision during the healing time. What I have seen is that after the
    normal healing process this problem resolves completely in virtually
    all patients.

    Practical experience is important for any doctor who implements a new
    technology. Some technologies and techniques require much more
    surgical skill than others. Some have a faster learning curve than
    others. In our 50 Tough Questions For Your Doctor, we recommend that
    a doctor have performed at least 100 of the procedures proposed for
    you. That may be a bit restrictive for IntraLASIK, but in a few
    months, 100 is probably easily accomplished by a higher volume

    So to summarize, IntraLASIK seems to be more accurate and somewhat
    safer long-term, but you will put up with less than optimum vision
    quality for a few weeks to a few months while the cornea heals.

    And your wallet will be a bit lighter with IntraLASIK.

    Best of luck with your decision.

    Glenn Hagele
    Executive Director
    Council for Refractive Surgery Quality Assurance

    Email to glenn dot hagele at usaeyes dot org

    I am not a doctor.
    Glenn -, Apr 10, 2004
  9. artvandelay

    CatmanX Guest

    Excellent post SErebel.

    The flap is not really the issue I would be concentrating on. I would
    be looking at the experience, results of other patients and
    pretesting. Are they both corneal specialists, or general
    ophthalmologists that do RS?

    One question you may want to ask: What can you do if it goes wrong? Go
    through Glenn's 50 tough questions (maybe not all, but select some
    good ones).

    Do you choose a GP because he has a shiny hew digital stethoscope, or
    because he cares for your wellbeing. In the end, you should be going
    for the one you feel is going to do the best job.

    CatmanX, Apr 10, 2004
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