IntraLase is the first blade-free laser technology for performing the first step of the LASIK procedure: creating the corneal flap. Prior to IntraLase, this first step was done manually using a hand-held device with an oscillating metal razor blade, called a microkeratome. While LASIK has proven to be a successful and relatively safe procedure, the majority of complications with LASIK arise from the use of microkeratomes. IntraLase makes LASIK safer by replacing the hand-held microkeratome blade with the silent computer-guided precision of a laser, virtually eliminating severe sight-threatening blade-related LASIK complications as a result. IntraLase delivers micron-level accuracy more than 100 times greater than a microkeratome.
IntraLase Makes LASIK Better
IntraLase improves the overall safety profile and visual results of LASIK, be it custom or standard. The IntraLase laser is dramatically less likely to produce seriously thin flaps or extremely thick flaps, events which could lead to devastating complications. Clinical studies confirm that patients see better following LASIK with IntraLase than with the hand-held microkeratome blade. More patients achieved 20/20 or better vision with IntraLase-initiated LASIK. Patients who stated a preference in a prospective, randomized study preferred the post-operative vision of their IntraLase-treated eye 3-to-1 over their blade-treated eye. IntraLase created fewer high- and low-order aberrations, which can be associated with night glare and halos. In several studies, standard tests performed to diagnose dry eye indicated better results for IntraLase-treated patients. IntraLase patients required fewer enhancement procedures following LASIK. The precise IntraLase flap significantly reduces the incidence of post-operative induced astigmatism as compared with microkeratome-created flaps.
True “All-Laser” LASIK
While most commonly associated with the excimer laser, LASIK is not an “all-laser” procedure due to the use of the microkeratome blade. Only LASIK procedures that use IntraLase for the first step can be considered “all-laser.” Pulsing at a speed of one-quadrillionth of a second, the ultra-fast IntraLase FS femtosecond (fem-to-second) laser brings micron-level precision and computer-controlled accuracy to corneal flap creation.
Making the Flap: How IntraLase Works
Unlike the microkeratome blade, which cuts across the cornea to create the flap, IntraLase doesn’t traverse the cornea; in fact, it never touches the outer cornea but rather creates the flap using an “inside-out” process, virtually eliminating severe sight-threatening complications as a result. The INTRALASE® FS laser uses an infrared beam of light to create the flap from below the surface of the cornea. The beam of laser light is focused to a precise point within the stroma (central layer of the cornea), where a string of tiny 2- to 3-micron bubbles is formed. Thousands of these microscopic bubbles are precisely positioned to define the flap’s dimensions and distinct beveled edge, as well as location of the hinge. Bubbles are then stacked along the edge of the flap up to the corneal surface to complete the flap. The process from start to finish takes approximately 45 seconds.
The surgeon then lifts the flap to allow for treatment by the excimer laser. When treatment is complete, the flap is accurately repositioned, thanks to its beveled edge.
With IntraLase, the surgeon can precisely control the critical first step of LASIK. Pre-programmed laser specifications include flap diameter, depth, hinge location and width, and side-cut architecture – factors which may vary by patient. IntraLase flaps also feature a distinctive beveled edge, which allows for precise repositioning, alignment and seating of the flap after LASIK is completed. This ability to personalize specific parameters is impossible with a microkeratome or other hand-held bladed instrument.
IntraLase is the most sophisticated and accurate technology for corneal flap creation available today, and has given patients greater confidence in choosing vision correction surgery. The higher degree of assurance and safety, virtually no risk of severe sight-threatening complications and more predictable outcomes have been shown to increase patient satisfaction in their LASIK experience and outcome.
Advantages of Intralase
- Improved Safety:
Eliminates the most severe microkeratome-related complications, including invasive corneal incisions and button-hole flaps.
- Better Vision:
Patients achieve statistically better vision when IntraLase is used in the LASIK procedure. In comparison with microkeratome-initiated LASIK, more patients achieved 20/20 vision and those with a preference preferred the post-operative vision of their IntraLase treated eye 3-to-1.
- Highest Degree of Predictability and Precision:
Micron-level precision creates significantly more predictable and accurate flap dimensions, including, most critically, reproducible flap thickness, within ± 10 microns, whereas variability with microkeratomes has been reported up to ± 40 microns. This increased precision preserves valuable corneal tissue and improves the predictability of the LASIK treatment.
The number of LASIK retreatments (or enhancements) is significantly lower for laser-created corneal flaps, avoiding the patient inconvenience of subsequent surgeries and the increased surgeon costs entailed with reoperations.
- Reduced Dry Eye Symptoms:
In several clinical studies, standard tests performed to diagnose dry eye show a significant reduction in symptoms, the largest of which shows patient symptoms were reduced by 72 percent. This lower occurrence of dry eye symptoms may be due to the uniform and typically thinner flap, creating less disruption of nerves in the cornea.
- Individualized Flaps:
The laser flap can be tailored to the individual patient’s needs, allowing physicians to individualize all steps in the LASIK procedure: custom diagnosis with wavefront; personalized flap creation with IntraLase, and, custom laser treatment with custom ablation.
Comparison of Intralase technology Vs. Microkeratome:
|Risk of abnormal flap, incomplete flap, lost flap||No||Yes up to 1%. These range from mutilated flaps, lost flap, button hole, incomplete flap. All resulting in the interruption of the procedure.
No LASIK can be performed
|Ability to produce exact flap thickness||Yes. 100 times more accurate than traditional blade||1-2% chance in creating a flap of extreme value of thickness|
|Risk of corneal abrasion||Almost 0%||4-5%|
|Predictably better vision||Yes. Clinical studies have shown that more patients achieve 20/20 or better with the Intralase||No|
|Ability to perform CustomVue on most thin corneas||Yes, due to the predictability of the flap.||No. have to perform PRK due to an unpredictable flap.|
Negative issues with Microkeratomes (Old Blade Technology)
- Flap too thin
- Flap too thick
- Non-planar (uneven) flap
- Buttonhole flaps, procedure must be stopped. LASIK can never be performed again on that eye.
- Risk of perforation of the eye
- Striae, fine wrinkles in the flap causing decreased vision
- Folds, significantly reducing vision
- Obtaining suction
- Maintaining suction
- Loss of suction, can be catastrophic during the flap making process
- “Blind” procedure, where the surgeon does not see what is going on with the eye
- DLK, inflammation of the eye
- Causing epithelial injury, i.e. corneal abrasion.
- Neurotropic effects, increased incidence of dry eye
- Blade quality
- Toxins from “mechanisms”