The Intralase Laser
Blade-free LASIK was made possible by the Intralase Corp., which markets the laser used to create the precision corneal flap.
The laser emits pulses as short as one-quadrillionth of a second (femtosecond), using an infrared beam of light to separate tissues, simply dividing them without heat or impact. The pulses create microscopic bubbles within the corneal tissue, which then constitute the boundaries of the flap.
The laser works in concert with a special computer which calculates the precise cut needed to allow the excimer laser (the one that creates the actual vision correction) to do its work within the patient's cornea.
Benefits of Intralase
While Intralase isn't right for everyone, the blade-free lasik vision correction surgery can produce real benefits for some patients. They include:
-- Decreased risk of flap complications.
-- Decreased incidence of postoperative dry eye
-- Unlike other alternatives to LASIK, it preserves many of the benefits of LASIK including a short and largely pain-free recovery.
-- More accurate outcomes in terms of patients' postoperative vision.
-- Benefits of vision correction surgery are available to those who might have previously been poor candidates.
-- Less pressure on the eye during the surgery.
-- Reduced incidence of patients needing a second operation to correct their vision.
-- Flaps created with a laser are less likely to become dislodged later.
What is Intralase?
Intralase, also called blade-free LASIK, is a special laser that takes the place of the blade that creates a "flap" in the cornea. With the Intralase laser, surgeons are able to make a smaller and more precise incision into the cornea than available in standard LASIK. After the flap is created, the cornea is shaped just as it is in standard LASIK, with a "cool" far-ultraviolet laser.
This procedure is considered safer than standard LASIK because many LASIK complications were related to the flap. It also allows patients who were previously considered poor candidates for LASIK to have their vision improved surgically.
How Blade-Free LASIK Works
The surgeon uses computer software to guide the Intralase laser, which uses infrared energy to create a series of extremely small (3 microns) bubbles in the central layer of the cornea. The depth and diameter of the flap thus created are calculated with great precision, allowing the surgeon to customize the shape to the patient's eyes and the correction being performed.
One side of the shape being formed is left uncut, so that the surgeon can fold back the top layer after the correction is performed, placing it precisely where it belongs for optimum healing.
Unlike the blades (microkeratomes) in use in standard LASIK, the Intralase allows the surgeon to make corrections to the cut even when the surgery is in progress.
Costs of Blade-Free LASIK
Because surgeons must cover the cost of the Intralase equipment, they typically charge $250 to $500 more per eye for blade-free LASIK than for the standard surgery. When given a choice, many patients say they prefer to pay this cost in return for the decreased chance of complications.
Some vision correction surgeons are switching entirely to Intralase and bundling the extra cost into their price structure. Others go on a case-by-case basis, saying that for some patients -- particularly those with mild to moderate nearsightedness and no complicating problems with their corneas -- the extra cost is not worth it.
Precision Vision Correction
The actual vision correction provided in blade-free LASIK -- the part done by the excimer laser inside the cornea -- is exactly the same as in standard LASIK. However, some studies suggest that the blade-free technology helps prevent occasional complications with the flap that interfere with visual acuity.
Indeed, several studies of patients who had standard LASIK in one eye and Intralase in the other found that they tended strongly to prefer the Intralase eye.
The blade-free procedure may also help reduce patient anxiety about the operation. At least LASIK surgeon reports that when given a choice, three-quarters of their patients prefer the Intralase before any surgery is even performed.
Who Can Have Blade-Free LASIK
Many of the criteria for blade-free LASIK are the same as those for standard LASIK. A patient must be over 18 years old, have a stable corrective lens prescription for at least a year, free of eye disease, and not pregnant or nursing.
In addition, however, patients who may have been rejected for LASIK in the past because their corneas are too thin could find that they can still have LASIK using blade-free technology, because the Intralase device is capable of cutting a much shallower "flap" than the older microkeratome (blade) system.
Intralase is not recommended for those who had earlier forms of vision-correction surgery such as radial keratotomy.
Blade Free vs. LASIK
Many surgeons are moving entirely to Intralase vision correction technology, citing increased safety, better visual acuity among patients, and patient preference.
It should be noted that blade-free vision correction surgery does not entirely remove the risk of flap complications. Study results suggest that for patients with mild or moderate nearsightedness, the Intralase surgery does not offer a great deal of measurable benefit, while for farsighted patients or those with thin or abnormal corneas, it may enable a much more precise correction and thus be worth the extra cost.
In addition, Intralase appears to offer a better experience to those having wavefront or custom LASIK.