How All Laser LASIK Eye Surgery Works

Unlike mechanical instruments, IntraLase technology is uniquely able to program the dimensions of your flap based on what’s best for your eye. Then the IntraLase laser creates your flap from below the surface of the cornea—without ever cutting it. How?

1. Ultra–fast pulses of laser light position microscopic bubbles at a precise depth determined by your doctor.

2. The laser light passes harmlessly through your cornea.  Then the laser creates rows of these bubbles just beneath your corneal surface as it moves back and forth across your eye in a uniform plane.

3. Next, the IntraLase laser stacks bubbles around your corneal diameter to create the edges of your flap. These bubbles are stacked at an angle that is determined by your doctor and is individualized to the way your eye is shaped.

4. The process takes only about 30 seconds from start to finish— it’s quiet and it’s comfortable.

5. Your doctor then gently lifts the flap to allow for the second step of your LASIK treatment. When treatment is complete, the flap easily “locks” back into position and rapidly begins to heal.

Because of the superior accuracy of the IntraLase method, certain patients who were ineligible for LASIK may now be able to have treatment. Ask your doctor today if you are a candidate.

	DR. SIBLEY uses the ALL-LASER LASIK (INTRALASE)   for the crucial  1st step of your LASIK..   Two lasers are used in our bladeless Intralase LASIK procedure.  The 1st laser is a femtosecond laser (0.000000000000001 second), different from the 2nd  Excimer cold laser type used to resurface the eye.  The Intralase (cold) directs its laser beam into a tiny 3 micron (0.003 mm) spot, which is focused to a precise depth within the cornea.
	In less than one minute, using computer precision and extremely high speed of delivery, approximately 1 million pulses are delivered to the exact location desired by the surgeon.  Discrete laser bursts create a million tiny CO2 bubbles which result in simple,safe, and successful separation of the cornea and creation of the protective flap without the need of any blade.
	The surgeon lifts the flap and uses another type of cold laser ( EXCIMER) to correct the vision.  Dr. SIBLEY performs an excimer laser treatment to resurface the eye, allowing you to see without glasses.  After the excimer laser treatment, the flap is placed back into its original position. No stitches are needed.

The FLORIDA EYE CENTER LASIK surgeons use the newest ,safest, and most precise computer software to guide the IntraLase laser beam. The All-Laser Intralase applies a series of tiny (3-micron-diameter) bubbles within the central layer of the cornea to separate the layers. This is all done under the high magnification of the doctors microscope.

The resulting protective corneal flap is created at a precise depth and diameter pre-determined by the surgeon.

For increased safety, just as occurs with a mechanical microkeratome, a small section of tissue at one edge of the flap is left uncut, forming a hinge that allows the surgeon to fold back the flap so that the cornea can be accessed and reshaped for your personalized, "custom" laser vision correction.

Comparing IntraLase with Traditional LASIK:

The Difference Is in the Corneal Flap

With our new, safer All-Laser Lasik (IntraLase) , people with thin corneas who once were unsuitable for LASIK may now be candidates.

Most people have corneas that are between 500 and 600 microns thick, and most microkeratomes cut flaps ranging between 100 and 200 microns thick. Because of its precision, the IntraLase appears capable of more reliably and consistently producing corneal flaps as thin as 100 microns. This means surgeons now have more options to perform LASIK in people with thinner and flatter corneas, according to MARK SIBLEY, M.D., refractive surgeon with experience using IntraLase.

Intralase Facts

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 15 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 common and 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.

Fewer Retreatments
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

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