Femtosecond lasiks or microkeratome suregery - what is your choice?

clipart_judge_cartoonThe debate among LASIK surgeons concerning the best way to create a corneal flap during the laser eye surgery continues.

In the March 1, 2009 edition of Ocular Surgery News (Europe/Asia-Pacific Edition), two experienced LASIK surgeons offer their views about which flap creation technique is superior.

Though most LASIK surgeons use a precise cutting tool called a mechanical microkeratome to create the corneal flap during LASIK, femtosecond lasers are continuing to gain popularity. An estimated 30 percent of today's LASIK procedures involve the use of a femtosecond laser for flap creation, and some experts say soon over half of all LASIK procedures will include this technology.

The case for femtosecond lasers

Bojan Pajic, MD, Chairman and Medical Director at AugenZentrum Pajic and Research Institute, Reinach, Switzerland, prefers femtosecond lasers for LASIK flap creation.

Dr. Pajic notes that disadvantages of first-generation, low-frequency femtosecond lasers—including slow flap creation speed, long suction time on the eye and a less-smooth interface between the flap and the underlying corneal bed (compared to the interface created with a microkeratome)—have been largely overcome with new, faster femtosecond lasers.

Dr. Pajic uses a femtosecond laser for 90 percent of his LASIK procedures. He most frequently uses the Ziemer LDV femtosecond (FS) laser, but he also uses an IntraLase FS laser.

"I have performed thousands of procedures and would not hesitate to say that flap quality, smoothness of the bed and safety are now much higher than with even the best microkeratomes available," says Dr. Pajic.

Dr. Pajic also notes a recent study of 938 LASIK patients where the LDV laser was used on one eye and an Amadeus SIS microkeratome was used on the other eye to create the flap. The results of the study showed the femtosecond laser created more precise flaps than the microkeratome, and a significant visual acuity increase was found in the femtosecond laser eyes, whereas the visual acuity in the microkeratome eyes remained stable.

Dr. Pajic acknowledged that microkeratomes are much less costly than femtosecond lasers. In his opinion, however, prospective LASIK patients generally are willing to pay a higher price for a blade-free, all-laser procedure.

Dr. Pajic is convinced femtosecond lasers will replace microkeratomes for flap creation in LASIK surgery in the years ahead and may soon be used in cataract and glaucoma surgery as well.

The case for microkeratomes

James S. Lewis, MD, prefers to use a microkeratome for LASIK flaps. Dr. Lewis practices in Elkins Park, Pennsylvania. He also is Director of LASIK and Corneal Surgery at the Pennsylvania College of Optometry (Elkins Park, PA).

In the March 1, 2009 edition of Ocular Surgery News (Europe/Asia-Pacific Edition), two experienced LASIK surgeons offer their views about which flap creation technique is superior.Dr. Lewis says he will consider switching from his current Moria One Use-Plus SBK mechanical microkeratome only if a medical equipment company can develop an "ideal" femtosecond laser.

The characteristics of this ideal femtosecond laser, according to Dr. Lewis, would include:

  • It would be small enough to fit under his excimer laser to eliminate the need to move patients from one device to another.
  • It would rarely need service and, when necessary, the manufacturer could ship him a "loaner" laser overnight.
  • It would completely separate the flap from the underlying cornea so the flap can be easily lifted without risk of trauma to the eye.
  • It would produce virtually no inflammation, eliminating the need for topical steroids after surgery.
  • It would consistently create thin flaps with consistent thickness, diameter and hinge size specified by the surgeon.
  • It would cost under $40,000 and cost less than $100 to operate per case.

Dr. Lewis noted that the flaps he creates with the Moria SBK microkeratome have a thinner, more natural appearance than femtosecond laser flaps. "I believe the flaps created by finely honed steel are more physiologic than those generated from a series of tiny plasma explosions," said Dr. Lewis (referring to the cutting action of a microkeratome blade compared to the microscopic "photodisruption" of corneal tissue from energy pulses created by femtosecond lasers).

Dr. Lewis says he is confident he is "providing the best care, making the best flaps, and respecting the integrity and physiology of corneal tissue" when using a microkeratome rather than a femtosecond laser for LASIK flaps. He also feels he is performing quality LASIK in a more cost-effective way by using a microkeratome rather than a more costly femtosecond laser.

Dr. Lewis concludes that many surgeons feel the same, and therefore microkeratomes for LASIK flap creation are "here to stay."

Thus it is your choice either to use the femtosecon surgery or microkeratome surgery since its not of much difference at the present state. But in near future we feel it seems more probable that greater sophistication to be added to femtosecond surgery which would enhance the success percentage in Lasik surgeries. For more information regarding the details of the difference between the two techniques you can link to Mechanical Microkeratome LASIK Equals Bladeless (Femtosecond) LASIK (IntraLase) in Eye Health [http;//eye.taragana.net/archive/mechanical-microkeratome-lasik-equals-bladeless-femtosecond-lasik-intralase-in-eye-health]

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