Femtosecond lasers, once a technology only available to high volume LASIK practices due high costs, have become more readily available to all ophthalmologists. Offering quick and consistently well constructed flaps, they have become the preferred choice among almost every physician who has access to both them and microkeratomes. In addition to their lasik benefits, femtosecond laser technology is now being studied for its utility in cataract surgery. LensAR (Winter Park, FL) in fact, has recently been granted FDA 510(k) clearance for anterior capsulotomy. While alternative uses for femtosecond lasers are very exciting for ophthalmology, advances in LASIK surgery continue as well.
The VisuMax femtosecond laser (Carl Zeiss Meditec, Dublin, CA) operates at a blazing 500 kHz, allowing flaps to be created in seconds. As opposed to traditional suction methods which can incorporate conjunctiva, vacuum occurs only on the cornea, and creates much lower increases in intraocular pressure. In addition to reducing rates of subconjunctival hemorrhages, this allows a more comfortable patient experience. While not available in the US yet, the Visumax has the ability to selectively remove precise amounts of tissue in techniques such as FLEX (Femtosecond Lamellar Extraction) to perform the entire laser vision correction with only a femtosecond laser. One of the first physicians in the US to use the laser, Dr. Sonia Yoo (Associate Professor of Clinical Ophthalmology, Bascom Palmer Eye Institute, Miami, FL) remarks, “The patients appear much more comfortable during the process and post-operatively the flaps appear less edematous.” Dr. Richard Awdeh (Assistant Professor of Clinical Ophthalmology, Bascom Palmer Eye Institute, Miami, FL) agrees, “I had a patient who had lasik on one eye performed with the Intralase (Abbott Medical Optics). Because of suction issues I used the Visumax for his second eye. The patient told me that the Visumax experience was much more comfortable than the Intralase – in fact he had barely any discomfort at all with the Visumax.” Dr. Yoo has also had access to the latest generation of the Intralase and notes that it too is an excellent laser, “With these faster femtosecond lasers, the stromal beds appear much more smooth, the flaps are easier to lift, and the flap thickness consistency is excellent.”
The Femto LDV laser (Ziemer) offer femtosecond laser technology in a much more portable solution. This makes it an excellent option for physicians who want the technology in multiple offices, or for those who prefer a roll-on roll-off solution. In addition, the actual laser delivery system is hand-held and attached to an articulated arm, making it easy to incorporate into a setting with an excimer laser already in place. Compared with other femtosecond laser systems available, the LDV laser operates at much higher pulse rates and lower pulse energies, minimizing common femtosecond issues such as OBL (Opaque Bubble Layer).
While femtosecond lasers becomes more common in all surgical aspects of ophthalmology, the original indication, LASIK flap creation, will likely remain the most commonly used. And even though our current outcomes are outstanding, advances in this technology continue to push the limits of what visual outcomes we can achieve for our patients.
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