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While there has been a significant decline in young patients seeking laser refractive surgery, the introduction of presbyopic intraocular lenses has increased the need for exact results. Excimer lasers, providing excellent post-op vision enhancements, have once again become important tools for today’s practicing ophthalmologist. There are several available lasers today, each with their own advantages and disadvantages.
The Nidek EC-5000CX laser has been a preferred platform of many surgeons due to its ease of use and low running cost. Their topography-guided Navex Quest update appears to be a tremendous advance, unfortunately this update is not yet available in the US either.
The MEL 80 uses a 0.7mm spot Gaussian beam profile to provide fast ablations (the company estimates a 7D treatment to be performed in 22 seconds). An integrated video camera and pivoting slit lamp provide practical resources for the treating physician.
The Technolas excimer laser, previously owned by Bausch & Lomb, has greatly improved with iris recognition and a 4D eye tracker. It has also been developed to couple well with the parent company’s femtosecond laser, FEMTEC. Unfortunately, newer advances such as PTA (Personalized Treatment Advanced) are currently unavailable in the US.
The Ladarvision LADAR4000 has become a less used, though certainly still effective excimer laser. Following the recall of the Ladar6000 upgrade and Alcon’s shift to promoting the Allegretto Wavelight, the popularity of this platform has decreased. In addition, pupillary dilation is required for treatment with this device.
The latest model from Abbott Medical Optics, the VISX S4 IR, features variable spot scanning with a variable repetition rate (VSS) pulse packing algorithm. The beam size can range from 0.65mm to 6.5mm with a repetition rate of 6 to 20 Hz. The Advanced Customvue treatment allows iris registration coupled with a wavefront guided treatment. A benefit of this laser is that it does not require pupillary dilation for treatment.
The Alcon Allegretto Wave excimer laser features incredibly fast treatment times with a repetition rate of 200 Hz. With a spot size of 0.95mm and Gaussian beam profile, ablations can be performed in a wavefront optimized pattern to minimize tissue use. Furthermore, by treating larger optical zones of up to 8mm, postoperative glare and haloes may be minimized.
In summary, there are multiple options available for surgeons desiring to add refractive laser treatments to their practice. With more competition arising between companies, physicians can expect to benefit from competitive pricing. This, combined with our patient population’s increasing desire to have “the best” uncorrected vision, should encourage all ophthalmologists to consider excimer lasers.