has anyone ever heard of INTRALASE?

http://www.intralasefacts.com/


would that encourage more people getting LASIK?

would that encourage more people getting LASIK?

Probably not, most people don't realize LASIK involves a microkeratome until they start looking into it. Either way, the surgeon is still cutting tissue and I think there is some doubt as to whether intralase actually results in improved outcomes.

We use the keratome. Im not convinced that intralase gives any better vision either. I saw an intralase flap-once. It had a temporal hinge, which gave it away immediately, as opposed to nasal or superior. Also, the edges of the flap were VERY easy to see, unlike with a keratome much of the time. Not that it has any effect on vision. The visual outcome is much more dependent on 1) the surgeon and 2) the laser.

Intralase had early problems with laser specs, ie too much power in too long of bursts that lead to some hazing of the cornea. This hazing of the cornea led a lot of surgeons to ignore or downplay the advancement, and justify keeping with the (I believe) cheaper microkeratome procedure. I've seen this first hand. In some cases there are economic reasons, not just medical/surgical reasons for keeping with older technology.

There may also be the belief that patients don't really want to pay the extra cost of the intralase.

As of now, the laser used for flap production is much more precise than a few years back. It uses less power and therefore the hazing is greatly reduced. The resulting flap thickness appears to be much more precise and uniform. A microkeratome will have a very thin edge (does this lead to more complications, who knows?), whereas the edge of the intralase flap can be modified and the edge angle can be computed and rationalized... but who's to say one which angle is the best?

Not a fan of either really, but thought some may want to know.

PRK is making a big comeback however, and works better in some cases.

our surgeons use about 60% intralase 40% keratome when not doing PRK or epi. surgical outcomes have been similar between the two. i have noticed, however, more post-operative K edema w/ intralase.
but, i have more confidence in intralase regarding flap thickness/interface accuracy. but im not a surgeon, so they are the ones who are usually recommending or not recommending it to patients in our office. i simply sort out candidates vs non-candidates for corneal refractive surgery of any type. one of our surgeons is crazy about epi-LASIK, another hates it and also hates Intralase. i see the post ops, and both of their outcomes are similar, unless one of them is buying lunch that day.

our surgeons use about 60% intralase 40% keratome when not doing PRK or epi. surgical outcomes have been similar between the two. i have noticed, however, more post-operative K edema w/ intralase.
but, i have more confidence in intralase regarding flap thickness/interface accuracy. but im not a surgeon, so they are the ones who are usually recommending or not recommending it to patients in our office. i simply sort out candidates vs non-candidates for corneal refractive surgery of any type. one of our surgeons is crazy about epi-LASIK, another hates it and also hates Intralase. i see the post ops, and both of their outcomes are similar, unless one of them is buying lunch that day.


I must have mentioned this in another thread instead of here.. One thought with PRK is that it limits decreases in contrast sensitivity. Have you ever seen or heard any research about microkeratome lasik vs intralase in regards to contrast sensitivity?

I'm assuming you don't do pre and post op contrast sensitivity testing :)

I'm also assuming that a lot of patients that end up unhappy with lasik (that are "20/20") have enough of a drop in contrast sensitivity to be noticable.

I'm also assuming that a lot of patients that end up unhappy with lasik (that are "20/20") have enough of a drop in contrast sensitivity to be noticable.


bingo.

Currently I'm doing an extern with a surgeon who does intralase. He is also the guy in the area who does all the PKP (corneal transplants) when the other lasik guys screw things up. B/c he takes over care of all the lasik-gone-wrong cases in the area, I'm thinking he has thought about it a lot. He does not use the microkeratone at all anymore. I have not read enough literature to have a good opinion for myself yet, but right now I thing he may be right.

I have seen both procedures several times and the intralase just seems less scary to me...IMO.

As a surgeon, the intralase makes more sense. Thinner more accurate flaps allow for further treatments in the future if necessary. Also, there is less chance of surgical error in creating the flap.