LASIK

Femtosecond Laser for Bladeless LASIK

Intralase is the brand name for a Femtosecond laser used in LASIK eye surgery to create the flap that is required to perform LASIK. Intralase has been around since 2001 in the United States and was the first Femtosecond laser approved by the FDA. At that time, 100% of LASIK was done with a device called a Microkeratome, which is similar in concept to a deli slicer. It had a rapidly oscillating super-sharp blade that cut a very thin flap of your corneal tissue. The LASIK flap is then folded out of the way. The second amazing laser, the Excimer laser, is then applied to shape the cornea (the clear window over the colored part of your eye) the exact amount necessary to correct your nearsightedness and/or astigmatism.

Intralase Evolution 

The Intralase Femtosecond laser in 2001 was very slow. It took almost 3 minutes to complete the flap creation. Surgeon adoption of the technology was likewise slow. As the speed improved, more surgeons traded in their Microkeratome for the Femtosecond laser. Currently, my Femtosecond laser, the Ziemer Z8, makes flaps in about 15 to 25 seconds depending on the type of flap. The Intralase laser has some competition with two other lasers: the iFS 150 and the Ziemer Z4, Z6, and Z8 lasers. I use the Ziemer Z8 laser and absolutely love it for ease, speed, excellent flaps, excellent reliability, and excellent safety. I’ve used the other lasers, and would argue with anyone that the Ziemer Z8 is the best for many technical and esoteric reasons.

Intralase Eye Surgery

Intralase eye surgery really revolutionized LASIK surgery. It allowed us to make a flap using only a laser. The basic idea is that the laser makes extremely tiny and unbelievably fast superheated pulses that create a tiny gas bubble. It makes a shot about every 45-50 millionths of a billionth of a second. Yes, you read that right-the laser makes billions of tiny pulses for every LASIK flap we create. The gas bubbles overlap slightly so that it creates a cut or a space between the layers of tissue. The flap is then lifted in a very similar fashion to what it would be like if it was cut with a blade. The lasers have gotten faster, more precise, less gas in the tissue (this creates what’s known as OBL – opaque bubble layer that causes a temporary whitish appearing cornea after the procedure. Not to worry though, the whiteness disappears in 20 minutes or so.) The qualities that I like best about the femtosecond laser are:

  • Very thin and uniform flaps
  • Very little variability in the thickness of the flap
  • The flap is planar, that is to say it doesn’t change the refractive error because the flap is completely parallel to the corneal surface You will still be nearsighted or farsighted exactly the same way until the second laser (Excimer) is applied to reshape your cornea.
  • I also like that it does not cause corneal abrasions. Occasionally with the Microkeratome the slight friction of the device on the surface of the eye caused a corneal abrasion which is when the skin layer comes loose in variable amounts. With the Femtosecond laser’s crystal interface goes directly down on the eye and comes directly back up. There is no movement over the surface of the eye.
  • The comfort of the Intralase or any Femtosecond laser is about the same or slightly better than the comfort of a Microkeratome. Both the Microkeratome and Femtosecond laser have some downward pressure, and the vision blacks out for 10 to 25 seconds-which is anxiety provoking!
  • As for anxiety, I believe patients tolerate the laser better than the blade. It’s just psychologically nicer to know that there’s no blade cutting a flap on your eye. The flap is extremely precise with the laser.
  • You can center the treatment right in the middle of the pupil with modern Femtosecond lasers. After the suction is on the eye you can digitally move and center the flap to make sure it’s dead center on every single person. This increases our consistency, quality and comfort.
  • You also can adjust the size of the flap and the hinge location intraoperatively for increased consistency of the flap
  • Our Ziemer Z8 laser also can do the femto assisted laser cataract surgery.

Intralase LASIK Cost

The cost of the Intralase is incorporated into the total cost of the procedure. Costs for the surgeon varies depending on the manufacturer of the laser and the volume of surgery the surgeon performs.

Intralase vs. LASIK

This is a bit of a misnomer. It’s sort of like saying “Levi’s vs. Jeans.” Intralase is one of the two lasers that is used in the process of performing a LASIK procedure. The second laser is called an Excimer laser which is used to reshape the corneal tissue to alter the refractive error in someone’s eyeball. Intralase refers to the brand of the Femtosecond laser. The Intralase company was acquired by Abbott Medical in 2009. It is a highly innovative way to use a laser for extreme precision in microsurgery. Virtually any shape or cut can be programmed into the laser to perform microsurgery of the eye. Mind blowing!

Intralase LASIK

Intralase LASIK refers only to using a Femtosecond laser to perform the creation of the flap required in LASIK surgery. There are other companies that also make a Femtosecond laser to make the flap.

Intra-lase laser: this is just an alternative incorrect spelling of the Intralase Laser.

Microkeratome vs Intralase

The Microkeratome was initially used to make the flap for LASIK. LASIK was approved in 1997, but the device used to make the flap at that time is a modified version of another older device called the automated corneal shaper or ACS. The ACS was used for other corneal procedures in the 1990s. Fortunately, there were innovations in the Microkeratome that made it safer, easier to operate, and gave more consistent and thinner flaps. I personally used a device called a Hansatome to create the corneal flap. I quit using the Microkeratome in 2007, when the Intralase was introduced in its second or third version which was much faster.

Intralase and Bladeless LASIK

These terms are synonymous. Intralase is a brand of Femtosecond laser that obviated the need for a Microkeratome. A LASIK flap is created either with a blade or with a laser. My preference is to create the flap with the laser because it is more consistent, thinner, does not change the refractive error, can create any shape or side cut desired, and it can also be moved intraoperatively and made smaller or bigger.

What is Intralase?

The Intralase laser uses a solid state (no gases in the laser) laser to create an extremely fast tiny pulse of laser energy to create plasma (the fourth state of matter) which is a super heated gas. It’s so tiny that it doesn’t create enough thermal energy (heat) to damage the surrounding tissue. As much as it pains me to admit it as a graduate of THE Ohio State University College of Medicine, the Femtosecond laser was developed in the 1990s at…well, let’s just say north of Columbus, OH.  https://news.umich.edu/laser-performs-breakthrough-high-precision-corneal-surgery/

LASIK vs. Intralase

As a surgeon, I believe the Femtosecond laser is an amazing tool to create the flap. It’s safer, more consistent, slightly easier for the patient, and psychologically more palatable. I did my last bladed keratome flap in about 2007, and I’ve never looked back. Over the past 15 years, the femtosecond laser has gotten better, faster, more consistent and has the ability to position the flap intraoperatively, so the flap can be centered over the pupil. There are still some surgeons using a Microkeratome to create the flap, but I can’t recommend a Microkeratome as a good option. The Femtosecond laser is better, in my opinion.

The point is that LASIK is safer, faster, easier, and more accurate than it has ever been, and it’s always been amazing. Come in for your free comprehensive exam at SharpeVision Modern LASIK to see which procedure is best for you. Call us at 425-451-2020 or schedule online at sharpe-vision.com.

Making glasses a thing of the past,

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Dr. Matthew Sharpe- Founder of SharpeVision

Dr. Matthew R. Sharpe

Dr. Matthew Sharpe is an Ophthalmologist specializing in refractive surgery and the owner SharpeVision MODERN LASIK, with offices in Seattle, Austin, and Chicago. Dr. Sharpe is a world traveler, pianist, marathon runner, motorcyclist, and fluent French speaker. He enjoys every second of life, but finds he is happiest at home watching Netflix or cheering on The Ohio State Buckeyes with his wife, three children, and two dogs.
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