Intralase: infection rate and "trauma" to the corn

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Intralase: infection rate and "trauma" to the corn

Postby kschueleraugsburg » Mon Jul 23, 2007 2:49 am

Hello from Illinois!
I had my third eye exam this week to determin if I'm a candidate for laser vision correction. I may be a bit paranoid, but I went to three different eye doctors, all relatively well experienced.

One thing is still somewhat puzzling for me, and maybe the forum here can help.

I am considering Intralase (laser-only) Lasik, non-wavefront guided, with Bausch&Lomb Laser.

The last doctor I talked to said he would not recommend Intralase, because the creation of the flap with the keratome would be
a)less trauma for the cornea
b)quicker (20 sec versus 1 minute), during which there would be no blood circulation to the eye
c)the infection rate would be higher and really bad infection could happen.

He compared the Intralase process with the perforation of a stamp. The laser burn a large number of bubbles, and then the flap is "ripped" up and the cornea experiences trauma.

On this website and from other sources I read that Intralase is the way to go. Also, the doctors that talked against laser-only does not have an Intralase. How should I read this? I'm not really concerned, because if that was the case I assume I could read about it on the Internet, correct?

I have an appointment for surgery set for Aug 9....

Thanks for your help!
kschueleraugsburg
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Postby JPD » Mon Jul 23, 2007 4:16 am

I won't claim to be an Intralase expert, but I can give you my personal observation and information I have gotten from experts.

First of all, I would consider the fact the doctor your refering to doesn't have the Intralase to possibly be a Red Herring. He's not about to tell you "Oh ya, Intralase is better, but I don't have one".

Secondly, here where I live in Southern California we are fortunate to have many of the Countries best, and worlds best Lasik surgeons. I can tell you that ALL of the top Lasik surgeons in Southern California use the Intralase for flap creation.

Third and last point, and also the most significant to me. I was told straight out by a corneal specialist who was a different doctor then the one that did my surgery, that me having the Intralase flap, and I quote "Was the best possible thing I could have done." Now, that comming from a corneal specialist carries a lot of weight with me.
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Re: Intralase: infection rate and "trauma" to the

Postby LasikExpert » Mon Jul 23, 2007 5:41 am

kschueleraugsburg wrote:I am considering Intralase (laser-only) Lasik, non-wavefront guided, with Bausch&Lomb Laser.
Why conventional instead of wavefront-guided custom Lasik?

kschueleraugsburg wrote:a)less trauma for the cornea
Technically correct, but no study has shown that the cornea is less healthy after a flap created with a femtosecond laser microkeratome than with a mechanical microkeratome that uses a steel blade.

kschueleraugsburg wrote:b)quicker (20 sec versus 1 minute),
The use of a femtosecond laser microkeratome is a bit longer, but again no study has shown any detriment to an otherwise healthy eye.

kschueleraugsburg wrote:...during which there would be no blood circulation to the eye
This is not accurate. Both a mechanical and laser microkeratome are affixed to the eye with suction. This suction raises the intraocular pressure dramatically, however damage will not occur on an otherwise healthy eye.

kschueleraugsburg wrote:c)the infection rate would be higher and really bad infection could happen.
I can find absolutely nothing to substantiate this claim.

A flap made with a femtosecond laser is not always the way to go and several studies have shown that outcomes past six months are virtually identical with both, however the flap created with the femtosecond laser has a more accurate thickness. This may or may not be important, depending upon the overall thickness of your cornea.
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Postby kschueleraugsburg » Mon Jul 23, 2007 3:54 pm

Glenn:
You asked why not wavefront guided. I understand that this is considered more advanced, however three doctors told me "not necessary in your case". This maybe has to do with the high-order aberrations. One doctor told me that a wavefront guided ablation would most likely remove more tissue. All three doctors have the ability to do a wavefront guided procedure. If it really saves tissue, then it would be a good choice to not do it.
My readings (from wavefront analysis) for abberations are 0.11 and 0.17 (right and left), and doctors told me that everything below 0.3 was excellent. Not sure what the dimension is of this number. The key point for me is that three reputable surgeons are in agreement to not do it.

An interesting fact for me was: the results (myopia, astigmatism, corneal thickness, high-order aberrations, cornea topography, pupil size, field of vision, ...) from all three exams that I did were virtually identical, very low variation.

Thanks and best regards,
Kai
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Postby LasikExpert » Tue Jul 24, 2007 7:48 pm

According to some new studies, someone with higher order aberrations (HOA) as low as yours may not benefit significantly from the use of wavefront-guided ablation. You will undoubtedly have an increase of HOA after surgery, but the increase would likely put you up to "normal" vision.

That said, "normal" vision may be a bit less in quality than the vision to which you have become accustomed.
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Postby JPD » Wed Jul 25, 2007 3:35 am

LasikExpert wrote:That said, "normal" vision may be a bit less in quality than the vision to which you have become accustomed.


Are you saying then that someone with HOA's as low as him would still benefit from wavefront?
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Postby LasikExpert » Wed Jul 25, 2007 3:49 am

As a general rule, wavefront-guided ablation induces less HOA than conventional ablation. Normal (there is that word again) Root Mean Squared (RMS) HOA is about 0.35 to 0.40 microns. Poster kschueleraugsburg is quite a bit lower than the norm. If his/her vision is better than the norm, such as he can see the 20/10 line, has very good contrast sensitivity, etc., then being raised to normal HOA may seem like a degradation in vision quality - which it is, but from an unusually low level.

One of the other considerations is ablation depth. As a general rule, wavefront-guided ablation requires more tissue. If the corneas are thin, then conventional may be considered better.
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