VISX Customview v Allegretto and ablation zones

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VISX Customview v Allegretto and ablation zones

Postby jamesg711 » Mon Jul 31, 2006 12:17 am

What are the reasons that a patient or a doctor would use the Allegretto Wave over the VISX w/customvue? The Allegretto reports that 87% of patients see 20/20 one year after surgery and VISX S4 Customvue reports that 98% of patients see 20/20 one year after surgery. There must be a reason since many top docs have chosen Allegretto. The "top" doctor in my area (highest volume, best marketing) uses Allegretto but there are a few great doctors in the area with tons of experience that use the VISX w/customvue. Also, my pupils dilate to 7.5mm and 7.6mm in low light. Allegretto is 4.5mm-8.0mm optical and VISX is 6 with a transition to 9mm. Is the ablation zone large enough to reduce the chances of night halos for me? Does that mean one is better for Halos? Allegretto doesn’t use wavefront and customvue does? Is it not important? Why would a top doc get a laser that doesn’t have wavefront? Does the optical zone have to be larger than my pupil size or does the "transition zone" count? Please help. Thanks.
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Postby LasikExpert » Mon Jul 31, 2006 2:33 am

Like any other set of tools, one often is the best to use in a particular situation, but another will likely complete the job too. Depending upon the exact physiology of your eyes, it may be that one laser is significantly better than another, or that virtually any laser will do. I will not be able to tell you which laser is “best”, but I’ll give you some known strengths of the two you are considering. Only your doctor will be able to tell you what is required and what is optional.

The Visx S4 CustomVue is a wavefront-guided laser. The WaveLight Allegretto is wavefront optimized. More details are at Wavefront Lasik, but the short description is that the Allegretto used wavefront data in the lab to create a static ablation profile and the CustomVue uses a wavefront analysis of the individual eye to determine the best ablation profile. While the custom and individual ablation would intuitively seem the best, it is not always the best.

You mention very large pupils in low light environments. The optical ablation zone of the Visx S4 is 6.5mm and that drops down if correcting astigmatism. The optical ablation zone of the Allegretto can be much larger. This can be an issue. The transition zone does count, but the optical zone counts more. For the details, read Lasik and Pupil Size.

After you read these two articles you will understand that you require a wavefront analysis to determine if wavefront-guided ablation is really necessary, but due to your pupil size a wavefront-guided ablation may be too limited in size even if wavefront is required. At that point you may want to abandon refractive surgery. At least for now.

Take a look at those articles and post again if you have more questions. Ultimately, this will all become an issue for your doctor to advise.
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