Comparing the Latest Lasers Available- HOT TOPIC!

If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.

Comparing the Latest Lasers Available- HOT TOPIC!

Postby kness2 » Sun Jan 20, 2008 2:48 pm

I'm in India right now and they have a variety of wavefront lasers available here (some of them more recent than anything available in USA). I have a -7.25 in both eyes plus astigmatism. Can someone give me some information on which is the most advanced?

1. Zyoptix 100- seems to be older than the Allegretto

2. Mel 80 (Carl Zeiss)- has little information other than that the spot size is 70mm (same as Allegretto), but doesn't mention repetition speed. Apparently it ablates more tissue than the Allegretto, but am curious to know whether the software has been upgraded since then.

3. Wavelight Allegretto 400mhz- has the most info on it. They also have the Wavelight Concerto 500mhz here but it is extremely expensive (3 times the price)- so I'd only consider the the Allegretto.

4. Schwind Esiris- referred as the Rolls Royce of lasers on the site- but seems to use a different technology than the Allegretto. Here is what the surgeon claimed: "I use both abberometrically linked data as well as corneal wavefront data,for this we recieved the prize at the annual meeting of the american society of cataract and laser surgeons in san diego in april 2007. The 400 as well failed with its abberometric linkage and the company discontinued manufacturing the abberometer."

5. Nidex EC5000 CXIII on Navex platform Spot -combination of flying spot and broad beam, Moria M2 microkeratome. The doctor I spoke to said he has both the Nidek and the Allegretto 400 and said that the Nidek produced better results for him. (But from what I read on the net, many doctors say the opposite- which is confusing).


I heard that the Pulzar Z1 by Customvis is available in India, but haven't been able to find out where. Does everyone who has the Allegretto 400mhz have the same Allegro system, Eye-Q, and software? Or will I have to ask them individually?

When Glenn Hagele mentioned that the "newest version" of Wavelight having custom wavefront ablation, was he referring to the Allegretto 400mhz or the Concerto 500mhz?

By custom wavefront ablation, was he referring to wavefront optimized/guided/ or something else entirely?

I'm looking to have the most advanced laser technology on the market. I understand that newer lasers have less clinical studies on them- and I'm fine with that. I have worked in FDA clinical trials before and I realize that by the time sufficient data has come out for a laser, a newer technology has already taken its place. With this in mind, I don't mind taking a risk on a newer laser provided its specs "should likely" produce better results for me.

A discussion and comparison of the lasers above is what most people on this forum would like to see. Any volunteers?

Kness
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Postby LasikExpert » Mon Jan 21, 2008 10:21 pm

Because you have the advantage of living in India you have available many different laser platforms that are not approved for use in the United States. I am only familiar with US approved lasers.
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Postby tastyratz » Wed Jan 30, 2008 10:02 pm

I myself am also very interested in the Zeiss laser.

There is a place in Montreal Canada with 2 of them. California is the only USA location I have found but I live in NH so Montreal is only a 5 hour drive for me.

I have found nothing but rave positives on it however information as well is fairly scarce.
To help others I have found this:
http://www.accessdata.fda.gov/scripts/c ... or%20LASIK

Its data from the FDA website on data from laser submissions. The mel 80 has a rather impressive success rate in relation to the other lasers the fda lists- actually far above. Looking at their website Zeiss claims better than 20/20 and that 40% in their study achived 20/12.5!!

I know it always comes down to picking a fine doctor and that should always be the ultimate deciding choice but equally skilled it appears statistically to be the rolls Royce. Does anyone else have any good information on this device?
Any and all input on this laser is duly appreciated on my part as well.
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Postby kness2 » Wed Feb 20, 2008 3:35 pm

Actually I'm from Montreal. I'd get it done with the Mel-80- but it would probably cost $3500 for both eyes. For that price, I can fly economy fare to Mumbai, stay in a beautiful hotel with servants catering to my every need, get lasered with the Mel-80, Allegretto 400mhz, or even the Concerto 500mhz, with more advanced techniques than the FDA allows in the USA, and then fly the next day to Goa for a week's vacation in a beautiful resort in the sand and sun, come back to Mumbai for the 1 week followup, and then fly home!

I flew to India on vacation and decided to get my eyes done while here. The technology and specs allowed here are much better than anything allowed in the States. By the time the FDA comes out with their results and approves the technology, the companies have already introduced new algorithms with better results.

I'm scheduled to have wavefront lasik surgery tomorrow at Bombay Hospital with the Nidek EC5000 CXIII on Navex platform at a cost of 30,000 rupees ($750).

But I'm not so confident anymore and am thinking of cancelling-especially after seeing what you wrote about the Mel 80 (which is also $750 here). The info about the Nidek is confusing. Does it have a 0.8mm spot size or 1mm spot size or 0.8mm +2mm?

Does anyone here have any experience with the Nidex EC5000 CXIII ?

Tastyratz- if you could afford a little more- I would fly to India and get it done with the Wavelight Concerto 500mhz, or the pulzar Z1 (solid state laser with a 0.2mm spot size and 1kilohertz speed! I know it's somewhere here, but haven't been able to find out which clinic.)
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Postby tastyratz » Wed Feb 20, 2008 3:56 pm

Actually,
I scheduled my surgery in Montreal with the zeiss machine - $1300USD per eye with lifetime warranty but no pre/post op care.
I scheduled my pre/post op with my local doctor for 400$ - all said and done its costing me $3k - much cheaper than most places I have found with lesser doctors and lesser equipment.

I know I am not supposed to post names of places here but if you want I can PM you information.

I sent them the 50 tough questions and they passed it with flying colors - Everything I have heard was very impressive to me from them. They OWN 2 zeiss machines and have 2 doctors that just do the surgery all day since 1993. The 2 of them have done 80k+ surgeries so far.

I have to admit I am very hesitant on traveling to India nevermind for medical care. At least I know this place has cutting edge equipment and doctors - plus its only a 4 hour drive for me. The trip and extended time off of work would be quite the hassle

I too want the latest and greatest and need not wait for FDA approval however I think where we differ is I will lean away from the bleeding edge for things with a reasonably proven success rate. Need not be excessively matured but I don't want to be the test mouse.
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EC5000 CXIII, Mel 80, Wavelight Eye-Q 400mhz

Postby kness2 » Sun Feb 24, 2008 11:54 am

I cancelled my surgery with the Nidek EC-5000 CXIII and have had a chance to decide between the Mel 80 and the Wavelight Allegretto 400mhz. I have chosen to get it done with the Wavelight Eye-Q 400mhz. It has almost the same specs and spot size as the Mel 80 but it ablates twice as fast.

As for the Nidek, after some research I discovered that the company was sued on many occasions and that the laser has hardly changed or been updated in years! Perhaps the lawsuits left them with less money for R&D?

My myopia is -6.25 DS / -2.00 DC x 1800 in the right eye and –6.50 DS / -1.50 DC x 1800 in the left eye. What is yours?

You referred to studies showing that 40% of the people in the Mel 80 study achieved 20/12.5. If you look at the fine print, the participant selection was ridiculously skewed, with most participants having very low myopia and only a few with higher myopia scores. In this case, with today's technology, almost all the newer lasers would give the same 20/12.5 result.

I've also seen studies showing that the Mel 80 ablates much more corneal tissue than the Wavelight. (The more corneal tissue you keep, the stronger the corneal shape integrity, and the less the chance that regression will occur.)

I work in the medical field so have been able to evaluate the technical specs of the lasers and have conversations with the doctors using them.

Most of the lasers I've mentioned are not on the bleeding edge of technology- and are in heavy use everywhere but North America. For example, Wavelight's lasers have custom-Q, topography-guided, tomography-guided, optimized, and guided. The same laser in the USA does not have most of the features or advanced software algorithms.

The bleeding edge of technology would refer the solid-state lasers (Katana, Pulzar etc) which have a much smaller spot size of 0.2mm and a speed of up to 2ghz! Think of spot size like an artist's brush. The smaller the brush, the more fine details you can fix...

Most people are hesitant of traveling to India- myself included. I came here on vacation and after seeing the facilities, decided to get it done here in Mumbai/Chennai. I am scheduled for the wavelight tomorrow morning. Do you want me to update you on Tuesday?
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Postby LindaT » Mon Feb 25, 2008 12:31 am

Yes! Please! Of course! Give us an update!!! Don't leave us hanging!!! I'd love to hear how you're doing.
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Postby kness2 » Thu Feb 28, 2008 10:08 am

Update:

I got my surgery yesterday in Chennai at Sankara Nethralaya Hospital with the Wavelight Allegretto Eye-Q 400mhz. I was lucky enough to have the head of surgery as my surgeon.

Prior to surgery my best corrected visual acuity (BCVA) with glasses was:

Right eye (OD): 20/16
Left eye (OS): 20/17

Overall my BCVA was 20/16.

The day after surgery my scores are as follows:

Right eye (OD): 20/18+ (it is 20/18 but can see some letters up to 20/16)
Left eye (OS): 20/18

At the moment i don't feel satisfied, because my right eye vision is quite sharp and the left eye is not.

I'm not a believer in the 20/20 logic: that 20/20 is "normal" vision. In fact, what is normal differs from person to person. 20/16 is normal vision for me- I have been habituated to it all my life. Now I feel off kilter and disoriented because my vision is no longer as sharp and because one eye is seeing far better than the other. However I will be patient, as vision scores always improve in the month following surgery.
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Postby tastyratz » Thu Feb 28, 2008 2:17 pm

You make it sound like that's anything but a great success story.

Statistically you are the minority getting a correction that good. 1 day after surgery and your already better than 20/20? If that's a problem then you set your expectations too high. What if your surgery put you in that lump group between 20/20 and 20/40? I think those results are great.

Your bcva was not even between the eyes prior, and its also not now with just a slightly larger margin. You must have been used to the 20/16 20/17 before, I'm sure your eyes will adjust - don't forget this is all new. Everyone feels "funny" right after a new pair of glasses for a little bit - then that becomes "normal"

Even if they don't its only the day after - its only going to get sharper.

I have a script of -2.25 and -1.5 - Right now my bcva is 20/20 and slightly higher than 20/15.

If I have better than 20/20 after surgery Ill be thrilled.
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Postby kness2 » Mon Mar 03, 2008 11:37 am

LOL tastyratz, I understand what you're saying- that 20/18 is an excellent vision to get the day after surgery. However, I have been so used to 20/16 and now i've lost 2-3 lines of vision.

The main claim of most wavefront lasers is that it will at least maintain your BCVA, and rarely degrade it, but the contrast sensitivity will not be as good as with glasses.

It is now five days after the surgery. If I look through my right eye at a book 2 feet away, everything is crystal clear and sharp. But when I look through my left eye at the same close distance, the lines are fuzzy and there's a bit of a haze. It seems that my near AND far vision has been affected- which is what I have to get used to.

There is a minority of people whose sense of vision is more acutely sensitive than others. In this minority, a little change in vision that would normally be negligible to the average person, is more serious. I must be one of those people.

I might have to get a contact lens for the left eye with a -.50 correction just so I feel less disoriented.

Does anybody have any experience with a situation like this?
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Intralase with Zyoptix 100 at maxivision in India

Postby salieeee » Wed May 28, 2008 4:22 am

I am in india on vacation myself and am scheduled for intralase lasik surgery on friday with the 60khz femtosecond intralase laser and the B &L zyoptix 100 excimer laser. What is the general opinion about intralase and also someone mentioned that the zyoptix 100 is an older laser? Does that mean I should hunt for a place with a better laser? I am going to maxivison in hyderabad in case anyone knows of a better location in hyderabad, India. Also when I had my corneal thickness tested in the states my thickness was about 40microns thinner than what the zyoptix orbscan said it was in India. I think it was an allegreto used in the states. So which corneal thickness should I trust in? The zyoptix said one eye was 527 and the other 520. The corneal thickness measured in the states 475 and 483. orbscan done 3 years ago with the zyoptix in india was 530 and 524. I am not sure weather to be concerned about thin corneas or not. Can I tell the doc to leave 300microns untouched? My vision is -6.75 and -7.5. I would appreciate any advise you can give me. thanks.
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Postby tastyratz » Wed May 28, 2008 1:53 pm

the post was that it was older than the allegretto.
I don't know what the age and release date are on them, you can conpare them and find out that easily enough I am sure.
newer/older matters less than what works and the doctors - only you can decide just how safe/cutting edge/bleeding edge you want. do you want to be more risky with a brand new machine with incredible specs or do you want the old tried and true but not as good. That balance is your own personal safety decision. I really cant comment on the rest of your post.

to update anyone interested on my surgery - I went to get it done in montreal canada the end of April and was turned down.
My corneal topography showed a large divot that could be early signs of keratoconus.
I'm a 24y white male and its only in 1 eye making it statistically far fetched.
I also am a very hard habitual knuckle eye rubber and it seems like the deformation is actually related to my constant eye rubbing (I had no idea it was really bad for me!) I even had a "last hurrah" of eye rubbing hours before the surgery to get it out of my system. Doctor thought it was 90% not keratoconus and was almost positive I was probably fine, but because there was any hint he couldn't ethically perform the surgery. I have to say I give him credit for that and respect his establishment that much more because of it.

I stopped rubbing my eyes completely and I am going to have another topography in 6 months. hopefully Ill be heading back up for eye surgery and montreals best bagels Ive ever had :-)
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Postby salieeee » Wed May 28, 2008 3:36 pm

The clinic I am having my surgery at said that they upgraded their old technolas 217z laser to the zyoptix 100. What does upgrade mean exactly? is it more of a software upgrade or is the instrumentation changed too? does anyone know if the z100 has 3d eye tracker etc? most people on this site have had good results with the allegreto, i'm not sure what to do. is the zyoptix still a good machine? it has iris recognition etc. also this doc has only had the intralase machine for 5 months but has said he has crossed 200 patients. should i be concerned?
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Postby LasikExpert » Thu May 29, 2008 1:21 am

For most patients the probability of a good outcome is about the same regardless of the laser so long as it is a current version. All the manufacturers tout their laser as the best, but for most patients the outcomes are very close to the same.

Having performed 200 femtosecond laser flap creations (Intralase) is very likely enough practical experience.
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Postby salieeee » Thu May 29, 2008 3:14 am

Mr.Haegel why do you think I had different corneal thicknesses with the different scans a difference of more than 40 microns? what is the thinnest cornea you can have to still qualify for intralase wavefront custom lasik?
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