Custom vs. Flying Spot and pupil size concerns

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.

Custom vs. Flying Spot and pupil size concerns

Postby tfield77 » Fri Jul 28, 2006 3:08 am

Hi - I have an appointment to have Lasik done next Thursday and want to ask a couple of questions from an independent third party :)

First - have you heard anything bad about LasikPlus? They are quite the "hard sell", but I feel that is understandable considering they are a company with stockholders to answer to. I asked or was given the answer to most of the 50 questions and was satisfied with the answers - especially that they have turned away about 20% of the people that walk through their doors.

My first question - have you ever heard of a doctor saying Flying Spot would be better than Custom for a patient? I am about -4.25 in both eyes, very slight astigmatism and have nice thick corneas (if I remember right, he said somewhere between 550-575). My pupils, when dialated naturally in a dark room were around 8.5mm. The optometrist that I met with explained the two technologies like this:

Flying Spot: 9mm target width (not sure if that is the correct wording), takes off a bit more per diopter than custom, but uses a smaller beam (2mm) so therefore the ablation area would be smoother - he described it in terms of pixels - smaller pixels (smaller beam) makes a better picture.

Custom: The basic advantage being the software better figuring out how much to remove, but it is a broad beam technology and therefore we wouldn't get that smoother ablation area like Flying Spot.

I assume he suggested Flying Spot because I have a thicker cornea and can handle having more removed and it would give me a better result.

Does this sound correct to you? I don't know how the center makes its money, but the custom is $500 more per eye, so to suggest I would get the best results with the cheaper one sounds like I am getting an honest opinion.

By the way, in side research I noted that the Flying Spot he told me they use it the Bausch & Lomb - thoughts on this technology?

LAST of all (sorry so long) - my pupil size... he said I will be ok since the Bausch & Lomb has a 9mm target area.. but I've heard optical area and transition area all over the place. Would the only way I know this is by asking them? I think halos at night permanently is my biggest concern. Starbursts are no big deal because last night I noticed I had those with my glasess to a small degree :)

Thanks for your time...

PS. You suggest how much Vitamin C to promote healing? Anything else? I want to do everything I can.

Tonja
tfield77
 
Posts: 1
Joined: Wed Jul 26, 2006 10:42 pm
Location: Sacramento, CA

Postby LasikExpert » Fri Jul 28, 2006 4:11 am

Considering the sheer volume of LasikPlus patients out there, it would be impossible to not hear something bad about them; or anyone, for that matter. LasikPlus is a chain that promotes heavy discounts, hard sell, and must be very “efficient” to be profitable. As you mentioned, they have shareholders.

That need for efficiency can translate into a process that emphasizes a quick patient turnaround and care provided by non-surgeons more than the “touchy feely” and one-on-one nature of other offices. Whether or not you are okay with that is really a matter of personal choice.

Visiting multiple practices, including one that is an independent surgeon, before making a decision about where to have surgery is always a good idea. You can decide which environment is best for you. Despite the advertised low price, you may be surprised to find that the average actual price at LasikPlus is not that far off of other more traditional providers of care. This is another reason to visit multiple facilities before having surgery.

The statement that “flying spot is better than custom” appears to be taken slightly out of context. There are three major types of application of the laser energy to ablate (remove) corneal tissue. A broadbeam is the laser energy being applied to the entire treatment area with every pulse. A flying spot is a small spot of laser energy that is applied here, there, then here again until the entire treatment area is ablated. A split beam is a broadbeam laser with an adjustable iris in front of it to reduce the size of the area that hits the cornea. The Nidek EC-5000 is a broadbeam. The Visx is a split beam. The Wavelight Allegretto, Bausch & Lomb Technolas 217z Zyoptix, and the Alcon LADARVision are all flying spots.

Custom tends refers to wavefront-guided ablation that is determined by the unique properties of and individual’s eye. The Nidek EC-5000 cannot perform wavefront-guided ablations because it is a broadbeam laser. The Visx calls its wavefront-guided system CustomVue, Alcon named theirs CustomCornea, and Bausch & Lomb came up with Zyoptix.

The US version of the Allegretto is wavefront optimized. That means that wavefront data was used in the lab to develop the static ablation pattern, but it is not customized to each patient. You really should read our article about Custom Wavefront Lasik.

The Visx, Bausch & Lomb, Alcon, and Allegretto all provided relatively good and relatively equal outcomes in clinical trials. Each manufacturer will claim their system is superior. Most doctors will consider what they own to be better than what they don’t own. All in all, the quality of the surgeon is much more important than the quality of the tools that surgeon uses. There is no amount of technology that can compensate for an inferior surgeon.

I am going to refer you to our detailed article about Lasik Pupil Size for that information. This can be a very important issue, or one that is almost not important at all. You will need to ask your doctor for the necessary measurements and planned treatment zones.

The thickness of your cornea is neutral. No matter what system is used, about the same amount of tissue will need to be removed. The physics of refractive surgery are not changed from one laser to another.

At least one study found that 500mg of vitamin C twice a day for one week before surgery plus two weeks after surgery reduced the probability of late onset corneal haze, however haze should not be an issue if you have Lasik or IntraLasik. Haze would normally only be an issue if you are a very high myope and are having PRK, LASEK, or Epi-Lasik.

I see we are in the same city. Feel free to contact me via Personal Message, if you like.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California

Postby maxxed » Tue Sep 19, 2006 2:00 pm

Not quite correct about the Nidek being a Broadbeam laser.

It's actually a scanning slit beam. It applies energy as a 7.5 mm x 1mm slit of light which scans the cornea in several directions. That way it doesn't get excessive heating or central islands created by the laser hitting one spot on the cornea repeatedly.

True, the US version cannont create complex shapes on the eye as needed for custom ablation. The foreign versions of the laser (CX series) uses what Nidek calls segmental ablation to perform custom laser vision correction. I hope Nidek gets that version approved, because some of the best worldwide results have come from that platform.
maxxed
 
Posts: 7
Joined: Mon Sep 18, 2006 11:13 pm

Postby LasikExpert » Tue Sep 19, 2006 4:28 pm

Thanks for the additional information on the Nidek EC-5000. I agree that it is a pity Nidek has not been able to achieve US Food and Drug Administration approval for improvements to its laser. The US version is not wavefront optimized or wavefront guided and does not have advanced tracking abilities. This particular laser has been passed by all the others in both technology and outcomes. It may still be appropriate in some circumstances, but the range of those circumstances is narrowing every year that Nidek is unable to achieve approval of improvements and other manufacturers report superior results.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


Return to Thinking About It

Who is online

Users browsing this forum: No registered users and 2 guests