IntraLase® vs. Microkeratome
by Michele Boyer
A Microkeratome is the blade used in LASIK surgery to cut the corneal flap.
The microkeratome blade has been the standard method of cutting the corneal flap in LASIK since LASIK was first developed. Previously, the microkeratome was used in other corneal procedures such as ALK. The microkeratome blade is used to cut a flap that remains hinged on one side. The flap is laid back exposing the corneal tissue for shaping with the excimer laser. This has been a safe and effective means of creating the flap for many years. While there are few complications resulting from LASIK surgery, the many of the complications result from cutting this flap. All of these are correctable. They include post-operative epithelial in-growth, aberrations resulting from healing the edges of the flaps, and dislocation of the flap post-operatively. Some of the advantages of using this procedure are lower cost, longer history of success, and surgeons greater experience with this technology than with IntraLase®.
IntraLase, also known as IntraLASIK, Blade Free LASIK and All-Laser LASIK, is new technology used to create the corneal flap during the LASIK procedure. It “cuts” the flap using a computerized laser light rather than a blade. Since the cornea is also reshaped using a laser, this procedure, which replaces the microkeratome blade with a laser, is often called “all laser LASIK”. Because most LASIK complications are associated with using the microkeratome blade, IntraLase has been touted as a safer method. It not only cuts the flap with more precision, but it is, also, a completely sterile procedure.
In addition, with the IntraLase method, more patients achieve 20/20 vision than with a microkeratome. IntraLase is a computer-controlled laser that delivers pulses of femtosecond laser light to the cornea at a specified depth and position. Each pulse creates a bubble. All the bubbles are connected together forming a space, which in turn creates the corneal flap. The edges of the corneal flap are vertical, not tapered. These vertical edges of the “cut” make improve healing compared to the tapered edges created by the microkeratome blade. Since it is the tapered edges that are associated with corneal dislocation, aberrations and epithelial in-growth, post-op corrective surgery is required far less often using IntraLase.
With IntraLase, the flap can be designed and cut with great precision, qualifying patients for IntraLASIK who didn’t qualify for traditional LASIK (e.g., due to the shape or thinness of their corneas). Although InterLase technology uses a different laser to cut the flap than the excimer laser used to shape the cornea, this new technology provides the same precision in creating the flap as has been associated with shaping the cornea in traditional LASIK.
The greatest disadvantage of the microkeratome over the IntraLase® is the cost. Another disadvantage is that the procedure takes a little more time with the IntraLase®. Expect to pay as much as $300 additional per eye for IntraLase®. However, some LASIK surgeons are NOT charging an additional fee simply because they prefer this technology, consider it safer, and prefer that all their patients have all-laser LASIK.
If you are considering LASIK, a thorough screening by a qualified LASIK surgeon is a must. Finding a qualified surgeon means identifying one who has plenty of experience performing a variety of laser eye surgeries. A qualified surgeon will be ready to provide statistics about his or her practice that are well within the standards and guidelines established by the FDA. Find out what diagnostic testing will be done to determine your specific surgical needs and the type of surgery that is best for you.