All-laser LASIK has become increasingly popular. This is partially due to the development of the IntraLase femtosecond laser, which was approved by the FDA in 2001. (Learn More)

In traditional LASIK procedures, the microkeratome created a miniscule flap of tissue on the surface of the cornea, which allowed the excimer laser to reshape the underlying corneal tissue.

Using the IntraLase device rather than a microkeratome allows for thinner flaps, faster healing times, and fewer problems with the healing process. (Learn More) However, IntraLase is not a great solution for everyone, especially if you have had a laser-based refractive surgery before. (Learn More)

The surgical process for IntraLase LASIK is similar to traditional LASIK, but the femtosecond laser creates microscopic gas bubbles rather than allowing a blade to slice through the tissue. (Learn More) More people have benefitted from the improved IntraLase option, so ask your optometrist or ophthalmologist if this could be a good procedure for you. (Learn More)

IntraLase Devices & All-Laser LASIK

woman undergoing lasik procedure

The laser-assisted in situ keratomileusis (LASIK) procedure rose to popularity in the 1990s as a third option to correct refractive errors. Glasses and contact lenses have long been the first line of treatment for nearsightedness, farsightedness, and astigmatism, but many people want to stop wearing corrective devices.

LASIK has helped millions of people all over the world get at least 20/40 visual clarity. Improvements to LASIK technology and process, including the IntraLase femtosecond laser device, have helped this outpatient surgery to become even less invasive and time-consuming.

The LASIK surgery process involves two parts: creating a flap of tissue on the surface of the cornea, and sculpting the internal cornea to change its shape and correct the refractive error. For several years, the corneal flap was created with a microkeratome, which is a small surgical blade.

The IntraLase femtosecond laser was developed as an option to replace the microkeratome. Since its approval in 2001, more companies have created bladeless LASIK devices, but IntraLase remains one of the first, used in the patented IntraLASIK refractive surgical procedure.

Although it is a patented device, IntraLase is offered through many eye surgery clinics, and it could be a great procedure for you. Ask your ophthalmologist about bladeless LASIK like IntraLase to understand whether your eyes will benefit from this procedure.

IntraLase Improves LASIK Outcomes Compared to Traditional LASIK

According to the Food and Drug Administration’s approval information, the IntraLase device was designed to create lamellar corneal resections and incisions using photodisruptions, or laser light-based slices, in the tissue on the surface of the cornea. This creates the “flap” of tissue that is pulled back so the second part of the procedure (reshaping the cornea with an excimer laser) can take place.

The IntraLase femtosecond laser was designed to improve the LASIK process in several ways, like:

  • Allowing for greater precision in creating the flap on the cornea.
  • Making thinner flaps so people with naturally thin corneas could benefit from LASIK.
  • Creating a corneal flap through a less invasive process so healing time is faster.

Eye surgeons report that the flap created on the surface of the cornea is often the main source of vision problems following LASIK surgery. Though these complications are rare, healing problems, scarring, or unhealed and unsecured corneal flaps are often what cause poor LASIK outcomes.

Surgeons report that microkeratome flaps might lead to problems like:

  • Free caps, or flaps that failed to reattach and heal.
  • Partial flaps, in which part of the flap did not reattach to the cornea.
  • Buttonholes, or improperly formed flaps.
  • Epithelial slough from damaged eye tissue, sometimes due to flap problems.

Many eye surgeons report great improvements in these issues with laser-guided corneal flap creation. It is also easier to predict how thick the flap will be, how well it will hold in place, and how it will heal together. While the listed problems have also, in some cases, occurred with the IntraLase device, problems with corneal flaps are much rarer with IntraLase compared to microkeratomes.

Although there are benefits to the IntraLase device in an iLASIK or IntraLASIK procedure, traditional LASIK with the microkeratome takes less time. This is, in part, because more eye surgeons are trained on the microkeratome device, so they can use it more effectively. Some eyes surgeons report that the suction involved to secure the corneal flap takes only about three seconds with a microkeratome, while it takes 15 to 20 seconds during an all-laser procedure.

It may be easier to find an eye surgeon trained in traditional LASIK using a microkeratome. But bladeless LASIK procedures are increasingly popular with consumers, so more ophthalmologists are pursuing IntraLase training.

More trained surgeons equals lower costs for the procedure overall, so you are likely to pay about the same amount for traditional compared to IntraLase LASIK. The range generally falls between $2,000 and $3,000 per eye.

IntraLase May Not Work for Everyone

laser eye surgery

People who have naturally thinner corneas benefit more from IntraLase, compared to those with normal or thicker corneas. The IntraLase device was originally designed to be more precise compared to a microkeratome, but the benefits may also involve the shape of the corneal flap that either device creates.

Microkeratomes create a meniscus flap, meaning the flap on the surface of the cornea is thinner in the center and thicker at the edges. In contrast, lasers reportedly create a planar flap, or one that is an even thickness at each part. Some medical studies suggest that there are fewer higher-order aberrations with IntraLase or other all-laser LASIK procedures, compared to bladed LASIK.

You are not a good fit for IntraLase if you:

  • Are younger than 20 or older than 45.
  • Have an unstable refractive error, meaning you need new glasses or contact lenses about every year.
  • Have an eye disease like cataracts or glaucoma.
  • Are pregnant or breastfeeding.
  • Have an underlying chronic illness that reduces your body’s ability to heal, such as an autoimmune disease.

People who have had previous refractive surgeries, like a prior LASIK procedure, are not good candidates for IntraLase all-laser eye surgery. Traditional LASIK may be an option if you still have enough corneal tissue, or you may need another type of refractive surgery, like photorefractive keratectomy (PRK).

With either the microkeratome or IntraLase femtosecond laser, the flap will not need stitches or special surgical glue to go back into place and begin healing. The edges around the laser-cut flap can be more precise, allowing for a better healing process and less scarring.

LASIK Surgery & the IntraLase Device for the Corneal Flap

Like traditional LASIK, you will start IntraLase by meeting with your optometrist or ophthalmologist for a full eye exam. You’ll discuss the available surgical options, including financial considerations, and then determine which will work best for you. You will discuss the healing process and get a referral to an eye surgeon if your eye doctor cannot perform the procedure.

Then, you will have a wavefront analysis done on the surface of your corneas, which is essentially a map of that area so your eye surgeon can understand where to remove tissue so your corneas change shape appropriately. The wavefront analysis can be programmed into a modern excimer laser, making this operation very precise.

You will need to get someone to drive you home after the LASIK procedure because you will not be able to see clearly for the rest of the day. On the day of the procedure, you can expect the following:

  • Preparation: LASIK with IntraLase is an outpatient operation that takes about 10 to 15 minutes per eye, so you will be awake for the procedure. Your eye surgeon will give you eye drops to numb your eyes, and use a device to hold your eyelids open. You may also receive a mild sedative to keep you relaxed during the procedure.
  • First stage: Your eye surgeon will use the IntraLase femtosecond laser to create the flap in your cornea. While the microkeratome slices like a very small scalpel, the IntraLase uses a different approach to creating a precise corneal flap.
    • A laser is focused on the area.
    • The beam hits and creates shockwaves in the tissue.
    • Shockwaves create cavitation bubbles.
    • The cavitation bubbles fill with gas.
    • The gas bubbles allow for tissue separation.

While this may not seem more precise than a scalpel, the IntraLase device creates microscopic bubbles, so the tissue is thinner and better able to fit together when the procedure is complete.

  • Second stage: Your corneas will have some tissue removed using an excimer laser, so they will reshape to clearly refract light onto your retina.
  • Completion: The corneal flap will be put back into place, and you will rest in a postsurgical room for about an hour to ensure everything is okay. Then, you will go home and follow your doctor’s aftercare instructions.

IntraLase Improves Healing Time & Reduces Side Effects

IntraLase’s current manufacturers have worked to reduce any risk of side effects, but there is always some risk involved with any surgical procedure. Side effects from most LASIK procedures, including iLASIK, typically resolve in about six months, but they can include:

  • Dry eyes.
  • Double vision.
  • Glares or halos around lights.
  • Undercorrection or overcorrection, requiring a second surgery.
  • Astigmatism.
  • Infection or inflammation.
  • Other flap healing problems.
  • Regression back to original refractive error.
  • Vision loss or serious changes (very rare).

Studies have found that the IntraLase and other, similar femtosecond laser devices create fewer aberrations during the healing process. While you will need to follow an aftercare regimen for several weeks, just like with traditional LASIK, you are likely to experience better healing and vision outcomes.

A study on iLASIK involved 240 people undergoing refractive surgery, with 138 of those receiving iLASIK. After three months, there were fewer corneal aberrations in the all-laser group, with 94 eyes, or 68 percent of the group, achieving 20/20 vision without continued use of glasses or contact lenses.

IntraLase Is One of Many Bladeless LASIK Options

Since the IntraLase device was approved by the FDA in the late 1990s, its uses have expanded to other types of laser surgery for vision improvement or maintenance. More surgeons using the device means improved safety and reduced cost, so all-laser surgery using the IntraLase femtosecond laser is one of the most effective refractive surgeries on the market in the United States.

If you are interested in the IntraLase device as part of iLASIK or IntraLASIK, rather than pursuing traditional LASIK, talk to your optometrist and ophthalmologist. They will assess your eyes and determine which type of laser eye surgery is right for you.

 

References

A Look at LASIK Past, Present, and Future. (June 2009). American Academy of Ophthalmology (AAO).

INTRALASE Fusion Laser. (February 2007). United States Food and Drug Administration (FDA).

LASIK Eye Surgery: Is It Right for You? (April 2019). Mayo Clinic.

‘Blade Versus Bladeless’ LASIK Debate. (June 2016). All About Vision.

Refractive Therapy. (2017). Ontario Association of Optometrists (OAO).

LASIK Eye Surgery. WebMD.

Femtosecond Lasers and Laser Assisted In Situ Keratomileusis (LASIK). (January 2015). EyeWiki, American Academy of Ophthalmology (AAO).

The LASIK Procedure: A Brief Guide. (April 2019). All About Vision.

LASIK: Know the Rewards and the Risks. WebMD.

LASIK Quality of Life Collaboration Project. (September 2018). U.S. Food and Drug Administration.

LASIK Eye Surgery. (November 2019). Mayo Clinic.

Effects of Advanced Surface Ablations and IntraLase Femtosecond LASIK on Higher Order Aberrations and Visual Acuity Outcome. (September 2011). Saudi Journal of Ophthalmology.