Yes, it’s true! Prospective laser eye surgery patients really do not ask about or are concerned with which laser is used to correct their vision.

Well, first of all let’s look at the TWO factors which have the biggest impact on the quality of the person’s vision after treatment. And bear in mind that this is how well their eyes will be able to see for the rest of their lives.

The first is the laser that is used. The second is the knowledge and skill the surgeon.

Laser eye surgery results have got better and better over the past 15 years – and this is mainly because the lasers have got a lot, LOT better! Yes, we know more about good surgical technique and what to do and what not to do. But mainly it is better technology that has improved results.

So why don’t patients care about this? (Because they really don’t!!) When we surgeons start talking about this or that laser, you can see patients’ eyes start to glaze over!

The truth is that they feel they are not qualified to make any judgments about laser performances. After all, it’s a complex piece of machinery. So people adopt a head in the sand approach and just HOPE that all lasers are pretty much the same (they are NOT).

Patients assume “a laser is a laser is a laser…” and don’t want to get involved in some serious thought about laser performance. It looks like a difficult subject.

Even though it is pretty easy to see how these machines stack up. Because ALL the information is publicly available. The US government clinical trials run by the Food & Drug Administration (FDA) compare all lasers side by side.

We have published all these laser eye surgery results on our www.focusclinics.com website (see them here: www.focusclinics.com/treatments_results.php

The clear winner so far is the WaveLight Allegretto laser from Germany. We at FOCUS Laser Vision use it for that reason. So do Accuvision in London. You can also find it (although the older model) at Manchester Royal Eye Hospital.

So PLEASE! before you have laser eye surgery, look at which machine that clinic uses and check here for the results from using that laser. Because no matter how good the surgeon, they CANNOT get better results than the laser is capable of giving. It simply is not possible. Lewis Hamilton still needs a world beating McLaren car to win the race.

You have ONE pair of eyes. You need a great surgeon AND a great laser.

So remember… your eyes and your choice, always. All lasers are not made equally!

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Moria will unveil their new One Use-Plus SBK microkeratome at the upcoming 2008 meeting of the American Society of Cataract and Refractive Surgery in Chicago. Moria will present the clinical outcomes of their clinical trials. In eyes receiving this Moria SBK (ultra thin-flap LASIK), the flap thickness accuracy, speed of sight improvement, higher order aberrations and smoothness of corneal bed underneath the flap all compared favorably or equally to femtosecond (dual laser) SBK flap technology, according to Moria.

With many surgeons wary of creating ectatic (excessively weakened) corneas with their LASIK procedures, the interest in using thinner flaps has risen. Some surgeons routinely use flaps in the 130-µm range or thinner, using either mechanical microkeratomes or femtosecond lasers. I myself routinely create flaps that are 110 microns using the Ziemer femtosecond laser, without problems.

However, there can be additional risks when working with ultra-thin flap (less than 100 microns), such as microstriae (micro wrinkles) appearing in the flap afterwards.

I will be visiting their stand at the ASCRS meeting to check these results for myself and will report back to you!

What is the difference in the two laser eye surgery procedures?
There are basically two laser refractive procedures to correct myopia (short sight), hyperopia (long sight) and astigmatism: 1) LASIK and 2) LASEK. [You can consider LASEK and PRK as basically the same procedure for most discussions - they are both forms of 'surface' laser eye surgery with pretty much identical results].

Both LASIK and LASEK procedures are very safe and will give you the same final results. It can be quite confusing if you are thinking about laser vision correction and want to know which procedure would be best for you. While both LASIK and LASEK can give you excellent vision in a safe and reliable way, some surgeons prefer one or the other, or may indeed only offer one type anyway!

How is the prospective patient supposed to decide?!
What happens in practice is that patients are greatly influenced by what their particular clinician says, and understandably so. It is always worth seeking a second opinion and comparing the findings and comments of each centre. This shouldn’t threaten any clinic worth its salt. Some patients feel more confident with one person or another, based on perhaps only “chemistry”, but it is very important to know the difference in the techniques.
LASIK and LASEK are both very effective procedures and can be used to treat myopia (short sight), myopia myopia(long sight), astigmatism (irregular corneal shape) and reading vision problems.
Please note that most clinics do not have the correct technology required to correct reading vision problems and higher levels of long sight.

[tags]astigmatism, FOCUS Laser Vision, LASEK, laser eye surgery, LASIK, long sight, short sight, surgeon, Technology[/tags]

I get asked about the so-called ‘femtosecond‘ lasers now being used in LASIK laser eye surgery, and what these devices do. OK, here are the answers.

First of all, LASIK eye surgery is a laser procedure with two parts. First we have to make a thin flap from the top part of the cornea, basically a thin hinged layer we can temporarily fold to the side (painlessly!).

Next we use an ‘excimer‘ laser to reshape the exposed cornea to correct the vision focusing problem. The laser will polish away certain areas, depending on your prescription, to bring back clear vision.

The flap is put back in place and heals over very quickly. The eye feels gritty or scratchy for about 3-4 hours only. OK, so far so good.

For the first stage, making a flap, we have used a mechanical device called a keratome (or microkeratome). Keratomes have been around for 50 years and use a blade to make a controlled cut. This stage is where significant complications can occur, so we have been looking for a way to make this corneal flap but without the need for a blade.

Along come femtosecond lasers.

The eye lasers use ultra-short infra-red low energy pulses to create microscopic bubbles at a precise depth below the surface of the cornea. If you do this millions of times, you can create a super precise separation as a sheet, and hence a near-perfect corneal flap, which you can now fold to the side ready for vision correction with a second laser.

The femtosecond laser means we no longer run risks from using a blade to cut a flap. This means safer LASIK eye surgery.

You can watch a video of femtosecond laser eye surgery here.

More on femtosecond lasers coming soon.

Definition for femtosecond:

(This definition follows U.S. usage in which a billion is a thousand million and a trillion is a 1 followed by 12 zeros.)

A femtosecond is one millionth of a nanosecond or 10^-15 of a second and is a measurement sometimes used in laser technology. So that’s one billionth of a millionth of a second! As a comparison, one femtosecond to a second is like one second to 32 million years.

For comparison, a millisecond (ms or msec) is one thousandth of a second and is commonly used in measuring the time to read to or write from a CD-ROM player.

A microsecond (µs) is one millionth (10^-6) of a second.

A nanosecond (ns or nsec) is one billionth (10^-9) of a second and is a common measurement of read or write access time to random access memory. A picosecond is one trillionth (10^-12) of a second, or one millionth of a microsecond. An attosecond is one quintillionth (10^-18) of a second and is a term used in photon research.

[tags] LASIK, femtosecond, laser eye surgery, safety, risks, compications [/tags]

You can hear Bella Roberts talking with me just 24 hours after her breakthrough Z-LASIK laser eye treatment. You can read more about Z-LASIK in my previous posts, and compare to Bella talking about her LASIK just before having the surgery!

Why have Z-LASIK all-laser eye treatment? Why have FOCUS Laser Vision spent more than £300,000 on this next generation laser technology, when a mechanical bladed microkeratome is only(!) £30,000? The answer. Safety, accuracy and vision results.

Femtosecond lasers have been shown to be more accurate, safer and give better vision results for LASIK laser eye surgery. Many UK clinics have installed the Intralase femtosecond laser as up until now it has been the only game in town. That will change now the Ziemer LDV has arrived. So watch this space!

Z-LASIK laser eye treatment at FOCUS Laser Vision in London starts at £595 per eye.

[tags] femtosecond, Z-LASIK, Ziemer, FOCUS Laser Vision, Intralase, LASEK, laser eye surgery, LASIK, long sight, longsight, PRK, short sight, shortsight, surgeon, technology [/tags]

Z-LASIK laser eye treatment has arrived in London. The first procedure happened at FOCUS Laser Vision on Thursday January 17th 2008. Yours truly was the surgeon behind the wheel. I did 12 Z-LASIK treatments and by the next day every patient could see better than 20/20! It’s a pretty amazing technology.Bella Roberts was the first patient to see the difference (pun fully intended!). Bella is 33 and a mother of three. She was quite badly short sighted and has used glasses for most of her life. She had been pretty nervous about laser eye surgery, whether PRK or LASIK, but was convinced by the new Swiss technology and put herself forward as the first ever patient to get Z-LASIK in the UK.You can see Bella talking about her vision and how she feels, just 20 minutes before she gets the op!Z-LASIK uses a new laser to create the flap in the first part of the LASIK procedure, instead of a blade as in traditional LASIK. Getting rid of the blade eliminates many of the main risks from LASIK, when formerly the flap was cut with a fine blade.Treatments start from £595 per eye for all-laser blade free Z-LASIK.

[tags] femtosecond, Ziemer, Intralase, astigmatism, LASEK, laser eye surgery, LASIK, long sight, PRK, short sight [/tags]

The UK’s first Ziemer LDV [tag]femtosecond[/tag] laser has just arrived in the country and the first procedure will be carried out pretty soon. So watch this blog space!

If you are not familiar, femtosecond lasers are used for performing the first stage of [tag]LASIK[/tag] [tag]laser eye surgery[/tag]. (LASIK simply comes in two parts – first create a thin top layer of the cornea which can be folded to the side and secondly applying the treating laser to reshape the cornea to get rid of the need for glasses. See this weeks posting on LASIK Video – the Basics).

Traditionally, and still in many clinics, this has been done with a mechanical blade device called a ‘microkeratome’. Micro because, well, the blade is pretty small, about a centimetre or so across. ‘Kera’ means the cornea and ‘tome’ refers to cutting. These devices have been around for decades. The blade oscillates to and fro at very high speeds to make a precision cut. Modern microkeratomes are very reliable but can still occasionally cause problems and tend to cut deeper and with significantly less accuracy than the new femtosecond flap makers. So many clinics have invested in the new technology – it means safer and more accurate LASIK.

So when you read about All-Laser LASIK, Blade Free LASIK or IntraLASIK, they are talking about using these new lasers (called femtosecond lasers) to create the flap in the first part of the LASIK procedure. The Ziemer LDV femtosecond laser is a next generation machine that looks to outperform all current femto lasers (there are 3 models around) because it works in a different way. Much more on this coming soon!