LASIK Lasers: Which Is Best & Why?

LASIK is a form of eye surgery that uses a special excimer laser. This is a revolutionary technology that has made corneal surgery effective, predictable, and safe.

Excimer lasers are precision instruments that enable a surgeon to remove microscopic portions of tissue from the cornea. The process is called ablation. Due to its precise nature, this procedure is possible without affecting or hurting the surrounding tissue. 

While several types of lasers have gotten FDA approval, many surgeons and surgical clinics have preferences for a specific one. According to research studies, all of the excimer lasers approved by the FDA offer comparable outcomes.

What Are the Different Types of Lasers Used in LASIK?

An ultraviolet laser called an excimer laser is used in LASIK surgeries. 

LASIK is a delicate surgical procedure where an extremely thin flap of corneal tissue is created, allowing the surgeon to use laser energy to gently reshape the cornea. The flap is repositioned and acts as a natural bandage to speed healing. 

In some LASIK surgeries, the flap is created with a laser tool called a femtosecond laser. In others, the surgeon uses a fine metal blade called a microkeratome. 

The femtosecond laser may be referred to as an IntraLase femtosecond laser. This instrument is favored by many surgeons as a way to perform blade-free surgery that is accurate and safe. 

There is some debate and differences of opinions among surgeons about these two approaches. The microkeratome or automated knife was originally the instrument of choice for LASIK surgery. Now, a femtosecond is more commonly used as it is considered a safer method for creating the corneal flap. 

Talk with your doctor to find out what they use and how it may affect your comfort. With advancements in laser vision correction, many of the top clinics rely on laser technology for optimal outcomes, rapid healing, and safe procedures. 

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What Is an Excimer Laser?

An excimer laser emits a beam of light, called a cool beam. This is ultraviolet light that has a very precise wavelength. The typical wavelength for removing corneal tissue is 193 nanometers. 

The laser beam uses high-frequency pulsations to penetrate tiny portions of the cornea. With this method, it can gently remove precise sections of tissue, as small as 0.25 microns. To get a feel for how tiny this is, consider that one micron is one-thousandth of one millimeter. 

Excimer lasers work with a computer program, enabling your surgeon to program your exact refractive error. Using this precise guidance, your surgeon programs the excimer laser with specific measurements to reshape your cornea correctly. 

As each individual is unique, this technology helps your surgeon provide uniquely personalized treatments for the most successful outcomes.

Which Excimer Lasers Are FDA Approved? 

The FDA has a list of approved excimer lasers for use in the United States in vision correction surgeries. There are 35 FDA-approved excimer LASIK, including these:

• Allegretto WAVE Eye-Q Excimer Laser System (Alcon)

• MEDITEC MEL 80 Excimer Laser System (Zeiss)

• Nidek EC-5000 with Navex Quest Customization (Nidek)

• STAR S4 IR Excimer Laser System and iDesign Advanced WaveScan Studio System (Johnson & Johnson)

• TECHNOLAS 217Z Zyoptix System for Personalized Vision Correction (Bausch & Lomb)

Alcon Laser Technology

One of the top names in laser technology is Alcon, the producer of WaveLight Technology. This is an FDA-approved tool that offers surgeons extreme accuracy and flexibility. 

The Alcon EX500 Allegretto excimer laser is considered one of the most revolutionary excimer lasers available. With this technology, surgeons can use extremely fast laser treatments. 

Data from Alcon, cited by the Moran Eye Center at the University of Utah provides a greater understanding of why WaveLight Refractive Technology is so beneficial:

• At least 20/20 vision was achieved in 93 percent of nearsighted patients. 
• At least 20/20 vision was achieved in 83 percent of farsighted patients. 
• “Good” or “Excellent” is how 92 percent of patients described their ability to see.

How Do LASIK Lasers Work?

Lasers for LASIK include three categories: topo-guided, wavefront-guided, and wavefront-optimized.

Topography-guided LASIK is a way of integrating a 3D map as a diagnostic tool. Using a topographical map of the eye helps surgeons pinpoint specific anatomy, diagnose issues, and recommend corrective treatment. 

This topographical map is synched up to a computer-guided system. 

Using the wavefront excimer laser helps surgeons to adapt to the unique needs of each patient. The outcome of using wavefront laser technology can be better visual acuity, improved night vision, lower re-treatment rates, and optimal outcomes.

According to a 2019 study comparing topography-guided with wavefront-optimized, both methods achieved predicted visual results. The topography-guided LASIK was found to have lower levels of ocular trefoil, a problem that causes one to see glare or halos.

What Is the Best Laser for LASIK?

According to a review in Ocular Surgery News, wavefront-optimized (WFO) LASIK appears to offer better results than what was previously reported from standard LASIK. 

Some research confirms that wavefront-guided LASIK (WFG) (sometimes called custom LASIK) is producing better results. The example cited confirms that WFG ablations improve outcomes, such as reducing glare and halos, improving nighttime vision, and improving contrast sensitivity.

After comparing WFO and WFG LASIK, several studies report that WFG LASIK produces consistently better visual outcomes. 

According to the University of Utah, one efficient combination is the WaveLight refractive suite. This combines the WaveLight EX 500 Excimer Laser, the WaveLight FS200 Femtosecond Laser, and a comfortable bed for the patient. The combination enables the surgeon to work efficiently and use the best tools in a synchronized manner. 

The latest generation of laser technology offers improvements that help surgeons achieve the best results. As an example, the topography shown with iDesign helps surgeons to perform operations that achieve the best-corrected vision for patients.

Talk with your doctor about the available technology and your personal treatment plan. Your surgeon’s choice of technology considers your unique medical condition and the best treatment options for optimal outcomes.

How LASIK Lasers Have Advanced Over the Years

LASIK lasers have improved dramatically over the years. Major changes include corneal mapping and the ability to cut the corneal flap with the femtosecond laser, described above. Other 

In the past, lasers did not have eye-tracking systems. Today, most excimer lasers have automated systems for tracking eye movement. This makes it possible for the surgeon to monitor eye movements during surgery and keep the laser beam positioned accurately. 

Recent research confirms that lasers with eye trackers produce better surgical results. This may also explain why LASIK complications are decreasing compared to earlier systems.

References

1. LASIK — Laser Eye Surgery. (October 2020). American Academy of Ophthalmology.

2. LASIK Eye Surgery. MedlinePlus.

3. Laser Vision Correction. Weill Cornell Medicine.

4. List of FDA-Approved Lasers for LASIK. (September 2018). U.S. Federal Drug Administration.

5. Wavelight Refractive Suite — LASIK. University of Utah.

6. Topography-Guided Versus Wavefront-Optimized Laser in Situ Keratomileusis for Myopia: Surgical Outcomes. (June 2019). Journal of Cataract Refractive Surgery.

7. Refractive Error: Optical Principles and Wavefront Analysis. American Academy of Ophthalmology.

8. Latest-Generation LASIK Technology Helps Patients Achieve Best Vision. (September 2019). Ocular Surgery News.

9. On the Safety of 193-Nanometer Excimer Laser Refractive Corneal Surgery. (May–June 1992).