Experience with the IntraLase® Laser: Fewer Complications, Fewer Retreatments, Improved Outcomes, and Stable Surgical
Volume

Ming Wang, MD, PhD

The IntraLase femtosecond laser has had a very positive impact on surgical results in our practice. For economic reasons, success with the laser requires that practices be committed to a comprehensive approach to all-laser LASIK.

THE BOTTOM LINE

Using the IntraLase laser can lower complication and enhancement rates and improve outcomes. The downside to its use is economic: purchasing and operating the laser are both much more expensive than they would be with a microkeratome. As a result, the laser is most appropriate to market-leading practices that are comfortable with high-end pricing and are committed to a comprehensive program of staff education, marketing, and working to optimize the use of such all-laser LASIK technology. Because the laser dissects tissue by means of a highly localized shock wave, it has the potential to induce significant local tissue reaction and inflammation. This can be moderated by having the surgeon be involved in adjusting the key laser paratmeters: lowering the laser stromal bed and side-cut energies, using a preoperative vasoconstrictor, increasing the duration and frequency of topical steroid administration, and chilling the patient's drops.


Ming Wang, MD, PhD, is a clinical associate professor of ophthalmology at the University of Tennessee, staff surgeon at Saint Thomas Hospital and director of Wang Vision Institute, Nashville, TN. He has no financial interest in the product discussed.

 

IMPACTS OF THE
INTRALASE LASER
Retreatment rate cut by approximately 50%

Improved outcomes

- Hard to quantify accurately because
custom LASIK adopted at same time
- Predictable, planar flap causes less
surgically induced astigmatism
- Flap size and thickness does not depend on tissue deformability,
corneal pachymetry and curvature
Near zero incidence of flap
complications
Did not increase surgical volume
Required significant commitment to a comprehensive all-laser LASIK
practice
- Physician had to learn the laser and its optics and
be involved in optimizing the laser parameters
- Staff had to understand the laser and its benefits and communicate
them to patients
  Significant internal and external marketing required
Greater cost of flap-making offsets much
of the financial gain from higher pricing
Must maintain premium price point
Practice must be market leader
- Must be able to maintain volume at a
higher price
- Higher pricing limits size of patient
pool

 

PEARLS FOR USING THE
INTRALASE
Maintain same time between IntraLase
and excimer for every patient
Reduce laser energy of both side cut
and stromal bed cut to a point where
flap can just barely be lifted
Preop vasoconstriction to reduce 
postop inflammation
Liberal use of steroids
- Increase length of steroid regimen to
6 days
- Increase dosing frequency to six
times a day
Refrigerate all drops to chill the cornea
Artificial tears every 15 minutes while
awake for 1 week postop
Thinner flaps are possible, hence higher
myopic correction
Postop pain and photophobia
- Keep eyes closed for remainder of
day after surgery
- Rescue medication (extra-strength
Tylenol® or Tylenol 3)