What is a femtosecond and why is that important?

Back in the year 2000 (almost 10 years ago) I was approached by some people that I knew in the vision correction industry and was told that they were working on a new laser which among other things could be a better way to do LASIK.  Intrigued, I flew to San Diego and watched Dr. Lee Nordan (now retired) perform some of the first uses of this new device, a femtosecond laser, to make a corneal flap.  It was much different than the production devices we have today, slower for one thing, but it did make cornea flaps with light, which was a really neat trick.  The company which had just started was called Intralase, and the core of its competence was drawn from scientists and physicists who had worked on this project at the University of Michigan.

I became one of the group of three chosen to help develop this technology clinically which was cleared by the FDA for clinical use.  We started performing these procedures in 2001 as the first step in LASIK rather than using a razor blade, which was the standard technique that dated back to a technology from 30 years earlier.  Gradually, we were able to get improvements in our results, and over the next few years transitioned into using this for all of our LASIK cases.  At this time we were a tiny minority of doctors, most of the others were skeptical of both the technology and the much higher price tag to acquire it. Commercial acceptance came slowly.  In the end there was such an advantage to patients that it became apparent that this was the better way to have LASIK.

In the last few years this femtosecond technology has become mainstream in LASIK vision correction, and it is estimated that about half of all LASIK is performed using this all bladeless method.  In short it is better because it is safer, the results are more accurate, and some studies show that the results are actually better.  Intralase was purchased by a much larger and wealthier company (AMO).  The main reason it is not always performed is the cost, and in fact many centers charge a premium for this type of LASIK, usually about $500 additional to their standard price.  While some may question the ethics of offering a choice of methods to patients based on price, others like ourselves, have long ago switched to 100% blade free so there is no pricing difference and we do not have to make this decision.  Now that the femtosecond/Intralase method is the more or less "standard of care", where do we go next?

About two years ago I was approached by another company, Zeiss/Meditec, who had developed a newer and more elegant femtosecond laser and asked if i would like to participate in the implementation of their product.  It is not designed to be just a flap maker like the Intralase, but also is so precise, that it can actually remove the refractive error right from the eye by precisely cutting it out!  In fact these procedures are being performed in Europe and other countries, and may prove to have advantages over LASIK in the coming years.  I had the honor of being granted a temporary medical license in Germany and was able to travel there and do some of these procedures myself.

Here in the USA we use this laser, called the VisuMax, for making flaps only.  It is even better in my opinion than the Intralase, in that we can cut along the natural curve of the cornea, can use much lower pressure on the eye, use much lower energies, and can make the cuts much more precisely with even fewer problems.  There are a few other sites that have been added in North America since we did the first cases on this continent, and these are at very prestigious institutions as well as at the US Naval flight center in San Diego.  We now have TWO femtosecond lasers, the Intralase and the VisuMax which is something that no other center in the United States can claim.

Here is the take home message about LASIK in 2009/2010 -- find a center that offers femtosecond lasik and doctor(s) well experienced with it.  You will be getting the best technology for the critical first step of the LASIK procedure.  The second step involves another laser, an excimer laser and choosing the best one of these is another story for another post later, so stay tuned.