We are so glad that the competition is trying to catch up!

Being one of the small handful of doctor/investigators to usher in the femtosecond lasik procedure almost 10 years ago, and with a long period before general acceptance by most of our competitors, I am always amused to notice just how many local "experts" there now are on the all blade free procedure.  It was five years before a second Colorado doctor stepped up to this technology, and it was not a center in Denver.  Today there are a whole bunch of doctors with a variety of femtosecond lasers, all claiming to be the latest and greatest.

Lasers are tools, and a better tool can do a better job.  It is equally important that the person who is using that tool understands its application and its limitations.  There are private web discussion groups where doctors tell of their problems, questions, and frustrations with Intralase and many other new technologies.  In general, more experience leads to a better understanding and ultimately more predictable results.  The latest wrinkle being heavily marketed is the Intralase IFS laser.  This is the current offering by AMO as the upgrade to the standard 60 kHz laser that we now maintain as our "backup laser."  Why a backup?  Because the real industry leader worldwide is the VisuMax laser by Carl-Zeiss/Meditec .  It is technically a world apart from any other product that exists.  It is the laser that the prestigious Bascom Palmer Eye Institute in Miami is working with and it is being studied by the Naval Center in San Diego, and several other key sites in the US and throughout the world.  Just one look at this device gives you a clue that it is much more than a fancy flap maker.

The VisuMax was designed not as a flap cutter, but as a complete refractive workstation.  What does this mean?  It means that a precise lenticle of tissue can be resected from the cornea to correct refractive error, a contact lens, if you will, can be removed from within the cornea of the eye to fix any refractive error.  I know it sounds unbelievable that a lens can be extracted from the front of the eye so accurately that it can correct vision as well or better than etching with the modern excimer lasers.  Does this work?  Yes, and it may someday replace LASIK as the best and most reliable way to restore vision.  In the USA it is currently working as a flap maker,  a very basic application for such a sophisticated device.  At its introduction the VisuMax ran at 200 kHz, but now most  are running at 500 kHz..  What does this mean and why does it matter?

The original Intralase we had ran at 15 kHz -- that is 15,000 spots per second.  To make a flap takes hundreds of thousands of spots so it took a long time to cut a flap, about a minute.  Prior to the current introduction, the Intralase that is present at 95% of all sites runs at 60 kHz (60,000 spots/second). Compare this to the  500,000 Hz or spots per second  our laser runs at, and it still takes 15 seconds for a flap -- why not just one second?  Because we make a lot more tiny spots with lower energy per spot and this makes a cleaner and more precise and a gentler cut.  Think of pixels on your computer screen, we are working in a much higher resolution.  So we are happy that some of our competitors have upgraded their 60 kHz Intralase machines to 150 Khz because this will be close to the original VisuMax, but not nearly the performance of the 500 kHz model.  It shows an industry acceptance that faster and lower energies are the way to go and that if Intralase is the product choice, then this is a slightly better product.  As I said, we still have an Intralase, and it works well and is a great backup machine for the rare times that it could be needed.

But the number kHz is like horsepower in a car, it is good, but is not the only thing that makes for an excellent vehicle or laser.  There are other things which set the VisuMax apart even more than speed.  For instance the VisuMax has mastered the curved cutting technology which follows the natural shape of the eye, whereas the Intalase regardless of model, has to push the front of the eye flat in order to cut a flap.  There are technologies that are proprietary which means I don't know about them or cannot talk about them or both which makes this a superior device.  Let me just say that when it comes to accuracy, and reproducibility, there is no comparison to the VisuMax platform.  Zeiss is the worldwide master of optics. For instance,  they make the machines that make computer chip manufacturing possible in addition to an unbelievable number of other medical, scientific, and industrial devices.  When I visited their manufacturing facilities throughout Germany, I was amazed beyond words at what they have accomplished. 

In addition to this, many at Zeiss have a particular passion in femtosecond lasers and technology.  Their vision for this product goes well beyond its present applications.  In the field of eye diagnostic instruments they dominate the industy.  Almost every eye doctor in the world has at least one piece of Zeiss equipment in their practice, and the surgical microscopes by Zeiss are considered the finest in the world.

Now that blade free femtosecond LASIK has become the standard of care for LASIK vision correction, we are so pleased that other companies are pushing forward and recognizing that improved technology will improve the results for patients.  When paired with another great Zeiss product, the MEL80 excimer laser, we have a workstation with results beyond compare.  The VisuMax also works well with other excimer laser platforms at our facility. For the first critical step in LASIK we find that the VisuMax is the industry leader, and all the other companies will find it difficult to catch up.