Are there advantages to i-LASIK?

It is important to distinguish real technological advancements, from marketing hype and this is especially true when it comes to laser vision correction.  There is not much question that I-LASIK is the latter of these in that it was the matching of two existing technologies.  The VISX laser was one of the first approved lasers, and although there have been some improvements, it is still a broad beam first generation technology which is limited as compared to many newer lasers that have been available for a number of years since.  Yes, there is a good chance of getting to 20/20 vision with VISX but no greater than any other platform, and it has limitations in the type of ablation that can be created.  This gets into subtler issues than just 20/20.  For instance, it is based on the original Munnerlyn formula and does not take into account a prolate optimized ablation pattern such as the Wavelight (Alcon) or the MEL80 (Zeiss) lasers can create.   Other posts on this blog have discussed the benefits of these newer patterns.  Even scanning spot lasers can have this limitation which was true with the Bausch and Lomb laser where they considered doing a clinical trial withhttp://www.dishler.com/pages/technology#zeiss the newer ablation patterns but abandoned this effort due to economic constraints.  The Nidek laser was another intermediate step with scanning slits but also based on the older ablation patterns and for this reason has been largely abandoned.  Some centers still offer LASIK with the Nidek at a reduced price, but is that really worth it?    In today's world, many laser centers are moving up to the newer type ablation lasers from "VISX type" and it is worth considering this since it represent a real change in technology.

With all modesty, if anyone should know about this it would be me, since one of the earliest approved LASIK lasers was the Dishler Laser.  That is correct, I was the inventor (with a lot of help of course) of a laser design that was FDA approved to correct nearsightedness and astigmatism over a very large range.  This laser was also a broad beam design, and although it had significant advantages over the VISX laser at the time (they thought it was so similar to theirs that they sued me for patent infringement!) we have long ago retired this laser due to advances well beyond the capability of that design.  At best I would say that the VISX laser is the vanilla of lasers, sufficient but not extraordinary.  Of course, this is just my personal opinion--that is what blogs are for.

Moving on the femtosecond lasers is something which I also know something about.  We had the third femtosecond laser in the United States about 10 years ago.  Of the first 1000 femtosecond flaps made, we did about 900 of them making us the very first real commercial site for Intralase.  We have had one of the first lasers of each succeeding upgraded model to the current FS60 which is now in thousands of sites and has done millions of procedures worldwide.  It is a great machine, and makes really nice flap.  This is the mainstream flap maker and as such has been paired with practically every other excimer laser in the world for LASIK procedures.  To claim some specific superiority with the VISX laser and call this I-LASIK is clever marketing but no real technological advance.

There is a real technological advance in femtosecond lasers, and it is the Visumax laser, also from Zeiss.  Again, there is a post specifically on this topic, but in essence, it is faster, more accurate, works more gently and at lower energy than the Intralase laser.  We have both of these platforms, and at this point use the Intralase as a reliable backup system or for unusual cases where it might be a better option.  We are doing about 98% of all of our femto flaps with the Visumax.  Consequently we are pairing the Visumax with the Zeiss Mel 80 which is really nice since they are both part of a combined workstation which is efficient, ergonomic, and very patient friendly.   But we also can use the Visumax with the Wavelight laser and these results are also very excellent.  Maybe we should call it  'very good lasik' or v-LASIK?