Femtosecond laser versus mechanical microkeratome technology debate continues

Chicago-Femtosecond laser technology (IntraLase Corp.) for LASIK flap creation certainly offers some distinct advantages over mechanical microkeratomes, according to its proponent, Perry S. Binder, MD, University of California-San Diego School of Medicine. However, surgeons still have to weigh the advantages versus the “significant disadvantages” of the femtosecond laser technology, which is the cost of the device and increased time per procedure, noted Helen Wu, MD, New England Eye Center, Boston.

Drs. Binder and Wu outlined their arguments for and against the femtosecond laser technology during a symposium entitled “Controversial procedures in refractive surgery: Do they have a place in our future?” on Monday afternoon at the American Academy of Ophthalmology annual meeting.

The compelling arguments in favor of adoption of femtosecond laser technology include:

• Predictable flap thickness with small standard deviation.

• Programmed hinge diameter.

• A more stable flap with fewer induced higher-order aberrations.

• A smooth stromal bed.

• Lower risk of traditional flap complications.

• Improved visual outcomes early.

• More fibrosis at the edge of the flap for a more secure flap.

While the positive points of femtosecond laser technology were acknowledged by Dr. Wu, she discussed the significant cost of purchasing the device and the increased cost that must be passed onto the patient. She also noted that the creation of a flap with this newer technology does increase the time of the surgery by about 20 minutes. The technology can create an opaque bubble layer that must clear before proceeding with the ablation, she noted.

Some patients have also experienced transient light sensitivity following the procedure with the femtosecond laser technology, although Dr. Binder noted that this could be reversed easily with topical steroid treatment.

After hearing the pros and cons, audience members were asked the question: “Should we use femtosecond laser technology to make flaps?” The majority (64%) replied no in an electronic vote.