Lasek Information

What is Intralasik?
The" Intra" component denotes the use of the Intralase Femtosecond laser and LASIK is an abbreviated term for "Laser Assisted In situ Keratomileusis" With Intralasik, the first step of cutting the flap is accomplished using a highly precise laser, the Intralase Femtosecond Laser.The Intralase software directs the Intralase laser to optically focus its beam into a tiny, 1 micron (.001mm) spot of energy that passes harmlessly through the outer layers of the cornea until reaching its exact depth within the stroma (central layer of the cornea). In an "inside out" process, the laser beam creates a separation plane by forming an interconnecting series of bubbles made of carbon dioxide and water vapor.The laser beam stacks a pattern of bubbles along the periphery of the treatment plane, leaving an unseparated section of tissue to act as a hinge. As with a traditional LASIK approach, the surgeon then folds the tissue back to expose the underlying corneal layer to prepare for the excimer laser treatment that will re-shape the cornea. With Intralasik, surgeons can avoid the complications related to surgical blade problems. The Intralase laser precisely delivers the laser energy directly to the outer surface of the cornea, which suffers no trauma. A higher degree of accuracy in both the depth and size of the corneal flap is now possible with Intralase.

There are a number of valuable benefits that this form of surgery provides.1) SafetyThis is the most valuable advantage of Intralasik and the main reason why Optimax invested in this expensive technology. With the accuracy and safety checks offered by Intralase, major complications do not occur.2) PrecisionFlap measurements are highly accurate.This provides the surgeon with confidence to :a) Treat patients previously rejected because of thin corneas.b) Avoid the risk of ectasia - a complication that can occur from an unexpectedly thick flap. In ectasia the cornea is thinned beyond the margin of safety resulting in instability.c) No induced changes in refraction which can occur with irregularly thick flaps from LASIK affecting visual outcome.3) OutcomesBy being able to cut the initial flap in such a controlled fashion, we are able to closely predict our results. In creating such precise and uniform flaps we avoid surprises of new astigmatism and aberrations.TechnologyIntralase FS60 for flap creation on IntraLasik, Custom IntraLasik andPAC IntraLasik.The VASTLY IMPROVED 4th GENERATION INTRALASE called the IntraLase-FS60 (femtosecond) has been introduced at Optimax ,Malaysia to create BLADE-FREE LASIK flaps.( The conventional alternative, is when the LASIK flap was created using a microkeratome with a blade.)4th GENERATION INTRALASE-FS60 HAS VAST IMPROVEMENTS FROM LESSONS LEARNT FROM THE 1ST GENERATION INTRALASE:• Twice as fast procedure time (usually less than 20 seconds). • Enhanced patient comfort and safety during the procedure. • Improved flap quality creation software. • Smoother corneal surfaces than before, for better results. • Administers less energy to the cornea for greater safety.THINNER FLAPS CAN BE CREATED TO SAVE CORNEAL TISSUE!Of course the biggest benefit of 4th Generation IntraLase-FS60 is the increased SAFETY and PRECISION from its older version of ALL-LASER BLADE-FREE procedure.How does IntraLase-FS60 Laser Work?
• Pulsing at a speed of one-quadrillionth of a second, the laser uses an infrared beam of light to prepare the flap. • The Intralase has pulses that are focused within the tissue to create an incision below the surface of the corneal tissue. • A series of closely-spaced bubbles of 2-3 micron in diameter each, is created, which are absorbed into the tissue and leave a cavity in the stroma. (Hence the tissue above created is the flap used for Lasik) • The process takes under 15 seconds, on average ( twice faster than the older version). • The surgeon then lifts the flap to proceed with the Excimer Laser sculpting. • The surgeon can precisely control laser specifications for flap diameter, depth, and edge angle.
In short there is no longer any worry about irregular or non-perfect flaps for Lasik!

Customized Treatment
Introduction Customized treatment, also known as wavefront laser or wavefront-guided laser, uses 3-dimensional measurements of how your eye processes images to guide the laser in re-shaping the front part of the eye which is the cornea. With a wavefront measurement system, some extremely precise, individualized vision correction outcomes that would be impossible with conventional lasik surgery, contact lenses or spectacles may be achieved.
Wavefront-guided treatment provides the most technologically advanced measurement not just of standard visual but also of scattered light errors known as 'aberrations'. Wavefront technology or aberrometry is based on the principle that if an eye had no imperfections at all, light passed through it would not scatter. But because no eye is perfect, light scatters to form distinct patterns - called a wavefront. Wavefront technology measures your personal/individual patterns and thus allows the surgeon to plan a treatment that exactly matches individual vision errors.
With customized treatment, your eye's ability to focus light rays is measured, and a 3-D map is created that demonstrates irregularities in the way your eye processes images. Information contained in the map guides the laser in customizing the treatment to reshape your eye's corneal surface so that these irregularities can be corrected. Standard prescriptions for glasses, contacts, or traditional LASIK procedures can correct ordinary vision defects such as myopia (short-sightedness), hyperopia (long-sightedness), and astigmatism. But other irregularities associated with the eye's optical system could not be addressed until the advent of wavefront and related technology used in the customized treatment. Wavefront technology has the potential to improve not only how much you can see, but also how well you can see. This reduces the risk of post-LASIK complications, such as glare, halos and difficulty with night vision.
How much you see depends on vision defects known as lower-order aberrations associated with common refractive errors including myopia, hyperopia, and astigmatism, which traditional LASIK can treat. How well you see can depend on presence of the type and numbers of visual distortions known as higher-order aberrations, which can include irregularities caused by the irregularities of the cornea other than common refractive errors. These higher-order aberrations can create problems such as decreased night vision, glare, shadows and halos. However, higher-order aberrations may or may not affect vision. Unlike traditional LASIK, customized laser treats both lower- and higher-order aberrations. Custom LASIK's advantage lies in the area of quality of vision: 1. Greater chance of achieving 20/20 vision. 2. Reduced chance of losing visual quality. 3. Reduced chance of night-vision disturbances and glare.
Technology - How Custom LASIK Works Using the wavefront device to transmit a safe ray of light into your eye, the light is then reflected back off the retina, out through the pupil, and into the wavefront device, where the reflected wave of light is received and arranged into a unique pattern that captures your lower- and higher-order aberrations. All of these visual irregularities are then displayed as a 3-D map, referred to as a wavefront map. This information is then electronically transferred to the laser (in wavefront-guided systems), and computer-matched to the eye's position, enabling the surgeon to customize the LASIK procedure to your unique visual requirements.
FAQ What is Customized LASIK? Customized LASIK is a technology where the tissue removal pattern is tailor-made for each of your eyes. It sets out to improve overall visual quality in terms of contrast sensitivity and fine detail as well as to reduce higher order aberrations such as haloes, glare for night vision. What is the difference between customized and conventional LASIK? Conventional LASIK can provide excellent results when correcting a wide range of vision problem like short-sightedness, long-sightedness and astigmatism, these vision problems are known as lower order aberrations. Customized LASIK goes beyond reshaping your cornea based on prescription; it also corrects other imperfections in your optical system that may affect the clarity of your vision and how well you see at night and in low light that previously could not be detected. These are known as higher order aberrations which contribute to glare, shadows, halos and other annoying visual effects. Unless these higher order aberrations can be addressed along with the lower order aberrations, the quality of your vision may not be ideal, even if you have measurable vision of 20/20.
Optimax's Customized Treatment With the various laser machines available, Optimax is offering the different customized platforms that cater for different eyes
LADARWaveTM Wavefront (CustomCornea® - ALCON)
ZywaveTM Aberrometer (Zyoptix 100- Bausch & Lomb)
WASCA Analyzer (Carl Zeiss)
OPDScan Aberrometer (NIDEK)
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Risks of LASIK Surgery
Before getting involved with any surgery, you should educate yourself about the risks. This is true of LASIK.
LASIK ComplicationsThere are several complications associated with LASIK procedures, some more prevalent than others. How do you know if you have to worry? Most studies conducted during the late 1990s suggest the risk of complications averaged 5%.
Since that time however, newer technology and better-qualified surgeons now report the risks associated with LASIK are more along the lines of 1%. This of course, only applies to patients that are meticulously screened prior to surgery. The good news is most of these complications resolve relatively quickly after surgery or are temporary.
Among the more commonly reported complications of surgery are flap complications. Flap complications occur in the hinged flap covering the front of the cornea. Doctors typically lift this flap to reshape the cornea then replace so the flap serves as a bandage.
One of the risks associated with cutting the flap using a microkeratome is abrasion. However, new technology including use of IntraLase technology has limited this risk significantly.
Some studies suggest cutting a flap and then using custom LASIK procedures may result in adverse outcomes, in part because surgeons don't use custom procedures to create the hinged eye flap. Therefore replacing it over the reshaped cornea may result in less than optimal outcomes.
Another risk associated with LASIK is Diffuse Lamellar Keratitis or DLK. Many call this disorder the "Sands of the Sahara". It results when dead cells lodge beneath the corneal flap. The cornea mistakenly assumes these cells are harmful and initiates an inflammatory response. Unfortunately this may result in scarring, and permanent vision loss may occur if prompt treatment is not initiated.
Irregular AstigmatismOne common side effect resulting from traditional procedures is irregular astigmatism. This can result when laser correction isn't conducted properly or when the corneal surface is not smooth. The symptoms can include seeing double. Many patients experiencing this complication will need additional surgery to correct the problem.
Sometimes double vision is caused by minor swelling after surgery and resolves itself.
Other Common ComplicationsHere is a list of some other complications associated with LASIK:
Keratectasia - This condition results when a surgeon cuts the flap too deeply or removes too much tissue during surgery. This results in weakening and bulging of the cornea. Distorted vision may be permanent.
Dry eye - Dry eye is a much more commonly reported side effect of LASIK surgery. This can contribute to inflammation and infection, but is typically resolved using artificial tears.
Infection - Some patients will develop infections following surgery. Fortunately the risk of infection is relatively low. Some doctors prescribe prophylatic antibiotics to help reduce the risk of infection.
Night Vision Problems - These are more common when surgeons use traditional LASIK procedures. They may also result when the surgeon treats too small of an area surrounding the pupil.
Over or under correction - This can result in blurry vision or minor visual disturbances. Many times patients will have to wear contact lenses or glasses to resolve the problem. Re-treatment with the laser is often possible.
It is important you carefully weigh your risk of complications and side effects when talking with your doctor. Your doctor can help you make an educated decision and decide whether the benefits of surgery outweigh the risks.
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LASIK Risks and Complications

By Marilyn Haddrill, with updates by Gary Heiting, OD; reviewed by Brian S. Boxer Wachler, MD
If you are considering LASIK and are worried that something could go wrong, you might take comfort in knowing that sight-threatening complications from laser vision correction are rare. Also, many LASIK complications can be resolved with additional surgery or medical treatment.
Choosing the right eye surgeon probably is the single most important step you can take to decrease any risks associated with LASIK. An experienced, reputable surgeon will make sure you are properly screened and let you know up front if you aren't a good candidate for LASIK eye surgery.
Even if you are not qualified for LASIK, you still might be able to undergo vision correction surgery through other means such as PRK, LASEK, or implantable lenses. If you do decide to have LASIK, a responsible eye surgeon will work closely with you to resolve problems if they do develop. You can choose a LASIK surgeon by taking certain steps such as checking credentials.
How Common Are LASIK Complications?
Public confidence in LASIK has grown in recent years because of a solid success rate involving millions of successful procedures performed in the United States. With increasingly sophisticated technology being used for the procedure, most LASIK outcomes these days are very favorable.
The U.S. military also has adopted widespread use of refractive surgery including LASIK to decrease reliance of troops on corrective eyewear. This trend is particularly relevant because troops deployed for active duty are not allowed to wear contact lenses.
As of 2008, more than 224,000 military personnel had undergone laser vision correction. Since the procedure first was introduced in the military in 2000, researchers have conducted more than 45 studies regarding safety and effectiveness of LASIK and other procedures.
Outcomes have been overwhelmingly positive. Most soldiers see 20/20 or better after the procedure without corrective eyewear, and the rate of complications has been very low. According to one study, only one in 112,500 patients required medical disability retirement due to complications from laser vision correction during this eight-year period.
In a recent study of aviators from the U.S. Navy and U.S. Marine Corps who underwent wavefront-guided LASIK, all patients attained 20/20 uncorrected visual acuity (UCVA) within two weeks after surgery. When questioned about their satisfaction one month after surgery, 95 percent of the patients said the procedure was helpful to their effectiveness as an aviator, and 100 percent said they would recommend it to other aviators. Study results were presented at the 2008 annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS).
Retired U.S. Navy Capt. Steven C. Schallhorn, MD, a former fighter pilot and the first U.S. Department of Defense eye surgeon to perform refractive surgery, says he favors wavefront-guided LASIK because of outcomes producing superior night vision vital to the performance of fighter pilots.
LASIK Complication Rates Are Decreasing
The safety and effectiveness of LASIK continue to improve. Complications generally were more common in the early years of LASIK, when studies in the late 1990s indicated that up to 5 percent of people undergoing laser vision correction experienced some type of problem.
Experienced LASIK surgeons now report that serious complication rates can be held well below 1 percent, but only if surgical candidates are selected very carefully. For example, you may be eliminated as a LASIK candidate if you have certain pre-existing conditions, such as diabetes, that may affect how well your eye heals.
It's very important that you mention any health conditions you have and any medicines you take during your LASIK pre-operative exam and consultation. Your eye surgeon needs to know this information to properly assess your suitability for laser vision correction and your risk for complications. It is especially important to discuss any health condition you have that might hamper your ability to heal; this is one of the standard LASIK criteria used for assessment.
Also, you might want to take AllAboutVision.com's online LASIK screening quiz to help you anticipate what kinds of questions you may be asked to determine if you are a good candidate.
Make sure you mention any problem with dry eyes, which is one of the most common reasons you may be eliminated as a candidate. However, many people with mild to moderate dry eyes can be treated before LASIK or other laser vision correction is performed.
The Truth About LASIK Risks
Left: What someone with post-op starbursts might see at night. Right: Nighttime haloes.
While LASIK outcomes overwhelmingly are favorable, remember that — as with any surgery — risks of complications still exist. Fewer than 1 percent of patients still experience serious and ongoing vision problems following LASIK, because no surgical procedure is ever risk-free.
Even people who have excellent uncorrected visual acuity after LASIK based on eye chart testing still can have bothersome side effects. For example, it is rare but possible that you may see 20/20 or better after LASIK but still have symptoms such as double vision, unresolved dry eyes or difficulty seeing at night because of glare or halos around lights.
When you sign the LASIK consent form provided by your eye surgeon prior to surgery, you should do so with a full understanding that, even in the best of circumstances, a slight chance exists that something unintended could occur.
Thankfully, most cases of undesired outcomes after LASIK can be corrected with additional surgery (called an enhancement) or with medical treatment, such as in the case of dry eyes.
Common LASIK Complications
When LASIK complications occur, they may be associated with the creation of a hinged flap in the clear front covering of the eye (cornea), which is lifted for laser re-shaping of the eye. The flap then is replaced to form a type of natural bandage.
If the LASIK flap is not made correctly, it may fail to adhere correctly to the eye's surface. The flap also might be cut too thinly or thickly. After the flap is placed back on the eye's surface, it might begin to wrinkle. These microscopic wrinkles in the flap are called corneal striae.
These flap complications can lead to an irregularly shaped eye surface. Most such problems can be resolved through re-treatment of the eye with enhancement surgery.
Studies indicate that flap complications occur in from 0.3 percent to 5.7 percent of LASIK procedures, according to the April 2006 issue of American Journal of Ophthalmology. But inexperienced surgeons definitely contribute to the higher rates of flap complications. Again, remember that you can reduce your risk of LASIK complications by choosing a reputable, experienced eye surgeon.
Some problems associated with LASIK flap complications include:
Irregular astigmatism can result from a less than smooth corneal surface. Irregular astigmatism also can occur from laser correction that is not centered properly on the eye. Resulting symptoms may include double vision (diplopia) or "ghost images." In these cases, the eye may need re-treatment or an enhancement.
Diffuse Lamellar Keratitis (DLK), nicknamed "Sands of the Sahara," is inflammation under the LASIK flap that may have several causes. Some inflammation of the cornea after LASIK surgery is normal. But if it is uncontrolled, as in DLK, it can interfere with healing and cause vision loss. If DLK occurs, it usually responds to therapies such as antibiotics and topical steroids. The flap also might need to be lifted and rinsed for removal of inflammatory cells and to prevent tissue damage.
Keratectasia or keratoconus is bulging of the eye's surface that can result from a flap that is cut too deeply, when too much tissue is removed from the cornea during LASIK or when the cornea initially was weakened as evidenced from cornea topography mapping prior to LASIK. Resulting distorted vision likely cannot be corrected with laser enhancement, and gas permeable contact lenses or corneal implants (Intacs) may be prescribed to hold the cornea in place.
A promising new treatment for keratectasia (also called "ectasia") is corneal collagen cross-linking with riboflavin (C3-R). In this non-invasive procedure, eye drops containing riboflavin (vitamin B2) are placed on the cornea and then are activated with ultraviolet (UV) light. This strengthens the links between the collagen connective tissue fibers within the cornea to halt the bulging of the eye's surface.
In some cases, it may be possible to perform a laser enhancement of the eye after collagen cross-linking treatment to restore vision loss caused by post-LASIK ectasia or keratoconus.
LASIK Complications: How They Affect You and How They Are Treated
Complications
Symptoms
Treatments
Incomplete corrections (undercorrection, overcorrection, residual astigmatism) or regression of effect
Blurry, less-than-perfect vision
Glasses or contact lenses; eyedrops; re-treatment with laser
Decentered ablations
Visual aberrations*
Eyedrops; re-treatment with laser
Oversize pupils (pupils wider than treatment zone)
Visual aberrations*
Eyedrops; re-treatment with laser
Haze
Visual aberrations*
Eyedrops; re-treatment with laser
Irregular flap (folds, wrinkles, striae)
Visual aberrations*
Surgical correction; second laser procedure
Dry eye
Dry, itchy or scratchy eyes, often with redness and sense of foreign object in eye, and sometimes pain
Prescription dry eye medication; artificial tears; punctal occlusion (blockage of tear ducts in order to retain tear film on eye), oral flaxseed oil
Diffuse lamellar keratitis (eye inflammation)
Visual aberrations*
Eyedrops; surgical rinsing of cells
Epithelial ingrowth
Visual aberrations*
Surgical removal of epithelium
Infection
Redness, oozing of eyes, sometimes pain
Eyedrops; oral medications
*Visual aberrations include symptoms such as glare, double vision, ghosting, halos, starbursts, loss of contrast sensitivity, and problems with low-light or night vision. Not all patients experience all symptoms, and some patients with these complications experience no symptoms and require no treatment. [See also: Higher-Order Aberrations.] Chart created by Keith Croes and reviewed by Brian Boxer Wachler, MD.
Other, more commonly reported complications that can result from LASIK eye surgery include:
Dry Eye After LASIK: Almost half of all patients report problems with dry eyes in the first six months following LASIK, according to the April 2006 issue of American Journal of Ophthalmology. These complaints appear related to reduced sensitivity of the eye's surface immediately following the procedure. If you have this problem, temporary remedies such as artificial tears or prescription dry eye medication may be needed along with oral flaxseed oil capsules. After about six months to a year, however, most dry eye complaints disappear when healing of the eye is complete. People who already have severe dry eye usually are eliminated as LASIK candidates.
Significant Undercorrection, Overcorrection, or Regression: This means that your outcome is less than optimal and makes it difficult to function in certain situations. There are various reasons for these problems. In many cases, the cause is simply that a patient's eyes did not respond to laser eye surgery in a predictable fashion. But it's also possible that results are related to an inaccurate diagnosis or incorrect settings programmed into software guiding the laser during eye surgery. Regression from "over-healing" occurs when your eyesight is optimal at first, but then begins to deteriorate over time. In most cases, a significant undercorrection or regression can be treated with additional laser vision correction or other refractive surgery methods such as conductive keratoplasty, once it is certain that the refractive error is stable.
Eye Infection or Irritation: These problems are rare and may require treatment with eye drops containing antibiotics or anti-inflammatory medication such as steroids. When bacterial infection occurs after LASIK, it appears to be related increasingly to an antibiotic-resistant form of Staphylococcus aureus. Survey results indicating a growing problem with this type of infection were reported at the 2008 annual meeting of ASCRS. LASIK surgeons also reported that infections occurred more frequently with surface ablations such as PRK and when bladed instruments called microkeratomes are used to create the flap during LASIK surgery. ASCRS reports indicate that flaps that are lifted and replaced on the eye during LASIK, serving as a type of "natural" bandage, appear to create a more sterile surgical environment than PRK and other surface ablation procedures.
A Note About Presbyopia and Cataracts
If you are under age 40 when you undergo LASIK, remember that your reading vision naturally will change when you are older, due to presbyopia. Normal age-related changes in the flexibility of your eye's natural lens will cause you to slowly lose the ability to focus at closer distances. If you are nearsighted, you will lose your near vision when you wear your glasses but may be able to read comfortably by removing them.
Presbyopia is not caused by LASIK and will occur whether or not you have refractive surgery. You also might want to review options for eye surgery to correct presbyopia.
As you grow older, you also might develop cataracts. Again, this problem is unrelated to LASIK surgery. If you develop cataracts after LASIK, this is purely coincidental. Having LASIK will not limit your ability to have cataract surgery in the future, if that becomes necessary