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How to choose LASIK

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Types of Modern Excimer Lasers Used for LASIK

  • Slit scanning lasers - Slit scanning lasers use relatively small beams linked to a rotational device with slit holes that enlarge. The laser beams scan across these holes during surgery, producing a gradually enlarging ablation zone. The approach provides a uniform beam and, potentially, smoother ablations than now obsolete broad-beam lasers. The disadvantages include a slightly greater risk of decentration and overcorrection.
     

  • Spot scanning lasers - Spot scanning (or "flying-spot") lasers, which are the most common, utilize small-diameter laser beams (from 0.8 to 2 mm) scanned across the cornea to produce the ablation zone. This approach has the potential to produce the smoothest ablations, to more readily allow customized ablations, and to better treat irregular astigmatism.

  • Wavefront - guided lasers - Many excimer lasers are connected to a device that detects and "maps" defects in the eye's optical system, based on how light waves travel through the eye. These wavefront devices individually guide the way the eye's cornea is reshaped to achieve a custom ablation.

Excimer Lasers and Eye Tracking
Most modern excimer lasers now have automated eye tracking systems to keep the laser beam on target. Studies have demonstrated that eye trackers produce better outcomes, compared with lasers that in the past did not use eye tracking systems.

Indications and Features of Excimer Lasers
In the following chart, OZ stands for optical zone, meaning the maximum size of the pupil allowing light to pass through the eye that can effectively be targeted for correction with a specific laser. TZ stands for the maximum treatment area, including a transition zone that can be used in an ablation to achieve vision correction in the targeted area.

Modern FDA - Approved Excimer Lasers

Model Indication Type of Laser Beam Optical Zone (OZ)
and
Treatment Zone (TZ)
FDA Approval Year
Alcon LADARVision 4000
& CustomCornea
(laser plus wavefront device
to guide laser)
Myopia: up to -8.00 D with or without astigmatism (up to
-4.00 D)
Hyperopia and hyperopic astigmatism: up to +5.00 D (near vision problems) and astigmatism causing distance vision problems up to -3.00 D
Scanning spot (0.8 mm) OZ: 5.5 mm
TZ: 7.5 mm
2002
(myopia with or without astigmatism)
 
2006
(hyperopia and
hyperopic astigmatism)
Alcon LADAR6000 & CustomCornea
(laser plus wavefront device
to guide laser)
Same as LADARVision 4000 Same as LADARVision 4000 OZ: 6.5 mm
TZ: 9.0 mm
2006
(flexible platform and faster than previous models)
Bausch & Lomb Technolas 217A and Technolas 217z
Zyoptix (laser plus wavefront device to guide
laser, approved 2003)
Myopia: up to -12.00 D with or without astigmatism (up to -3.00 D)
Hyperopia: up to +4.00 D with or without astigmatism (up to +2.00 D)
Scanning spot (2.0 mm) OZ: 6.0 mm
TZ: 7.0 mm
2000
(myopia from -1.00 to -7.00 D)
2002
(myopia up to -11.00 D)
2003
(hyperopia with or without
mixed astigmatism)
Carl Zeiss Meditec MEL 80 Myopia: up to -7.00 D with or without astigmatism (up to
-3.00 D)
Scanning spot (0.7 mm)
 
Gaussian profile with more energy applied centrally
OZ: 6.0 to 7.0 mm
TZ: 7.7 to 8.9 mm
2006
(myopia with or without astigmatism)
Nidek EC-5000 Myopia: -1.00 to -14.00 D with or without astigmatism (less than 4.00 D)
Hyperopia: +0.50 to +5.00 D and up to +2.00 D astigmatism
Scanning slit (7.0 x 2.0 mm) OZ: 5.5 mm
TZ: 7.0 mm
2000
(myopia from -1.00 to -14.00 D)
2006
(hyperopia and hyperopic astigmatism)
Visx Star S4 & WaveScan
WaveFront System (laser
plus wavefront device to
guide laser)
Myopia: up to -6.00 D with or without astigmatism (up to
-3.00 D)
Variable scanning spot beam
(0.65 mm to 6.5 mm)
OZ: 4.0 to 9.0 mm
TZ: 4.5 to 9.5 mm
2003
Visx Star S4 IR & CustomVue (laser plus
wavefront device to guide laser)
Myopia: up to -6.00 D with or without astigmatism (up to
-3.00 D)
Hyperopia: up to +3.00 D and up to +2.00 D of astigmatism
Mixed astigmatism:
up to 5.00 D
Same as S4 OZ: 6.0 mm
TZ: 9.0 mm
2005
WaveLight Allegretto Wave Myopia: up to -12.00 D with or without astigmatism (up to -6.00 D)
Hyperopia: up to +6.00 D with or without astigmatism (up to +5.00 D, not exceeding mean spherical equivalent or total refractive error of +6.00 D)
Mixed astigmatism: up to 6.00 D
Scanning spot beam (0.95 mm) with emphasis on applying more energy centrally (Gaussian profile) OZ: 4.5 to 8.0 mm
 
TZ: 5.2 to 8.7 mm
for spherical treatments;
7.0 to 9.0 mm for cylindrical
and spherico- cylindrical
treatments
2003
(myopia and hyperopia)
  2006
(mixed astigmatism)
WaveLight Allegretto Wave With Allegro Analyzer (laser plus wavefront device to guide laser) Myopia: up to -7.00 D with or without astigmatism (up to 3.00 D)
Mixed astigmatism: up to 6.00 D
Same as Allegretto Wave OZ: Same as Allegretto Wave
 
TZ: Same as Allegretto Wave
2006
2007
(mixed astigmatism)
Notes: "D" is an abbreviation for "diopters."
While FDA approval is based on studies with these levels of diopters, individual doctors are free to use their own discretion in deciding what is best for their patients. For example, a doctor may choose to use a laser for a patient whose vision falls outside the above ranges, or may decide against using any laser on a patient with -13.50 diopters of myopia, even though some are approved for up to -14.00. It is important that patients and doctors discuss the risks and benefits before surgery is performed.

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