Dr.s Moretsky and Cassidy are Phoenix LASIK specialist who use only the most advanced LASIK technology for laser vision correction surgery. They have helped thousands of Phoenix LASIK patients to obtain better vision. The web page below describes the two steps involved in LASIK surgery and how this painless 10 minute procedure can improve your vision.
Two Steps of LASIK
There are two important steps to LASIK eye surgery.
In step one, your doctor creates a micro-thin flap of tissue on the outer layer of your eye, also known as the cornea. The flap is important for rapid healing, greater comfort and better vision. If it is too thick, too thin, or irregular, it could affect the quality of your vision. Although complications with LASIK surgery are rare, when they do occur, they are often associated with the use of a hand-held microkeratome blade in step one.
Our IntraLase makes LASIK surgery better by replacing the standard hand-held microkeratome blade with a computer-guided laser that delivers micron-level accuracy over 100% greater than a microkeratome.
In step two, your doctor folds open the flap so that an excimer laser can be used on the inner cornea to correct your vision. Your flap is then returned to its original position where it seals without stitches.
Create the corneal flap
Reshape the cornea
Step One is important to faster healing, greater comfort and better vision.
The IntraLase laser is a more precise and safer method for creating the flap in Step One and is an essential component to making LASIK surgery better.
Every cornea is different. Every corneal flap is different, too. But there are certain characteristics that every flap must have, including precise diameter, centration and thickness, thereby setting the stage for your doctor to perform an excellent Step Two.
Traditionally, doctors have used a noisy mechanical procedure to create the flap. In this method, the doctor cuts across the cornea using a hand-held microkeratome with an oscillating blade. Achieving accurate depth, flap thickness, and centration on a curved cornea of varying dimension can be difficult with a microkeratome
The precision of this step is highly dependent upon the performance of the microkeratome device, which may be unpredictable despite a high degree of surgeon skill.
Creating the Laser Flap
The IntraLase laser actually represents a breakthrough in the field of ultra fast laser science. Generating light pulses as short as one-quadrillionth of a second, femtosecond laser technology has opened new fields of scientific study and provided the basis of femtochemistry research that won the 1999 Nobel Prize in Chemistry.
The use of the femtosecond laser in the field of Ophthalmology was developed by a team of Physicists, Biomedical Engineers and Ophthalmologists at the Center for Ultra fast Optical Sciences and the Kellogg Eye Center of the University of Michigan.
The IntraLase ultrafast femtosecond laser is the first bladeless laser technology for performing Step One of LASIK and the most accurate technology for corneal flap creation available today. The laser uses an infrared beam of light to precisely separate tissue through a process called photo disruption. In this process, the focused laser pulses divide material at the molecular level without the transfer of heat or impact to the surrounding tissue.
IntraLase creates the flap from below the surface of the cornea, using an "inside-out" process.
The silent beam of laser light is focused to a precise point within the stroma (central layer of the cornea) where each pulse of the laser creates a tiny 2-to-3 micron bubble of carbon dioxide and water vapor.
Thousands of these microscopic bubbles are precisely positioned to define the flap's dimensions, as well as the location of the hinge.
Bubbles are then stacked along the edge of the flap up to the corneal surface to complete the flap.
The process from start to finish takes approximately 30 seconds.
The surgeon then lifts the flap to allow for treatment by the excimer. When treatment is complete, the flap is repositioned.
With IntraLase, your doctor can create a corneal flap of exact diameter, depth, hinge location, centration, and overall architecture. Such accuracy and precision are nearly impossible in a hand-held blade.
Making LASIK Better
IntraLase creates a flap of precise size, shape and depth. To achieve such precision, your doctor uses the laser to rapidly separate micro-thin layers of the cornea as he creates a self-sealing flap. It is all a part of an efficient process that helps to assure you that Step One of LASIK eye surgery will be accurate, safe and a first step towards giving you the best LASIK result possible.
Safety, predictability, and control make the IntraLase laser, for flap creation, the choice of Moretsky Cassidy Vision Correction
For outstanding safety and effectiveness, Navy aviators may now receive "the best of the best" LASIK, which is offered at Navy Medical Centers. It includes the creation of the LASIK flap with IntraLase and correction of their refractive error with Custom (WaveFront Guided) treatment. Navy Aviators can now enjoy faster visual recovery with quicker return to flight duty. In the past, Navy Aviators could receive
laser vision correction, but using surface treatment (PRK). The recovery was slow and downtime of up to several months was required. PRK is still available, but is being replaced with IntraLase Custom LASIK.
National Aeronautics and Space Agency (NASA) recently approved LASIK for use on astronauts and astronaut candidates. NASA's decision was made following review of extensive military clinical data, using "all laser" LASIK, with IntraLase flap and Custom treatment, which showed that this combination of technology provided outstanding safety and vision. NASA's revised refractive surgery protocol follows similar moves by the Air Force and Navy, regarding their eyesight standards for pilots. The exact visual
standards required by NASA have long been a number one disqualifying factor for astronauts or astronaut candidates. It was not until IntraLase flaps, with Custom treatment, that NASA approved this procedure.
In a recent study the IntraLase flap associated with Custom treatment had improved clinical results.
Specifically faster visual recovery with better contrast and better night vision qualities when compared to
mechanical or bladed keratome flaps with the same Custom treatment. This is why LASIK with the
bladed keratome is not approved by NASA.
More Accurate Flap Information
The advent of the Intralase femtosecond laser, allows our surgeons to program a flap's thickness and actually customize the configuration of the flap's edges from a centralized control screen before ever initiating the actual process of creating the flap.
Because the Intralase laser focuses its energy on a specific area or plane of the cornea, the thickness of the flap it creates does not depend on a bladed device's translation speed across the cornea, corneal curvature or corneal thickness, all of which affect the shape and thickness of flaps created with mechanical microkeratome blades.
Compared with mechanical microkeratome blades, the Intralase laser offers more options for customizing the diameter, shape, orientation and position of the flap during LASIK surgery. Additionally the treatment ablation (tissue removal) strategy can be individualized based on different corneal anatomies and structures. The Intralase is better at creating thin flaps than mechanical microkeratome blades thus leaving stronger residual cornea and preserving more sensation which stimulates blinking and reduces dry eye
symptoms. See figure #1 and figure #2.
Physicians Support the IntraLase Laser
"I have performed thousands of LASIK surgeries with the microkeratome; there was always the concern that the flap might be too thick or too thin. By switching to the IntraLase laser I have been able to create consistently higher quality flap dimension and more predictable refractive outcomes eliminating all of the risks associated with flap creation with mechanical microkeratomes. All of which has allowed me to increase my patients' satisfaction."
Perry Binder, M.D.
San Diego, California
Leading doctors believes in the IntraLase laser. They use it for Step One in both standard and custom LASIK eye surgery because clinical studies confirm that LASIK surgery is generally safer with IntraLase and vision is usually better.
One prospective randomized study, for example, compared the IntraLase laser to the leading microkeratome. In this study, more patients achieved 20/20 vision or better in both standard and custom LASIK surgery when the IntraLase laser was used for step one. *
Another study comparing LASIK results with IntraLase versus the two leading microkeratomes demonstrated that IntraLase performed better in three areas important to LASIK results and safety-flap thickness, induced astigmatism and abrasions. **
Now, so many doctors believe in the IntraLase laser that the number of LASIK surgery procedures that begin with IntraLase grows dramatically each year.
Patients Support the IntraLase Laser
IntraLase offers patients like you the assurance that only comes with precise laser technology. With no blades or blade-related complications to worry about, 78% of patients, when given a choice, chose to have Step One performed with the IntraLase laser over a hand-held microkeratome blade. ***
"I am especially impressed with the higher percentage of patients in my practice that achieve 20/20 or better with IntraLase."
Thomas S. Tooma, M.D.
Newport Beach, California
* Daniel S Durrie, M.D.: Randomized prospective clinical study of LASIK: IntraLase versus mechanical keratome. Subsets presented at the Joint Meeting of the American Academy of Ophthalmology & the International Society of Refractive Surgery, November 14, 2003, Anaheim, CA, and the Symposium of the American Society of Cataract & Refractive Surgery, May 4, 2004, San Diego, CA.
** Guy M Kezirian, M.D. and Karl G Stonecipher, M.D.: Comparison of the IntraLase femtosecond laser and mechanical keratomes for laser in situ keratomileusis. Journal of Cataract and Refractive Surgery April 2004; 30:804-811.
*** Shareef Mahdavi: How IntraLase technology is impacting the refractive practice. SM2 Consulting, Pleasanton, CA. April 2004. Data on file, IntraLase Corp.
CUSTOMVUE LASIK
Advancing the Science of Custom Ablation
VISX STAR S4IR with "True" Wavefront Technology, Iris Registration and 3D Eye Tracking
The current generation of laser vision correction (LVC) is a lot more than simply customized wavefront ablation. The VISX excimer laser platform system includes multifactorial advances that create optimal outcomes for today's LVC patients. The CustomVue platform has at least six meaningful advances in addition to Wavefront customization that enhance clinical outcomes. These exciting advances include: the use of Fourier analysis; variable spot scanning; enlarged optical zone options; improved blend zones; iris registration; and pupil centroid shift compensation. Technology is advancing at an amazing and exciting rate. There has been much discussion in the field of Ophthalmology concerning the merits of wavefront customized LASIK versus wavefront optimized LASIK versus conventional LASIK. Yet these discussions are becoming outdated and irrelevant given the fact that only wavefront guided Custom treatment offers these other significant platform advances.
In short, the current generation of the VISX Star S4 IR Excimer laser includes many more benefits than just the addition of a wavefront analyzer. These added elements allow our surgeons to give patients the best possible outcomes for laser vision correction today.
Wavefront technology was originally developed to help reduce distortions when viewing distant objects in space. Today, it is revolutionizing the refractive surgery industry.
Wavefront technology is incorporated into the Wavescan diagnostic system which allows our doctors to now identify, measure, and correct imperfections in a patient's eyes 25 times more precisely than with standard methods used for glasses and contact lenses.
Using Wavefront technology in conjunction with the Star S4 Laser, Doctors Moretsky and Cassidy can take the digital information gathered by the Wavescan and develop an individualized treatment plan that can be transferred directly to the laser for a precise "High Definition" vision correction never before possible.
Because we value our commitment to our patients we utilize only state-of-the-art equipment based on its outstanding performance, quality, track record and safety features.
Our VISX Star S4IR laser with Wavefront Technology, Iris Registration and 3D eye tracking provides excellent predictability and has the most approvals by the FDA. This laser also has the widest treatment range available in the United States. With the latest hardware and software upgrades, our laser features design improvements intended to shorten the treatment time and expand the lasers capabilities and accuracy.
To use the VISX STAR S4IR, the surgeon must become VISX certified which requires a thorough training process. More people in the United States (approximately 7 out of 10) have been treated with the "gold standard" VISX laser than all others put together. Our laser is the most trusted laser vision correction technology, chosen by more ophthalmologists in the U.S. than all other lasers combined! Because the VISX Star S4IR is so successful it is the only laser we use.
Wavefront technology was originally developed to help reduce distortions when viewing distant objects in space. Today, it is revolutionizing the refractive surgery industry. This technology is incorporated into the Wavescan diagnostic system which allows our doctors to now identify, measure and correct imperfections in a patient's eyes 25 times more precisely than with the standard methods used for glasses and contact lenses.
This is "true" Wavefront guided, unlike the imitation Wavefront "optimized" Allegretto laser system that simply averages treatments to other patients by only steepening the side of the cornea and not actually correcting higher order aberrations. It does not capture the true fingerprint of the eye and treat it like the VISX CustomVue Technology.
Using Wavefront technology in conjunction with the Star S4 Iris Registration (IR) laser system, Doctors Moretsky and Cassidy can take the digital information gathered by the Wavescan and develop an individualized treatment plan that can be transferred directly to the laser for a precise "high-definition" vision correction never before possible.
IRIS REGISTRATION (IR)
The VISX Star Iris Registration System (IR), is the latest step in CustomVue technology pioneered by VISX. The idea is to insure the best alignment of the laser treatment pattern possible. The eye tends to rotate when a person changes from a seated to the lying position. This is often a fairly small amount of true rotation but is clinically significant when applying a laser vision correction application. In the past, registration marks would be applied to the eye by the surgeon before surgery and then compensated for under the laser manually. It was the surgeon's responsibility to adjust the patient's head position to compensate and correct for the ocular rotation. If this was not perfectly performed, it could result in misalignment of the laser treatment pattern. While the surgeon must always be prepared to make any necessary adjustments, the IR system aids the surgeon in this task by a computerized matching technique.
Rotation can occur when the patient changes from the seated to the lying position. This can result in misalignment of the laser treatment pattern.
How Does Iris Registration Work?
It starts at the examination, when an infrared image of the iris is obtained in the seated position and analyzed for the various characteristic features of the individuals' iris. At the time of the surgery, another infrared image is taken when the patient is lying down under the laser and these images are compared and superimposed. Any recognized rotation is then compensated for by the laser rotating the treatment plan using sophisticated software. This all occurs prior to initiation of the treatment pattern. The Iris Registration system recognizes and corrects any misalignment in the laser treatment pattern. The better the alignment of the laser treatment, the higher quality of the surgical result.
In addition to the rotational capabilities of the Visx IR system, the final benefit is achieved by precisely centering the laser application. This is referred to as "pupil centroid shift", which is a compensating technique unique to the Visx IR system. When the rotation alignment and pupil centroid shift systems are used, aberrations are reduced, and clinical studies have shown visual results are improved.
While the Allegretto laser system lacks Iris Registration (IR) and does not compensate for eye rotations and possible misalignment, the VISX Iris Registration (IR) System recognizes and corrects any misalignment in the laser treatment pattern.
Epi-LASIK
Epithelial sheet is created using a plastic separator
Sheet is lifted back and laser treatment is applied
Cornea is reshaped correcting refractive error
Sheet is repositioned and placed in proper alignment to heal
The introduction of Epi-LASIK bridges the gap between LASIK and other types of "no-flap" treatments such as PRK and LASEK (sometimes referred to as Advanced Surface Ablation or ASA). With PRK the surface layer of the cornea is discarded, before the laser is applied. LASEK (or "advanced surface ablation"/ASA) relies on a diluted alcohol solution to soften and shift the surface layer, after laser application. The shifted surface layer is then replaced and repositioned. With Epi-LASIK, the surface layer of the cornea is mechanically separated without a blade as a sheet, and then replaced after the laser application. We have found the recovery is faster, and there is less discomfort with Epi-LASIK because it eliminates the toxic effect of alcohol on the cornea compared to the ASA or "no-flap" treatment techniques.
It has been our experience, using ASA "no-flap" (surface treatment), Epi-LASIK or creating a flap with LASIK, all result in equally good visual results. However, LASIK patients recover faster, experience less discomfort and are more rapidly satisfied with their result. For those patients who are not candidates for a LASIK flap, we advise the Epi-LASIK technique because it eliminates the toxic effect of alcohol on the cornea.
After the Epi-LASIK procedure, you will be given instructions on how to manage any discomfort you may experience. You will also be given medications to speed healing. Most people return to their normal activities within 3-5 days. Because everyone heals somewhat differently, it can take a few weeks to a few months for patients to reach their final visual outcome. With all its advantages, Epi-LASIK has demonstrated to be a very safe and effective alternative to PRK and LASIK.
