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Our Laser Technology
Ans. The laser we use is the WaveLight 500 Hz laser and VisuMax Zeiss laser platform Please see the following link for details www.lasikindia.in/our-centre/our-laser/
Ans. What makes LASIK pain-free and what was invented 20 years ago is the ‘LASIK flap’. It is created before the laser removes the numbers. The thickness of the flap to be taken is determined during your evaluation process. We work best with the Moria M2 microkeratome, a completely automated and very safe device for creating the flap. Bladeless LASIK like EpiLASIK is a procedure where no flap is taken.
Ans. The US FDA gives a baseline of 250 microns cornea to be left behind after the laser treatment. Our centre believes in leaving at least 300 microns. Your calculation will be done during evaluation. It should leave at least 300 microns behind on the cornea after the laser treatment is completed. The cornea is like the door to your eye and the stronger or thicker the door, the better it is for you. The Wavelight Concerto 500 Hz laser which we use has its advantages in this respect of corneal saving as this laser saves upto 40% of the cornea compared to other lasers. In simple terms it means that another laser would remove far more corneal tissue to remove the same number. Also, when creating a 90 micron flap, which we do using the Moria single use head, it leaves even more cornea after the procedure. This great advantage for people with high numbers or people which other laser centres cannot treat.
Ans. We work on the uninterrupted power supply system or UPS with the laser. NEVER run the laser without it. Hence, there is no interruption in the surgical procedure even in case of power cut from the external source.
Ans. The laser systems should possess specific features for higher quality visual results. The Wavelight company [our laser company] was the first laser to have done the worldwide wavefront LASIK treatment which others have modified or upgraded in their already existing lasers. Features of our Laser comparing with other Lasers : 1. Laser Spot Size : The small laser spot size is mandatory to produce fine complex treatment patterns. Smaller the size, finer the treatment. Ours is the smallest in the world so far… viz 0.68 HM 2. Speed : Shortens ablation/ treatment time remarkably. To the benefit of the surgeon and to the comfort of the patient, Because shortened corneal exposure time allows faster visual recovery. The rapid rate is vital to maintain corneal hydration intra-operatively, especially in wavefront guided procedures with larger optical zones where a prolonged treatment time could adversely affect the planned treatment profile. A simple principle in laser refractive surgery is to keep the eye as physiologically hydrated as possible intra-operatively for a faster visual recovery. Hence, faster speed lasers have better visual outcomes. Our is the fastest in the world so far… viz 500 Hz keeping in mind the safety limit as well. 3. Optical Zone: Ideally the laser should have the widest treatment area that also removes the least tissue possible, which is what our laser supports. Most Other lasers in order to treat a wider area take out more corneal tissue. This also results in night vision problems. In the night the pupil expands or dilates to let in more light for visibility. If a laser treats a zone, which is smaller in diameter than the diameter of expansion of the pupil, then what you have is an untreated rim of cornea, which in the night is going to result in haloes or glares of light. Most lasers treat upto a 5 mm zone to 6 mm only, ours can treat upto 7 mm. In cases of patients with night glare due to earlier treatments, the ability of our laser to retreat is highly beneficial. 4. Eye Tracking speed The eye is kept fixed with the laser during treatment. However there are fine saccadic eye movements not seen by naked eye. The Wavelight Concerto 500 Hz is better than any other excimer laser system as it tracks the eye at 500 times a second and allows for spot on treatments. Most other lasers have an eye tracker which if the eye moves even to some extent during treatment, then the laser stops. 5. Topography Link treatment Is necessary for a customized laser treatment. Especially in re treatments when undergone earlier LASIK and patient is unhappy. For topography-linked retreatment’s, the Wavelight Concerto 500 Hz laser has the best capabilities at present.
Q I understand Wavefront-guided LASIK is what is being carried out recently by taking a 3D map of the eyes in order to customise the treatment to each person. I believe this is best for better night vision and the absence of glare and halo effects. A friend of mine had glare and not so great night vision. Have any of your patients had any issues with night vision and glare?
Ans. Wavefront-guided LASIK or custom LASIK is the most advanced LASIK method today. But it can be performed using various lasers. The speed of the laser and its application are very important in delivering results. Today, we use one of world’s fastest lasers the 500 Hz whereas most other lasers are 50-100 Hz and some 200-250 Hz. Many older lasers are only upgraded for Wavefront-guided treatments whereas the WaveLight is built from scratch for incorporating wavefront principles. That is why the WaveLight has near-zero night vision problems like glare and haloes, which may still occur with other systems. We also check your pupil size to ensure a more customized treatment zone. We have no recorded night vision problems, one of the reasons why many of our patients are from other countries. This laser is available at very few centres in the US. Further, the US FDA has stated the WaveLight laser to be the only laser to improve night vision.
Q How different are you from other laser/ LASIK centres or what are the advantages of Wavefront Analysis?
Ans. Dr. Anand Shroff, Chief Surgeon, at the Shroff Eye Hospital, Bandra, Mumbai, has several years of experience in LASIK and is among the country’s longest-standing users of the benchmark ‘flying-spot’ laser technology. He also is the first to use the WaveLight Allegretto 200 Hz excimer laser in India before the Allegretto Wave Eye-Q 400 Hz was launched at our Eye Hospital. We are now using the most advanced laser system in the world- The Wavelight Concerto 500 Hz laser, being the only ones in India and few in the world to offer this technology. Wavefront LASIK or custom LASIK is the most advanced LASIK method today. It can be performed using various lasers. The speed of the laser and its applications are very important in delivering results. Today Wavefront technology has been around since 1998. It is specifically for those patients who would end up unhappy if a standard LASIK procedure is done on them. These patients are detected during their LASIK screening and evaluation, by certain specific indications which would arise on the topography and aberrometry tests. It is also a technology for those who have undergone LASIK on poor obsolete lasers or have undergone PRK or RK [other techniques for removal of spectacle numbers] and are having problems. We believe in the best, having always stood for distinction in eye care. After working on different lasers and being offered other lasers still entering the market, we went ahead with the Wavelight wavefront 500 Hz laser because of its superior technology. Most lasers are retrofitted for wavefront or to simply put upgraded whilst this laser has been developed for wavefront from scratch. The detailed research in the laser system took into account the needs of the surgeon, patient as well as looked after the many drawbacks of the other laser systems. To put it simply, the ‘ wavefront’ is the way the natural light pathway goes in the eye thru the entire optics. This is supposed to be a smooth path in an ideal eye. As the light travels thru the other optical system inside the eye, like the lens, vitreous jelly etc. it undergoes further degradation. This is acceptable to a certain extent and that is why the eye surgeons have reached a 6/6 or 20/20 criteria as normal sight. However, when these errors or ‘higher order aberrations’ as they are known, exist to an extent in which they need to be treated then wavefront treatments [Custom LASIK] are a must for such patients. Earlier lasers without wavefront technology can only correct the spectacle number, which arises from the curvature irregularities of the cornea. Our laser can treat the entire optical system errors. Further, when we treat these optical errors by doing wavefront, some patients actually gain lines of sight, better than 6/6 OR 20/20. Then again, that is not our aim alone. We want to give quality of sight. By which I mean good contrast sensitivity and good night vision. In the night the pupil expands or dilates to let in more light for visibility. If a laser treats a zone, which is smaller in diameter than the diameter of expansion of the pupil, then what you have is an untreated rim of cornea, which in the night is going to disperse light in various directions resulting in haloes or glares of light. This is the problem most of the West i.e. USA is facing, because most of their lasers treat a 5 mm zone only and because of lighter colored eyes, their pupils [in US] can dilate upto 7 mm. Our laser can treat wide pupils and has a near zero percent of night vision problems in our experience. There is a lot more of this laser, which helps the patient and the doctor. We can now treat higher numbers with more accuracy, re- treat earlier laser unhappy patients to get better night vision etc. and include patients who would have been poor candidates for earlier technology. This is why our success rates have been good from the beginning, as we have been thorough in our patient evaluation and stringent in our eligibility criteria.
Q Is Wavefront technology Customized Ablation with the Nidek EC5000 CX III Advanced Vision Excimer Laser system on Navex Platform, which is approved by FDA USA superior than Wavelight Concerto 500 Hz?
Ans. 1 The laser you mentioned and their website do not mention anywhere the speed of the laser. 500 Hz is the speed of firing the laser shots on the Concerto. The eye barely moves 10 times a second so having a fast eye tracker and a snail-slow laser makes no sense. Besides if you use a broad-beam laser [a technology that we stopped using in 1998] at 1,000 Hz you’d probably destroy the eye. So the website very cleverly makes no mention of the laser firing speed and nor the fact that it is a broad-beam laser. 2 The Concerto is a concept laser that from the initial drawing board stage was meant to be limited edition. The company has sold all 20. No more will ever be made because the R&D and quality of laser head and optics make it far too expensive and uneconomical for the company to produce in large numbers. 3 You can find information about the Concerto laser on the Wavelight laser website. 4 LASIK is not just about the laser. We are India’s only Joint Commission accredited LASIK centre which means we follow the world’s highest patient safety norms. We will not re-use. You have a 0% chance of contracting HIV, Hepatitis B or C as everything is disposable and is thrown away after every case. 5 Our re-treatment rates are the lowest worldwide, because of our laser, the LASIK team, and our patient safety standards. 6 At the end of the day, it does not matter what we use. You have to take the decision and put a price on your eyes.
Q Do you do the LASIK surgery to the cornea or you go inside cornea and do laser and do you do intralase (LASIK)?
Ans. LASIK is not done inside or outside the cornea as such, but done on the corneal surface. To know what exactly is done, you need to know the steps of LASIK. Basically treating your numbers has the below two steps: Step 1: To create a ‘Flap’ to make this procedure painless and heal well. That is its only objective. Flap creation requires the skill of the surgeon as well as the use of a good equipment to be free from ‘flap related complications’. This gave the need to reduce ‘flap related complications’ by using a laser to create this…This laser is called the Femto second Laser. One of the first models was the Intralase. However, we use a more advanced laser system- the VisuMax Zeiss Femtosecond laser. When this flap is created by a laser, then the procedure is termed “Bladeless LASIK”. But please note that Femtosecond laser does not treat your numbers, it only creates the flap. Step 2: To treat the numbers completely, accurately with safety Your concern is treating your eye numbers ACCURATELY WITH SAFETY. The numbers are treated by another laser technology (the excimer laser), and if this old, then you will not have the desired outcome. VISIX or Zyoptix usually used with Intralase and has only been upgraded to customized wavefront treatments, not built from scratch for wavefront principles as our laser, the Wavelight Concerto 500 Hz. We use a far more advanced laser combination which is using the Zeiss VisuMax Femtosecond laser along with the Wavelight (Alcon) 500 Hz Concerto laser which gives excellent outcomes. It is very important for one to focus more about the laser technology being used to treat your numbers rather than the pre steps of using the blade or bladeless, so, we suggest that you visit our centre to know what suits your eyes the best.
Q Does the wavefront guided LASIK mean you will cut a flap or remove the top layer (epithelium)? Please also advise which machine you use for the op. i.e. – nidek, bausch & lomb, allegreto , etc.?
Ans I shall try and make this simple for you to understand, as your Q’s revolve around technical details. Most patients understand the complex terminologies better when explained as under…. Today no one is going to tell you that they are using a black and white TV, because without doubt you will know that this is an older technology as compared to colour TV, this is an analogy to non wavefront (no laser centre will say that their laser is a non wavefront one as it equates it to something old). However in wavefront, you have different lasers doing the job, just like you could get a colour TV which is Akai or Onida, or something completely high end, HI Fi Sony 3 D TV! that’s the comparison of which ‘laser’ is being used i.e. Nidek, B & L or what we use is the Concerto Laser. For specific advantages, the high end TV’s cost more. Now coming to the exact technique or procedure of LASIK regarding ‘flap’ epithelium’ etc. Again, to give you another example, please imagine a mattress with a bedsheet. The mattress is comparable to the cornea. In LASIK (with whichever laser you use, wavefront or non wavefront, Nidek, B&L or Concerto) what is done is a ‘flap’ is created in the thickness of the mattress. This is not done by the laser mentioned, but by a step prior to using the actual laser. The thickness of the flap (thinner the better, where we use disposable kits to give you a thin flap to help save cornea). The flap is lifted and then the laser reshapes the cornea according to your powers and data collected in the check up (here again we have a cornea saving advantage as the laser we use, the Concerto, uses less cornea to remove powers as compared to most lasers used today). Now, if we do not want to disturb the cornea or save as much of cornea as we can (in dry eyes / thin cornea, detected by Dr Shroff during check up), we do EpiLASIK, which is take the bedsheet away (the epithelium) and do the laser reshaping on the first layer of the cornea (without having made any ‘cut or flap’). This ‘bedsheet’ or epithelium grows back in 4 days time. This is EpiLASIK. So EpiLASIK is just a variation in the initial steps of LASIK, the laser treating powers remains the same which is the Concerto Laser in our case. Marketing terminologies have made it more difficult for a lay person to understand the exact technology/ technique clearly. However, I hope the above helps understand LASIK/ EpiLASIK better.