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Jun 16
Tagged with: Laser Eye Correction

From Maclean's, Canada's Newsmagazine, June 11, 07, pages 49 and 50.
"Eye surgery without a blade

Ophthalmologist David Rootman watches
through a microscope as tiny laser beams
pulse over each of Rico Ho's eyes, forming a
microscopic layer of bubbles within the cor-
nea. A monitor in the surgery suite shows
the same magnified image Rootman sees: a
circle filling with bubbles from top to bottom
creating a "flap" (a sliver of the cornea about
100 microns thick) that is then folded back
to apply a custom-designed corrective laser
treatment. "It's going beautifully," says Root-
man, still looking through the microscope
as he passes a cellulose sponge over Ho's eye-
ball, smoothing the flap back into place where
it immediately begins reattaching to the cor-
nea. As he steps through the waiting area to
the recovery room, Ho is clearly excited. "It's
already better," he says.
A year after his condition (a mix of myopia,
or nearsightedness, and astigmatism, a cur-
neal irregularity that distorts images) worsened
to the point that he had to ditch his contact
lenses for uncomfortably thick glasses, Ho,
27, decided to try laser eye surgery. in research-
ing his options, he quickly decided he wanted
it done with IntraLase. Commercially avail-
able for about four years, the computer-oper-
ated lntraLase is often described as the "blade-
less" option in LASIK (the form of laser eye
surgery that involves creating a corneal flap).
IntraLase carves the flap with bubbles instead
of a hand-held oscillating metal blade, known
as the microkeratome, that has been used
since LASIK first became available in Canada
in the mid 90s,
Rootman introduced the IntraLase tech-
nology to the Yonge Eglinton Laser Eye Centre,
in July 2005. After using it only one day, he
never wanted to go back to the microkera-
tome. IntraLase is superior, says Rootman,
for two reasons: precision and safety. He
believes it allows better control over the thick-
ness, shape and smoothness of the corneal
flap, and is much less likely to result in any
kind of surgical complication, such as a
"buttonhole" (in which a piece of tissue from
the flap remains on the cornea). "With the
microkeratome, the staff hold their breath
for the 10 seconds it takes for the blade to go
across the cornea and come back," he says.
"So does the surgeon."
While many eye centres across Canada are
adopting the technology, there is some debate
in the ophthalmology community about its
benefits. LASIKMD, which has 17 Canadian
locations and performs about 40 per cent of
laser eye surgeries in the country annually,
does not offer IntraLase, "To date there is no
scientific evidence that proves it is a better
way to create a flap," says spokesman Michel
Lanctot. "Yet people are paying between $300
and $500 more an eye just for that special
technology." Naysayers also point out that
the procedure takes slightly longer with
IntraLase, which has to do with the Suction
pressure required to harden the cornea prior
to making an incision.
It isn't that Rootman thinks the microkera-
tome is unsafe; he used it for almost seven
years and had good results "99.99 per cent
of the time." But Rootman thinks IntraLase
can do much more than get people out of
glasses; he sees it as the future of ophthalmol-
ogy: "I think in five years, all corneal surgery
will be done with the laser, we won't be using
knives at all." Already, he has performed 10
corneal transplants using IntraLase, operat-
ing on patients from his practice at the Toronto
Western Hospital in his private clinic, as part
of a study. "Those patients are only a couple
of months out now," says Rootman, "but I'm
convinced that it's going to be way better for
patients compared to the standard."
And that's not the only way in which laser
eye surgery traditionally thought of as "cos-
metic" because it eliminates the need for
glasses, is increasingly becoming an adjunct
to medically necessary procedures. For ex-
ample, in order to work properly, the new
Lasers are taking over corneal procedures
multi-focal lens many cataract patients are
now having implanted requires the removal
of any residual refractive error. "The com-
bination of intraocular and laser refractive
surgery has become the state-of-the-art care
for many cataract patients,"

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