History of Femtosecond Lasers in LASIK Flap Creation
Femtosecond lasers have been used to create LASIK flaps since the early 2000s, with the first FDA-approved femtosecond laser for LASIK flap creation entering clinical use in the United States in 2000. 1
Evolution of LASIK Flap Creation Technology
Initial Development and FDA Approval
- The first clinical series using femtosecond lasers for LASIK flap creation in the United States began in June 2000 2
- Before femtosecond lasers, mechanical microkeratomes were the standard method for creating LASIK flaps
- The American Academy of Ophthalmology's 2023 Refractive Surgery Preferred Practice Pattern confirms that femtosecond lasers have been an established alternative to mechanical microkeratomes for over two decades 1
Technological Progression
- Multiple generations of femtosecond laser platforms have been developed since their introduction
- The FDA has approved several femtosecond laser systems for LASIK flap creation, including:
- IntraLase (later acquired by Advanced Medical Optics/Abbott)
- VisuMax (Carl Zeiss Meditec)
- Victus Femtosecond Platform (Technolas Perfect Vision/Bausch & Lomb)
- WaveLight FS200 Laser System (Alcon Laboratories) 1
Advantages of Femtosecond Lasers over Mechanical Microkeratomes
Flap Precision and Predictability
- Femtosecond lasers create more planar flap architecture compared to the meniscus-shaped flaps produced by mechanical microkeratomes 3, 4
- They provide greater precision in flap diameter and thickness with standard deviations in flap thickness ranging from 4 to 18.4 μm 5
- Femtosecond lasers allow programmable angulation of the flap periphery 3
Safety Considerations
- Femtosecond LASIK flaps have lower incidence of epithelial defects and flap dislocations compared to mechanical microkeratomes 3
- The 2013 American Academy of Ophthalmology report concluded that femtosecond lasers were "as good as or better than mechanical microkeratomes for creating LASIK flaps" 5
Unique Complications of Femtosecond Laser Flap Creation
While femtosecond lasers have improved flap creation precision, they do have some unique complications:
- Diffuse lamellar keratitis (more common with femtosecond lasers than mechanical microkeratomes) 6
- Transient light-sensitivity syndrome
- Rainbow glare
- Opaque bubble layer
- Epithelial breakthrough of gas bubbles
- Gas bubbles within the anterior chamber 5
Current Status
Today, both mechanical microkeratomes and femtosecond lasers remain viable options for LASIK flap creation, with the American Academy of Ophthalmology stating that "either mechanical microkeratomes or femtosecond lasers can be used to create a flap prior to excimer laser ablation" 1. However, femtosecond lasers have gained significant popularity due to their precision and predictability advantages.
The technology continues to evolve, with newer femtosecond laser models delivering lower energy to cut flaps, resulting in reduced inflammatory responses compared to earlier generations 3.