Cosmetic Surgery Tips

Femtosecond Laser with LRI

So, what’s the big deal about femtosecond lasers? Well, medical science is always seeking ways to improve patient outcomes and reduce complications, and femtosecond laser technology is a significant step in this direction. Let’s explore how it works and why it’s so important for cataract surgery.

In this guide, we review the aspects of Femtosecond laser with LRI, What is Femto LRI, Which laser used in femtosecond, and How does LRI work?

What Is Femtosecond Laser Technology?

The femtosecond laser technology represents a big step forward in the field of ophthalmology with regard to development. The cornea is reshaped and cataracts are removed during this operation with an incredibly quick laser beam. Cataracts are also removed during this surgery. In the years after its first introduction in 1995, it has been deployed in more than 100,000 different circumstances all around the world, and thousands more are being carried out on a yearly basis.

The ability of the femtosecond laser to generate a minute channel through which light may flow without inflicting any damage to the healthy tissue that is around it is one of its most notable capabilities. As a consequence of this, people who have this approach are able to undergo surgical treatments that are less risky and recover from such procedures more quickly.

What is the femtosecond laser?

A femtosecond laser is a device that uses an ultrashort pulse of light to create incisions in the cornea. The laser is used to correct refractive errors, such as nearsightedness or farsightedness, by reshaping the curvature of the cornea.

The femtosecond laser works by focusing a series of optical pulses onto one point on the surface of your eye. These pulses separate into two parts: one that leaves through your pupil and another that directly enters your eye via its outer layer (the epithelium). LRI can be performed on all types of eye surgeries including cataract surgery, LASIK and PRK procedures, intraocular lens implantation (IOLs) and other corneal surgeries such as intrastromal keratoplasty (IKP).

How does the laser help with cataract surgery?

The femtosecond laser is used to create a small hole in the center of the patient’s cornea. The hole is then used to insert an intraocular lens (IOL), which is inserted before the cataract operation begins. The laser also reshapes your cornea so that it will be able to focus light properly after surgery.

The femtosecond laser can create tiny wounds on your eye, but these aren’t the same as traditional incisions made during other types of surgeries. The depth of these wounds is only 0.5 microns and they heal quickly without creating scars or leaving any visible marks on your eye’s surface after they’re healed up, which means you’ll never know that there was ever anything wrong with them! You may feel some pain when certain parts of your procedure are occurring because we’re using such fine instruments inside your eyes, but don’t worry—our doctors will make sure this doesn’t hurt too much or last long enough for any discomfort to set in!

Femtosecond laser with lri for astigmatism

Thanks to the laser, you will enjoy:

  • Faster healing. The laser replaces conventional surgical blades and sutures, which means that your wound will heal faster.
  • Less pain. The laser produces no thermal damage to surrounding tissues (such as nerves or blood vessels), so there is less pain during and after surgery.
  • Better vision. Because it’s so precise, you are less likely to experience complications with your vision following an LRI procedure than with traditional methods of corneal incisions and stitching up incisions in the eye. Your field of vision may be slightly narrower than before surgery but this should improve over time as scar tissue heals around the cornea and gradually expands it back into its original shape.

Femtosecond lasers are game-changers for cataract surgery. They provide surgeons with the precision to perform delicate procedures without damaging surrounding tissue or causing inflammation. For example, femtosecond lasers are used to make incisions in the cornea and remove the nucleus of your eye’s lens.

This technology is so important because it allows for better visualization and control during these procedures, which means that your surgeon can give you a higher quality result than was previously possible with manual tools such as microkeratomes (scissors) or diathermy machines (blades).

Femtosecond laser with lri is a revolutionary treatment for creating the most natural looking results possible.

LRI provides a unique combination of features that allow it to address many of the most challenging conditions in psoriasis and other skin cancers. LRI is capable of targeting and destroying abnormal tissue, while leaving healthy tissue unharmed.

The Femtosecond laser with lri is the ideal laser for precise, delicate and safe skin treatment.

Femtosecond laser with long-pulse infrared light (LRI) technology is a breakthrough innovation in laser eye surgery. The advantages of femtosecond laser with LRI include the ability to produce a flap with the highest precision, while avoiding any pre-existing corneal tissue.

Femtosecond lasers with infrared delivery capabilities, such as the Candela VELVET™ Laser, offer improved clinical outcomes and ease of use with the potential to reduce patient discomfort and shorten procedure times.

What Are the Advantages and Limitations of A Femtosecond Laser with LRI Tryphellas?

Femtosecond laser with lri is the most advanced and innovative technology in sight correction. Femtosecond laser with lri allows you to reshape your eyes while they are open quickly, safely and with no pain.

Femtosecond laser. Laser-guided re-pigmentation. A revolutionary new skin treatment that heals, reduces redness and works with your body to restore collagen.

The femtosecond laser is an extraordinary device that has revolutionized ophthalmic surgery over the past decade. As a consultant at an eye clinic, I have been able to witness firsthand the ingenious ways in which surgeons have adapted this technology to improve the lives of their patients.

The femtosecond laser with lri is a handpiece that uses argon gas, as opposed to water. As such it can be used in multiple environments and doesn’t require any cool down time following the procedure.

Femtosecond laser surgery is a new technique in ophthalmology with the aim of minimizing complications and achieving good visual outcomes.

Femtosecond laser with lri (FemtoLRI) is a new laser technology platform suitable for use in a wide variety of medical applications and tissue manipulation. The FemtoLRI technology offers an advanced treatment platform which provides flexibility, performance and value to the patient.

How Does a Femtosecond Laser Work

Femtosecond Laser with LRI is a groundbreaking technology; designed to fully treat the root cause of your skin imperfections. It doesn’t just treat the surface of your skin – it goes deep inside and treats the underlying structure that causes problems like acne, redness and discoloration.

Femtosecond lasers and the LI2.0 are a match made in heaven. With the femtosecond laser you can achieve a very precise treatment of the skin, which will give you more control over your treatment.

Femtosecond lasers are typically used for hair removal due to their precise, efficient and effective treatments. The technology can be applied across a whole range of skin types and colours. The procedure ensures minimal invasiveness, less pain and faster recovery time. Being such an innovative treatment methods, femto laser therapy has been used for many years in several fields of medicine but its potential is still not fully explored in terms of treating different skin disorders such as mild acne scars, vascular lesions or pigmented birthmarks.

The Femtosecond laser with lri is for the treatment of wrinkles and acne scars, it has a very powerful energy output. With its anti-inflammatory effect, the femtosecond laser is also suitable for redness and sensitive skin.

Femtosecond lasers are now used routinely in corneal refractive surgery owing to the accuracy and predictability of the outcomes, their safety and simplicity. Femtosecond lasers are also used for treatment planning for LASIK, LASEK and PRK.

For some subjects, a “rubberized” LRI is used that makes the skin extremely elastic and red, and it may be covered with a heavy layer of powder.

The laser treatment requires only 3 seconds. A laser beam is applied to the target area. Because the light source is broken into many hundreds to thousands of different wavelengths, each of them can be applied at almost any depth of the dermis or epidermis and can penetrate each layer independently.

With Femtosecond laser with lri and the femtosecond technology, you get sharp, clear skin that looks great and feels comfortable. You can also reduce or eliminate bruising and swelling after a procedure.

Femtosecond laser with LRI is a unique combination of a femtosecond laser with LRI. Using the combined method, it is possible to remove tooth stains completely, helping your smile to look even more natural and beautiful than before.

The FemtoLASER with IRIS performs laser assisted cataract surgery. It is the first FDA-approved laser technology to combine femtosecond laser with optical coherence tomography. This technology allows us to consider the most effective way to harvest subcapsular lens, help us with capsulotomy and placement of foldable IOLs.

Femtosecond laser with LRI is a minimally invasive alternative method for reduction of skin laxity in deep folds, such as the nasolabial folds and marionette lines.

best femtosecond laser

The best femtosecond laser is the one that’s right for you. Here are 4 of the best femtosecond laser systems to choose from.

1. LENSAR FSL

LENSAR FSL is the best femtosecond laser. It is a good choice for both cataract and LASIK surgery, as well as refractive and cataract surgery, or corneal and lens surgery.

2. WaveLight FS200

The WaveLight FS200 is the most advanced femtosecond laser in the market. This device offers a unique design that makes it easy to use, even by beginners. It has a compact size and an ergonomic grip, which are great features for those who want a comfortable experience during laser treatments. When you are using this machine, you will feel like there is nothing out of place.

The WaveLight FS200 also offers excellent versatility so that you can use it for different types of procedures. For example, it allows doctors and surgeons to perform soft tissue procedures such as LASIK or PRK (photorefractive keratectomy). In addition, this device can be used for hard tissue procedures such as cataract surgery or corneal transplantation as well as cosmetic applications such as wrinkle removal or skin tightening on face or neck areas where wrinkles appear early due to sun exposure over time.”

3. ZEISS VisuMax

ZEISS VisuMax is a femtosecond laser system that has been used in over 100,000 procedures. This technology is primarily used to treat cataracts and other eye conditions.

4. LenSx LSX Femtosecond Laser System

The LenSx LSX Femtosecond Laser System is the best femtosecond laser for cataract removal, and also for lasik and refractive surgery. The laser is FDA cleared, which means it is safe to use on your eyes.

The cost of femtosecond LASIK eye surgery with this laser system will range from $4,999 – $6,999 per eye. The price may be higher if you need treatment for astigmatism or presbyopia correction.

Cataract surgery using the LSX Femtosecond Laser System costs $5,499 per eye at some locations (prices may vary).

The best femtosecond laser to use is the one that works best for you.

The best femtosecond laser is the one that works best for you. It depends on your needs, budget and eye doctor.

The best way to determine which femtosecond laser is right for you is by doing some research on the technology itself. The second step should be identifying what kind of surgery you’re interested in getting done and seeing if it’s possible with a particular machine.

It’s also important to have an open mind about what your ideal tool will look like and how it operates—you might be surprised at how much variation there can be between them!

We hope this article has helped you decide on the best femtosecond laser for your needs. If you have any questions or concerns, please feel free to contact us at any time.

What is Femto LRI

In the 1990s, limbal relaxing incisions by and large replaced astigmatic keratotomy on the cornea for astigmatism correction. “The cornea has circumferential fiber rings around the limbus that extend within 1.5 D of the blood vessels of the limbus, so when you cut within that zone right next to the limbus and along, rather than across, the annulus of fibers, the cornea isn’t weakened as much and you don’t end up with wacky overcorrections,” explains Steven G. Safran, MD, PA, a staff surgeon at Robert Wood Johnson University Hospital in Hamilton, New Jersey. “We made the switch to limbal relaxing incisions from corneal incisions because they’re safer.”

Often done in conjunction with cataract surgery—most cataract surgery candidates have at least 1.25 D of astigmatism1—incisional keratotomy methods such as manual LRIs enjoy a long history of published studies supporting their safety and efficacy for astigmatism correction,2-5 in addition to well-developed nomograms, some of which have been in use for over 20 years. Performing manual incisions is relatively inexpensive, since there’s no need to purchase an expensive femtosecond laser. All you need to perform incisional keratotomy is a toric axis marker and a diamond knife, which can last forever with the proper care, experts say.

More recently, femtosecond lasers have been on the rise for managing astigmatism in conjunction with cataract surgery,6-7 making it very simple and convenient for the ophthalmic surgeon to create LRIs with the laser at the time of laser-assisted cataract surgery. Proponents of laser-assisted cataract and LRI procedures say that the femtosecond laser can ensure and increase incisional precision and uniformity. Additionally, technologies like pachymetry, real-time OCT and topography can be paired with the laser for added safety and improved anatomical visualization. 

In this article, we’ll hear from proponents of both methods, and discuss the current pros and cons of lasers and knives. 

Preeya K. Gupta, MD, a corneal specialist at the Duke Eye Center, says that the femtosecond laser provides an easy way to integrate astigmatism correction into your clinical practice, especially if you’re already using the laser to do cataract surgery. “Adding astigmatism correction takes only seconds of additional time. We should all be correcting even low levels of astigmatism, because it leads to better visual outcomes,” says Dr. Gupta. “The femtosecond laser provides a precise and automated way to do this.”

Dr. Gupta, who uses the LenSx laser from Alcon, prefers the laser to manual methods for a couple of reasons. “Before I started using the femtosecond laser, I did manual LRIs, but I didn’t do them on every patient,” she says. “I’d reserve them for patients who had 1 D or more of astigmatism. With the laser, on the other hand, I consider treating even low levels of astigmatism. I treat astigmatism for every laser cataract surgery patient.” 

It’s partly a matter of convenience, she explains. “If I’m already sitting at the laser for cataract surgery, it’s not a lot of extra effort to treat astigmatism at the same time,” she says. “The patient is already docked to the laser, whereas if I were to switch to manual incisions, it’d require several extra steps: You need to make a plan, have other instruments and have the patient sit up for marking. Using the laser for both cataract surgery and astigmatism correction makes sense from a practical standpoint.”

Shachar Tauber, MD, lead physician on the specialty council and director of telemedicine and ophthalmic research at Mercy Clinic Eye Specialists in Springfield, Missouri, who began his medical journey in the radial keratotomy and astigmatic keratotomy school of refractive surgery, says he was very grateful when excimer and femtosecond lasers arrived on the scene. “I’ve gotten completely away from manual keratotomy, even for transplants,” says Dr. Tauber, who uses the Catalys laser from Johnson & Johnson Vision. “I can have cyclotorsion set up for better accuracy with my marking, and I can pair my laser to the topographer. Incorporating topographic imaging allows for proper orientation of the steep axis and better planning of arcuates. With a laser, I feel confident that the quality, placement and accuracy of the incisions are excellent.”

Here are some reasons surgeons love their lasers:

• Improved precision. Dr. Gupta and Dr. Tauber both agree that, though surgeons are very skilled in creating manual incisions, achieving a level of precision comparable to that of a laser is difficult. “There’s more variability with manual incisions,” Dr. Tauber says. “With a laser I can input the exact number of degrees I want and set variables, like the optical zone diameter based on the pupil or the limbus, and be equal on both sides. The laser also sets up the incision’s length and depth, so it is independent of my hand. If we look at the precision of a laser for astigmatic incisions—whether intrastromal or anterior penetrating—it’s quite precise, and the error is very small and very consistent. Arcuate incisions for the Catalys were clinically validated within 0.83 ±0.66 percent of intended optical zone, 0.22 ±0.2 degrees of intended axis and 0.22 ±0.29 degrees of intended length.”8

“The curvature of the incision is also very precise with a laser,” Dr. Gupta adds. “You can standardize its placement on the optical zone a little more precisely than with manual methods.”

• Intrastromal incisions. “What attracted me initially to the laser was the ability to do intrastromal arcuate incisions,” says Dr. Tauber. “The laser leaves the top and bottom 20 percent [of the cornea] intact; this makes for a more pristine ocular surface. You can’t correct as much astigmatism with intrastromal incisions, and your incisions will need to be longer, but that’s the extent of its limitations. You can’t do intrastromal incisions manually.” 

Intrastromal incisions began with nomograms created by Dr. JulianStevens in London, explains Dr. Tauber. “That’s the nomogram we use,” he says. “We’re working with Dr. Doug Koch at the Baylor College of Medicine to continue perfecting intrastromals. In Europe, others have demonstrated the stability of intrastromal incisions as well as their faster healing rate. So far, there doesn’t seem to be any progression [to corneal melt], which is sometimes seen with anterior penetrating incisions.”

One other benefit of an intrastromal incision is peace of mind—though the possibility of infection is already rare with anterior penetrating incisions, there’s almost no risk of infection with intrastromals. “In theory, there shouldn’t be an infection when an incision doesn’t break the surface,” Dr. Tauber explains.

• Cyclorotation detection. The LensAR, LenSx (Alcon), Victus (Bausch + Lomb) and now the Catalys (Johnson & Johnson Vision) are some of the lasers that include a system for detecting and compensating for cyclorotation. “To me,” says Dr. Tauber, “the dividing line between manual and femto comes down to two things: the laser’s ability to do intrastromal incisions, which is better in my mind for the ocular surface, and the laser’s cyclorotation detection and correction. For the first time in the history of astigmatic correction we’re no longer using ink pen-style marking, which has a significant number of inaccuracies built into it for both astigmatic incisions and toric IOLs. With the advent of cyclorotation detection and correction, the femtosecond laser has become a solid tool.

“Traditionally, we marked the cornea with ink at the slit lamp or as the patient entered the operating room,” Dr. Tauber continues. “However, a paper in 2011 showed that manual marking error can amount to more than nine degrees, with a range up to 10 degrees.9 That’s quite a margin of error. Femtosecond lasers reduce that error, so we’re thrilled.”

• Real-time OCT. Manual LRIs may be dislocated or penetrate the cornea too deeply. Using OCT in conjunction with the femtosecond laser enhances precision and allows surgeons to see how deeply they’re cutting, Dr. Gupta points out. With OCT, surgeons can obtain in seconds images of the anterior and posterior cornea, in addition to pachymetry, corneal diameter, anterior chamber depth and iris boundaries. “OCT allows us to plan and program the laser to treat at a specific depth, say 80 percent,” she says. “When doing manual incisions, we’re not able to precisely image the cornea, so there’ll be some variability not only in depth of placement but also in the incision itself. Depending on the force of pressure, it’s also possible to perforate the cornea.”

“You have several safety margins when OCT gives you the anatomy,” adds Dr. Tauber. “Real-time OCT will change if your patient moves, which allows you to either stop before you start or to abort an incision, whether it be for cataract removal, a paracentesis or an arcuate. If your patient moves enough, the OCT will show you that the incision may not be where you want it. This rarely happens, but it’s a beautiful safety factor.”

“A surgeon must interact with the eye—a laser can’t do that,” says Dr. Safran, who finds lasers to be overkill at best and dangerous at worst. He says that while many studies show it’s possible to use a femtosecond laser for keratotomy and cataract surgery, their findings point to higher complication rates and no clinically-meaningful improvements over conventional means.10-11 

David F. Chang, MD, a clinical professor at the University of California, San Francisco, and in private practice in Los Altos, California, says his use of astigmatic keratotomy has declined substantially now that presbyopia-correcting IOLs all come in toric versions and the light adjustable IOL (RxLAL; RxSight) is available. When he does perform astigmatism keratotomy, however, he prefers a blade. “One indication for astigmatic keratotomy is for eyes with low astigmatism (i.e., estimated 0.5 to 0.75 D) because we don’t have lower-power toric IOLs,” he says. “Astigmatic keratotomy is also a less expensive alternative for patients who can’t afford a toric IOL.”

Here are some reasons surgeons prefer to stick with a blade:

• In-clinic convenience. With manual incisions, doctors have the convenience of correcting astigmatism at the slit lamp during a regular postop exam, rather than taking the patient back to the operating room or laser suite. Additionally, some surgeons believe that correcting astigmatism in the postop phase at a follow-up visit may result in better outcomes because the eye is more stable. 

Postop astigmatic correction can be very beneficial. For example, Dr. Chang’s preferred way of managing complex astigmatism is the light-adjustable IOL from RxSight. “We can effectively create a ‘customized’ toric IOL several weeks after surgery,” he says. “It’s based on the postop refraction rather than our preop predictions of surgically induced astigmatism, posterior corneal astigmatism, and cylindrical power and axis.” 

• Intraoperative aberrometry. Dr. Chang says that the best way to improve your LRI results is not by using a femtosecond laser, but by using intraoperative wavefront aberrometry. “Intraoperative wavefront aberrometry has significantly improved my AK results more than relying on preoperative nomogram planning,” he says. “This is because after you place one LRI, you can immediately re-measure the actual refractive astigmatism. Based on this, you could lengthen the first LRI, or add a second LRI opposite to the first. So the best way to improve your LRI results is not by using a femtosecond laser, but rather titrating what you do with pseudophakic intraoperative aberrometry.

“For diffractive multifocal and EDOF IOLs, I always perform intraoperative aberrometry after the IOL implantation,” he continues. “This lets me refine the axis for any toric IOL. If my preop calculations called for a spherical lens, pseudophakic intraoperative aberrometry often indicates some residual astigmatism. Because residual astigmatism reduces multifocal and EDOF performance, I will then add one or two LRIs to reduce the astigmatism to 0.5 D or less, based on titration with intraoperative aberrometry measurements of the live refraction. Femto AK can’t provide me with the important benefit of adding or titrating LRIs based on the pseudophakic intraoperative aberrometry during surgery.” 

• Manual is sufficient. One common argument in favor of laser over manual methods is that lasers are more precise. “I think this is misleading,” says Dr. Chang. “There are no long-term studies that have shown superiority of femto AK to either toric IOLs or manual AK. You must have at least six months follow-up to evaluate the regression of effect with incisional keratotomy. There are even conflicting results from studies looking at consistency of femto LRI depth. The greatest variable for astigmatic keratotomy outcomes isn’t the depth of the incision, but corneal hysteresis and patient age.”

Dr. Safran adds that while precision is good, laser-like precision just isn’t necessary. “Besides the fact that laser LRIs are inaccurate by nature, you’re only trying to treat half a diopter or a diopter of astigmatism with an LRI,” he explains. “You’re not trying to treat 3 D. My manual LRI nomograms are small, medium and large, based on the patient’s age and how the tissue responds as I cut it. Let’s say you have a patient with 1.5 D of astigmatism. If I knock it down by 0.75 D or by 1.5 D and correct it all, the patient will be happy. If I overcorrect to 2 D, the patient will be down the other way, but it’s still only by half a diopter. Any correction between 0.75 and 2 D will work. LRIs don’t need to be super precise.” 

• Lasers aren’t an improvement. “For years, we had no real peer-reviewed data on femto corneal relaxing incisions until a 2016 paper on intrastromal astigmatic keratotomy,” says Dr. Safran. “But this study reported safety with only one month of follow-up data, and they achieved less than half a diopter of correction.12 Another study of 51 eyes concluded that laser CRIs were effective, but the data show that over the three-month follow-up period, the mean effect of astigmatism correction was decreasing while the range of outcomes was increasing,” he says. “It was getting more unpredictable.13

 “If you look at the laser studies, there’s very little effect—maybe a quarter of a diopter of correction, and that’s nothing—a homeopathic effect,” he continues. “But when laser goes wrong, it’s not fixable. We stopped cutting the cornea, because you end up with irreparable damage. Femtosecond laser corneal incisions don’t work until they do work, and when they do work, they create problems.”

Dr. Safran points to several studies showing troubling laser side effects in FLACS, which usually precedes laser LRIs, including acidic shifts in aqueous humor pH,14 increased levels of prostaglandins,15,18,11 miosis,16 increased inflammatory mediators and fibroblast growth factor,17-18 and higher rates of posterior capsular tears.11

 “There’s no evidence that FLACS is better than phaco, but plenty of studies showing it may increase complications,” Dr. Safran says. “Cutting the cornea with a laser to correct astigmatism is a bit like warming your hands with a burning coal. Nothing happens until you get burnt. Studies show lasers cause more astigmatism and don’t heal as well as manual incisions.”

The European Society of Cataract and Refractive Surgery conducted a multicenter case-control study across nine European countries and Australia that compared the visual, refractive and adverse outcomes of 2,814 FLACS cases and 4,987 conventional phacoemulsification cases.8 Seventy-two percent of FLACS and 74.3 percent of manual phaco eyes were within 0.5 D of target. One percent of FLACS and 0.4 percent of manual phaco eyes had worse postop CDVA of five letters or more at follow-up.

The study data suggest that laser use might be more proinflammatory than conventional phaco, and contribute to higher rates of corneal edema, uveitis requiring treatment and early PCO, reducing visual acuity. Though femto patients had less postop astigmatism and less surgically induced astigmatism in the study, femto didn’t yield better visual or refractive outcomes than conventional phaco. In fact, the femto group had worse postop visual acuity, more postop complications (3.2 percent versus 1.8 percent for phaco) and more patients with worse postop visual acuity than their preop visual acuity.

“Some say that lasers can help less-experienced surgeons achieve better outcomes, but that’s not the case,” Dr. Safran says. He points to a study of Wills Eye residents in which FLACS and manual phaco achieved similar complication rates and visual and refractive outcomes.9 At one month and one year follow-up, visual acuity in the manual phaco group was better (0.11 logMAR [Snellen: 20/26] at one month; 0.08 logMAR [20/24] at one year) than in the femto group (0.13 logMAR [20/27] at one month; 0.13 logMAR at one year), though these between-group differences weren’t statistically significant at either time point. Persistent postop inflammation occurred in significantly more cases in the femto group. The researchers add that rates of macular edema and elevated IOP were similar between the groups. 

• Cut where you want. “LRIs are much more predictable, heal faster and are safer than laser corneal incisions because you’re cutting along the circumferential corneal annulus of fibers, which contains blood vessels and stem cells,” Dr. Safran says. “If the manual LRI doesn’t work the way I want it to, it doesn’t cause a problem, because it’ll heal. It won’t cause that ectasia pattern that occurs when you cut the cornea.” 

Which laser used in femtosecond

The femtosecond laser is a high-energy optics technology used for eye surgeries and other medical procedures, including all-laser LASIK. During this bladeless procedure, your surgeon uses the femtosecond laser to create a flap in your cornea before altering the shape of the underlying tissue to correct your vision.

The arrival of the femtosecond laser represented a turning point in the evolution of LASIK eye surgery. While LASIK has been around for nearly 25 years, all-laser LASIK only became available after the FDA approved the first femtosecond laser (Intralase) in 2001.

Today there a number of FDA-approved femtosecond lasers on the market. Check out this video detailing how femtosecond lasers are used in LASIK surgery, or skip ahead to read more about how femtosecond lasers work, and which type is best.

Femtosecond Lasers & All-laser LASIK: How does it Work?

If you are having all-laser LASIK, the femtosecond laser will be used during the first step of your procedure: creation of a corneal flap.

Early versions of the femtosecond laser sometimes took longer than the surgical blade (microkeratome) used in traditional LASIK to create the corneal flap. However, the latest versions are purported to take less than 10 seconds.

Which Femtosecond Laser Is Best?

As of 2013, there were four types of femtosecond lasers approved for use in the U.S. for LASIK surgery: Intralase, Visumax, Ziemer and Femtec. Studies have demonstrated that all of these lasers generally make very precise corneal flaps during all-laser LASIK. All pose a lower risk of some flap complications when compared to traditional LASIK with a microkeratome blade. Your surgeon’s choice of femtosecond laser likely comes down to personal preference regarding the features.

To learn more about the various types of femtosecond lasers, contact a qualified refractive surgeon today.

Use in Laser Cataract Surgery

Femtosecond lasers are also now used in cataract surgery. However, these lasers are different from the femtosecond lasers used in LASIK. Please read our laser cataract surgery page to learn more about the types of femtosecond lasers used in laser cataract surgery.

How does LRI work

Limbal Relaxing Incisions (LRI for short) are partial thickness incisions made at the outer (non-seeing) edge of the cornea called the limbus, in folks with astigmatism, in order to reduce or even eliminate their need for distance glasses or contacts.

The incisions are strategically placed at the limbus to “relax” the steepest part of the cornea’s curvature, making it more evenly round and thereby correcting astigmatism.

LRI is often performed during surgery for cataracts or implantation of intraocular lenses or can also be done following Corneal transplantation.

Who is Limbal Relaxing Incisions good for?

This procedure is often ideal for patients who:

Have undergone prior eye surgery and have residual astigmatism

After performing a comprehensive eye exam, your surgeon will discuss whether this option is the best fit for you. It is important for patients to be in good overall health and to have realistic expectations before undergoing this procedure. While most patients typically experience significant improvements to their vision after an LRI, some may still require vision correction in the form of glasses or contacts.

What are the risks of having an LRI?

The limbal relaxing incision procedure is remarkably safe and complications are extremely rare. That said, possible complications of LRI’s can include infection, over-correction, under-correction, micro-perforation of the cornea, induced astigmatism, discomfort, and decreased corneal sensation.

What happens during an LRI procedure?

An LRI procedure performed at AGEI takes about five minutes per eye. It is performed with anesthetic eye drops, does not require stitches and you can go home the same day following a brief examination in the recovery room. Prior to surgery, your doctor uses a special computer to produce a topographical map of your eye and create a template that will guide your procedure.

Here’s what takes place during an LRI procedure:

After your eyes are cleansed, your doctor applies numbing eye drops and puts on a device that keeps you from blinking during the procedure.

Next, you are asked to look into a light while a femtosecond laser or a Diamond scalpel makes precise incisions in your cornea using the template designed to address the specific amount of vision correction you need. AEI’s Treatment System includes a laser-guided measurement system that provides real-time feedback on the vision change achieved, thus enabling the surgeon to refine the incisions immediately until the desired vision correction is achieved.

Once the tiny arc-shaped incisions have been completed, antibiotic drops are placed in your eye, and the eyelid holder is removed.

Following the procedure, you are taken to the recovery area, where you will receive a final eye check prior to going home.

What can I expect after getting Limbal Relaxing Incisions?

Some patients may experience the following post-operative symptoms for a few days following the procedure:

Any post-operative discomfort will be managed with over-the-counter pain medication such as Tylenol.

Most patients are able to return to work and their regular routine the day after surgery. Vision will likely improve significantly within the first day, although there are a few patients who may experience blurry vision for several weeks after the procedure.

Why choose AGEI for Limbal Relaxing Incision Surgery

At AGEI, our LRIs are guided in real time with Intraoperative Aberrometry (a laser-guided system that measures the eye’s focusing power). This system enables us to titrate the astigmatism correction with exquisite refinement, ensuring that the relaxing incisions have the precise angle, depth, and length and are placed in the exact optical zone needed to safely correct your astigmatism.

Because AGEI was the first center in the world to introduce this technology (Wavetec Ora Aberrometer), we have the most extensive experience with this device.

1. Roberts HW, Wagh VK, Sullivan DL, et al. Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery. J Cataract Refract Surg. 2018;44(8):955-63.

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