Comparing the LASIK Lasers

Since the late 90's when the first excimer laser received FDA approval for LASIK eye surgery, several companies have developed their own version, touting top of the line technology and making claims that illustrated the advantages of their machine over the competition. Some companies continued making improvements, introducing new models, or funding studies that might illustrate a proven advantage to their machine: anything to gain a competitive advantage in the market place.

Of course, let's not forget marketing to the consumer. If you've spent anytime reading up on LASIK on the Internet at all, you've no doubt seen some advertorial, press release, or other company propaganda telling you why should trust your eyes to no other machine than the one in this ad.

Well it's not true of course. There are differences, usually minor or insignificant, but it is hard to sift through everything that is out there and find out why a doctor would choose one machine over the other, or which laser might offer any few small advantages. So we found out for you, asked doctors why they use the laser they do, found out what exactly might help your outcome, and asked questions to find out if the laser really does make difference.

LASIK Lasers in the United States

If you take a look at the list of FDA approved lasers you will see that there are several models that have been approved for use in the U.S., though there are four systems that dominate the marketplace: these are machines made by Alcon, Bausch & Lomb, Nidek, and VISX. Of these four, Nidek is the only one not currently FDA approved with Wavefront technology, which gives the LASIK machine a detailed map of the eye.

Usually when patients are looking into LASIK they are concerned with how likely they are to reach that mark that all glasses wearers are shooting for: 20/20 vision. When using this measurement, most doctors will tell you that all the available machines will perform about the same. Here is what ophthalmologist Dr. Richard L. Lindstrom has to say about how the lasers compare: "we have all 4 laser platforms in the TLCVision system (the company for which Dr. Lindstrom works) and in over 100 locations with over 300 surgeons and 200,000 procedures per year. There is no clinically significant difference in visual outcomes as measured at 20/20 or better at 30-90 days postoperatively between platforms. Custom Wavefront driven laser treatment is statistically better than conventional (just over 10% more 20/20 with one treatment and a 50% reduction in the enhancement rate) so I and TLCV recommend Custom Wavefront driven treatment whenever possible."

Indeed, Dr. Lindstrom’s feelings are the same ones stated by doctors throughout the country and frequently proven in studies that test functionality and results of the different machines. Of course, there is more to vision than just being able to make out objects at a given distance.

Seeing at Night

One of the biggest concerns for many LASIK patients has been the ability to see clearly at night without visual aberrations like halos and night glare. New studies are beginning to compare the different lasers and their ability to offer sustained night vision. In a recent study authored by Dr. Steven Schallhorn, director of cornea and refractive surgery for the Naval Medical Center, the four different lasers were compared to study differences in visual outcome and night driving ability.

Though there was no difference in visual acuity (the ability to see objects at a distance that is measured with 20/20 as its standard), there was a difference in night vision that was dependent upon which laser was used. In this study only the Alcon and VISX machine were used with Wavefront technology. About 20-25% of patients had worse night-driving abilities following LASIK with the Wavefront machines, while about 40-50% of patients saw worse at night after being treated with the other two machines. It was also reported that VISX offered better identification at night than the other three lasers.

Though studies that compare the available lasers are just recently gaining popularity, it is likely that many more will take place in the near future, offering even better information for the discriminating consumer.

Cost Concerns and Other Intangibles

All decisions are not just based on studies and statistics. There's also cost, and the laser you choose may make a difference in this all important factor. If you're going to choose Wavefront LASIK it is going to cost you: anywhere from $200-$400 more per eye. In addition to that, the Nidek company is the only one that does not charge surgeons a royalty every time they use their machine. In many cases (though not always) practices will offer a slightly lower price when using this machine.

Then there's the upkeep; after all, it is important for the machine to work correctly every time, not just when it's new. According to Dr. Richard Mauer of Mauer Eye Center, one of the reasons that he chooses to use the VISX machine in his office is because they have a very good service record and a good response rate to service calls. He also says that "[it] offers the smoothest ablation pattern and the smoothest disc." (A smooth disc could mean fewer complications and better ability to see at night).

When asked, though, if a patient should sift through the research and try to decide which laser would serve him or her best, Dr. Mauer said that "[the patient] would be better of finding a doctor that [he/she] trusts."

So ultimately it comes back the hands that use the machine and not the machine itself, but knowing the differences can really help you prepare for surgery and see a better outcome.