Does the Laser your LASIK Surgeon Uses Matter? – Las Vegas Eye Institute

Does the Laser your LASIK Surgeon Uses Matter?

The simple answer is: YES! But it’s like any tool in life; the device is only as good as the person using it. So you need great LASIK lasers, great diagnostic equipment, and a great surgeon to put it all together for the best possible LASIK outcomes. Read on to find out why we recently swapped out our already excellent technology for something we feel is even better.

Why did Las Vegas Eye Institute recently invest in the new Alcon EX500 laser with Contoura Technology?

In July of 2022, we installed the Alcon EX500 with Contoura technology into our LASIK suite to add to our already advanced forms of laser eye surgery. We had already been obtaining excellent results with our prior excimer laser, but it was starting to show its age, and we found the manufacturer couldn’t keep up with our commitment to excellence and reliability. It was time to move on. We investigated many options, including the Zeiss Mel 80 (or waiting for their new Mel 90) and the Alcon EX500 with Contoura technology. Ultimately, we decided on moving forward with the Alcon Ex500 as the new Zeiss Mel 90 would not allow for topography-guided treatments or wavefront-guided treatments, so it would not allow for the level of customization that our old Visx iDesign 2.0 platform could already achieve.

The Alcon EX500 gave us several significant upgrades in comparison to our Visx iDesign 2.0. The Alcon model allows for extremely fast treatments with its pulse rate of 500 pulses PER SECOND; in comparison, our Visx used variable spots that had a maximum speed of 20 pulses per second. This doesn’t necessarily improve outcomes, but it allows for VERY fast treatments. We have found that our patients prefer to have their treatment completed as quickly as possible, and with this new technology, most of our treatments are completed in under 10 seconds. This higher laser speed also comes with MUCH higher eye tracking speed. Our Visx laser was tracking the eye 60 times per second while placing 20 pulses per second; in comparison, the EX500 tracks the eye 1050 times per second while placing its 500 pulses per second. Incredible speed requires incredible eye tracking, and the Alcon EX500 delivers in this regard.

Contoura importantly allows for a new level of customization that we will discuss further in this article. Lastly, wavefront-optimized hyperopic treatments (for farsightedness) benefit greatly from the enhanced speed of the EX500. For example, a +3.00 treatment could take one minute with our Visx platform, while the EX500 can perform the same treatment in only 10 seconds! Our typical nearsighted treatment with the Visx was taking 30 seconds, and the EX500 does the same treatment in about 6 seconds! Some treatments are so short that they are completed in under 2 seconds.

The Alcon Ex500 Laser at LVEI.

Are all LASIK Lasers the same?

All LASIK lasers are not the same. Your very first decision when considering LASIK should be to select the very best LASIK surgeon (we recommend one with advanced fellowship training in Cornea and Refractive surgery)to perform your LASIK surgery. Next, you do want to insure that your LASIK surgeon has the best technology backing them because, ultimately, your LASIK procedure is a combination of your surgeon’s skill and laser device performance. Lastly, make sure your LASIK surgeon has the most up-to-date diagnostic devices to ensure you truly are a candidate for the procedure they are recommending.

A major decision for us in choosing the Alcon EX500 was its ability to perform Contoura Topography-guided LASIK treatments to allow us to continue to perform the very best custom LASIK procedures for our clients. The Contoura platform integrates the Topoloyzer Vario Device to provide 22,000 data points that are analyzed to provide precise information on the shape of your cornea. This topographic information is then integrated into your treatment to give your eyes the most technologically advanced treatment possible.

Are all LASIK surgeries with Alcon Contoura the same?

No. Alcon Contoura treatments can be further enhanced if your surgeon utilizes Phorcides software developed by Mark Lobanoff in Minnesota to optimize your treatment even further. Unfortunately, not all practices with the Contoura technology can utilize Phorcides because it requires additional diagnostic testing devices that are expensive and not owned by many refractive surgery centers. Specifically, you need a device that can measure the curvature of the back surface of your cornea. At Las Vegas Eye Institute, we actually own 2 such devices: the iOptics Cassini Ambient and the Ziemer Galilei G4. We perform these tests on ALL of our LASIK candidates. However, we do not perform all of our procedures with Contoura or Phorcides because some patients are not candidates for the technology. We utilize our advanced diagnostics to determine when people will benefit the most from Contoura and Phorcides.

The Cassini Ambient at Las Vegas Eye Institute

The Galilei G4 at Las Vegas Eye Institute

What is Phorcides and why do I want my eye doctor to use it?

Phorcides is software that helps improve Contoura Topography-guided treatment outcomes. Contoura technology is incredibly complicated. To get the best outcomes with it, your eye doctor can alter his treatment to fit your specific eye even more by inputting data about the inside curvature of your cornea and information about your eyeglasses prescription to get even better results.

We have Phoricides software and use it when we think this advanced technology can improve the results of Contoura alone. Making this decision requires additional high-tech medical devices that we have invested in at LVEI. We have invested in the multicolored LED technology called the Cassini Ambient as well as the Dual Scheimpflug technology called the Galilei G4. These two advanced technology devices give information about the FRONT and BACK of your cornea that phorcides use to further customize your treatment. In comparison, Contoura technology alone only utilizes information from the front of your cornea and makes assumptions about the back surface of your cornea.

Are all treatments performed by the EX500 automatically Contoura?

No. Contoura is a technology that is an add-on to treatments with the EX500. Most practices do not perform standard cases with Contoura as it takes substantially more time to capture the Topolyzer Vario images, more time to plan the treatment, and lastly, Alcon charges more money for procedures performed with Contoura. Most procedures on the EX500 nationwide are actually performed with a technology called WFO or WaveFront Optimized. These are excellent treatments, and some patients do not have refractive errors that are eligible for Contoura. Regardless of your whether or not your treatment is done with Contoura technology, it SHOULD be performed with image guidance from the Topolyzer Vario device. Dr. Swanic performs all of his treatments (Contoura or Wavefront Optimized) at Las Vegas Eye Institute with iris registration, high-speed pupil tracking, and visual axis alignment.

What treatments are eligible for Contoura LASIK surgery?

Contoura is FDA-approved only for the treatment of Myopia (nearsightedness) with or without astigmatism. Contoura is available for treatments up to -8.00 spherical equivalent. It has a maximum astigmatism correction of 3.00 diopters. If patients have more astigmatism, the EX500 can actually correct up to 6 diopters of astigmatism, but it will be done as a wavefront-optimized treatment instead of a Contoura treatment and will still give excellent results. If a patient has over -8.00 diopters of nearsightedness, the EX500 can also treat up to -12.00 diopters based on its FDA approval; however, at Las Vegas Eye Institute, we are unlikely to go beyond -9.00 diopters of nearsightedness with LASIK surgery and would instead recommend Staar Evo ICL treatment at these high levels of myopia because we feel that provides better vision at high myopia.

My surgeon wants to charge me more for Contoura. Why?

At Las Vegas Eye Institute, we do not charge more for Contoura treatments because we like to keep our treatment pricing fixed, and not confusing, and we don’t want people selecting inferior technology and getting inferior results to save relatively small amounts of money. This is our philosophy, but it isn’t the philosophy of most practices.

We don’t blame other practices for charging more. The reality is that Contoura treatments take longer to capture, take a LOT longer to plan, and Alcon charges us more money to perform Contoura treatments compared to Wavefront optimized. Many patients don’t realize this, but all LASIK procedures in the USA require the purchase of a treatment card that costs several hundred dollars per treatment. Even though LASIK surgeons have already spent several hundred thousand dollars on the lasers themselves, the lasers won’t do anything without a treatment card inserted.

Las Vegas Eye Institute is a premium LASIK practice. We utilize the best LASIK technology, and the best preoperative testing devices, and we have Dr. Swanic, who completed a one-year fellowship in Cornea and Refractive Surgery at Jules Stein Eye Institute at UCLA after completing his ophthalmology residency at Tufts Medical Center. You may pay a bit more here, but I think we all know that generally in life, you get what you pay for.

Dr. Swanic is a Board Certified UCLA Cornea and Refractive fellowship trained surgeon.

What are Higher Order Aberrations (HOA) and does Contoura Treat them?

Higher Order Aberrations are features unique to your eye that are not specified in your glasses prescription. Contoura identifies your corneal higher order aberrations, carefully plots them out, and finally creates a plan that your eye doctor can analyze to determine if correcting them can improve your LASIK procedure results. We have been treating higher order aberrations for years at LVEI, but previously we treated them with wavefront data from our iDesign capture device. We have stopped using our Visx Laser, but we kept the iDesign capture device because it allows us to compare your wavefront aberrations to your corneal aberrations captured by the Alcon Contoura capture device. Most of the time, these two are nearly identical, and that gives us the confidence that using Contoura will help give you the clear vision you desire.

The iDesign high resolution wavefront capture device.

Can Contoura laser surgery help get me out of reading glasses?

Yes, but you need a careful evaluation to ensure that our technology can help you. When we perform LASIK eye surgery, we have the option of leaving some mild nearsightedness in your non-dominant eye to leave you with some functional near vision. We call this treatment blended vision. Some practices do very large offsets between eyes and this is known as monovision. We mostly perform what is referred to as blended vision at LVEI so that we can try to leave your distance vision as clear as possible while helping reduce your dependence on reading glasses. Blended vision correction is where Dr. Swanic tries to determine the least amount of under-correction he can perform that will leave you with functional near vision and great distance vision. This amount is often in a range of 0.75 diopters to 1.50 diopters; in contrast, monovision LASIK was often in 2.00 to 2.50 diopter range which severely compromised distance vision in the near eye.

Contoura allows correction to 0.01 diopters while traditional LASIK only allows for correction to 0.25D. When planning a blended vision correction for our patients, we like to have this opportunity to control down to 0.01 D so that if we feel you would do better with a 0.60 diopter boost for near over a 0.75 diopter boost, we can give that level of custom LASIK to meet your visual goals. Unfortunately even the EX500 advanced wavefront optimized treatments are limited to this 0.25 diopter limit.

If you are currently farsighted (hyperopic), then the EX500 Wavefront Optimized technology can improve your distance vision, but we have found that hyperopic patients are not as tolerant to being overcorrected to nearsightedness as patients that started out nearsighted. That being said, farsightedness is fundamentally a problem with poor near vision, and we can often reduce your dependence on reading glasses by correcting your far vision and providing a small overcorrection in your non-dominant eye.

What is Bladeless LASIK and does it relate to our new LASER?

All of our LASIK procedures at LVEI are bladeless. This has been true for years and remains the same with our new Contoura and Wavefront optimized LASIK treatments. When we perform LASIK, we always utilize the Zeiss Visumax laser to create the corneal flap for your refractive eye surgery. We don’t own a blade as we strongly believe the Visumax is the best and safest way to make a flap for LASIK. The Visumax laser also is helpful in patients with thin corneas because it can make an ultra-thin corneal flap to preserve corneal tissue and make more people candidates for LASIK.

Dr. Swanic has experience with bladed LASIK and understands that the visual results have been shown in studies to essentially be nearly identical to laser-assisted flap creation. However, blades carry certain safety risks that we don’t feel are appropriate in 2022 for a procedure that is elective. Elective procedures require that LASIK surgeons attempt to make surgical risks minimum. The Visumax does exactly that.

Why should you choose LVEI for your laser vision correction procedure?

LVEI was founded by Dr. Swanic in 2013 with the goal of bringing the highest quality of vision correction to the Las Vegas Valley. The practice that Dr. Swanic joined as an associate after his fellowship at UCLA was a striking step down in quality compared to what he was used to after completing his residency at Tufts and his fellowship at UCLA. Not even 2 years later, it was time to move on. He desired to give LASIK patients in Las Vegas the same, or better, care that those top institutions could provide. The LASIK outcomes and LASIK quality of his first practice did not meet his high standards. Nine years, and over 1 million dollars of investment in LASERs and advanced diagnostic equipment, have allowed LVEI to become the practice Dr. Swanic had always dreamt of creating. One thing our patients realize is that we never stop progressing and innovating; the drive for visual excellence in refractive eye surgery at LVEI is never ending, as it should be.

 

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