Reviewing the Current Status of Femtosecond Lasers in Refractive Surgery

F emtosecond laser technology is all around us now, and many refractive surgeons have chosen to invest in one of the four available technologies. This article will review the current status of those machines designed specifically for refractive surgery, which include the Femto LDV (Ziemer Group, Port, Switzerland), IntraLase (Abbott Medical Optics Inc., Santa Ana, California), Technolas 520F (Technolas Perfect Vision GmbH, Munich, Germany), and the VisuMax (Carl Zeiss Meditec, Jena, Germany). A fifth, designed by WaveLight AG/Alcon Laboratories, Inc. (Erlangen, Germany/Fort Worth, Texas), is rumored to be released this fall. (Editor’s Note: Please see the sidebars throughout this article for specific information on each femtosecond laser platform; all sidebars compiled by Jennifer Kreatsoulas, PhD, Senior Associate Editor.) First, before investing in femtosecond laser technology, it is advisable to determine what your specific clinical needs are. Will the laser be stationary in one operating room or will it be transported between locations? Will you use it for flap creation alone or also for therapeutic corneal procedures, such as penetrating keratoplasty (PKP), deep anterior lamellar keratoplasty (DALK), Intacs (Addition Technology, Inc., Des Plaines, Illinois) channel creation for keratoconus, and other indications? Are you interested in new devices, such as intrastromal corneal implants, like the AcuFocus Kamra corneal inlay (AcuFocus Inc., Irvine, California), and new procedures, such as Intracor (Technolas Perfect Vision GmbH) for presbyopia? Most of these questions can be answered by reviewing the technical features, procedures and handling, and clinical benefits and limitations of each system. I highlight these considerations below.