A friend told me that "two years ago the Summit was known to give more incidences of central islands than the VISX. She went on to say central islands are parts that the laser misses and cause irregular astigmatism."

Any truth to this? The laser center I'm considering uses the Summit Excimer laser.

Thanks,
Allen

Yes your freind is correct also according to www.lasiksafety.com FDA data shows that the Summit laser only produces 47% 20/20 as compared to 87% 20/20 with the Chiron 217.I don't think the Summit laser would pass current FDA criteria and I have heard The FDA plans to review the Summit Apex in the near future.

>Yes your freind is correct also according
>to www.lasiksafety.com FDA data shows that
>the Summit laser only produces 47%
>20/20 as compared to 87% 20/20
>with the Chiron 217.I don't think
>the Summit laser would pass current
>FDA criteria and I have heard
>The FDA plans to review the
>Summit Apex in the near future.
>

Couldn't that report be somewhat biased? From what I saw the doctor on the site uses another laser so what would he have to gain by promoting another type of laser? Your thoughts?

Thanks,
Allen

Your Dr. may be refering to an Autonomous Summit laser which is newer technology.The Summit Apex is old technology and because of the results it gives I would like to see it phased out!

Ken,

Actually, I was talking about the doctor on the board YOU sent me...if he doesn't use the Summit laser why would HE promote it as a good thing?

Btw, the laser at the center I may use is using the Summit Infinity laser. Is that any different from the one you mentioned?

Thanks,
Allen

The infinity is not likely much better than the apex,the Visx S2 has a good reputation and does not consume a lot of cornea also the Technolas 217 according to FDA data produces 87% 20/20 vision which is the highest rate I know of.The draw back with the technolas 217 is that it consumes almost double the cornea that the Visx does.

Interesting...I had not heard that.

Any thought from the doctors?

Thanks,
Allen

Dr. Debra Tennen who is on our site has used the Summitt laser for 4-5 years and has been very happy with the results. Initially there were central islands with all lasers (in the early 90's), but software upgrades in the lasers have made central islands far less common.
In Houston, the Dr. who I know the best is Joel Goffman, MD He uses the VISX laser. we have a few other surgeons in Texas - but I do not know which lasers they prefer
I think you need to talk with your surgeon about the laser issue. He/she may feel that the Summitt laser has provided excellent results. As well - your doctor will know your level of myopia and other things that will help determine what type of candidate you are

Best of luck

Bill Trattler, MD
Miami, FL

> The infinity is not likely much
>better than the apex,the Visx S2
>has a good reputation and does
>not consume a lot of cornea
>also the Technolas 217 according to
>FDA data produces 87% 20/20 vision
>which is the highest rate I
>know of.The draw back with the
>technolas 217 is that it consumes
>almost double the cornea that the
>Visx does.

The Infinity is much better than the Apex. The Apex is a broad beam laser. The Infinity is broad beam using the disk technology. This is a disk for astig and hyperopia that is inserted in the path of the beam to help smooth the ablation. Also, a rotating optic was added in the rail to help smooth the ablation and to help eliminate central islands. The nitrogen in the optic path was also increased to cover more area. The nitrogen allows the beam to spread less resulting in a more stable system for better results and improved lifetime of the optics. All excimer lasers run in the 193nm wavelength and ablate around .25 microns per pulse. The differences between the lasers are in the beam size and the way it is delivered. Thanks, Randy Hill

according to my surgeon, who says that they have NO transition zone, and that the S3 upgrade is just an upgrade for a dinosaur. He also says that Visx lasers are known for creating central islands, and that some surgeons are now using next-generation lasers to clean up the messes they seen that result from Visx ablations.

Daniel - it is amazing the incredible amount of faulty information you are spreading. The VISX laser has corrected my wife's eyes to better than 20/20, and has also treated two of the ophthalmologists in my practice - and they both have excellent vision following their LASIK procedures. One of the surgeons had about 9 diopters of myopia and 3 diopters of astigmatism. His vision improved extremely nicely, and he was able to work seeing patients and performing surgeries within a few days.
The S3 platform, I agree, is not much of an upgrade. It does not alter the way that the laser treats the eye - it just adds some nice features to the laser. Since it will not alter our results, my practice for the time being is not adding the S3.
As for your statement - at this point no laser has proven to provide better treatment results than other lasers. I know the VISX laser in my hands does an excellent job - and I have not one case of irregular astigmatism from the laser.
So again - please refrain from he says, she says type of stuff. If you are going to make a statement that a laser has a higher problem rate, you should have something to back it up. If there was a higher problem rate, I would certainly switch lasers. But for now, in my opinion, the VISX laser has provided excellent results.

Bill Trattler, MD
Miami, FL

I'll second Dr. Trattler on the VISX and excellent results. Perhaps the "dinosaur" theory goes to the fact that VISX was the first, but that does not mean they haven't bothered to make changes since the beginning. Generally I think VISX follows the "if it ain't broke, don't fix it" rule. Along with my eyes being corrected 20/20 plano, the 5 other people I spoke to who went to the same surgeon using the VISX have had similar excellent results. Perhaps it's all a matter of who operates the lasers that dictate the results. Imagine that.

Dr. Trattler,

Why don't you ask Dr. Howard Gimble about this? He is now using the Nidek.

Dr. Trattler,

Are you saying that central islands are surgeon-despendent? I always thought they were due to a lack of a completely homogenous beam from the laser, leaving untreated/undertreated areas of cornea.

Oh boy, more evidence against my doc!!

Dr. Trattler: Let me start by saying thanks for the website and all the great information you relay. Your time and efforts are greatly appreciated. Would you mind providing follow up comments to your statement that the S3 platform is not much of an upgrade? Two respected LASIK Centers here in Houston (Mann-Berkeley Eye Center and Baylor Vision) both use VISX lasers. Mann-Berkeley has already upgraded to the S3 and Baylor Vision's upgrade is pending. From the layman's view (mine), it would seem that an auto-tracking laser would be superior to one that makes no correction for small eye movements. I've just read some posts from one Doctor here on your website who raves about auto-tracking and says she wouldn't use anything else (Dr. Wong, I believe). I've read a post of yours on a LASIK Internet NewsGroup where you said your procedure locks the eye, or words to that effect, so an auto-tracker doesn't help your procedure. Perhaps this is why you don't consider it much of an upgrade? How do accomplish this? Thanks in advance for your reply.

Rick Robertson

After review, I believe Dr. Wong is a "he" and not a "she." Sorry Dr. Wong!

Rick Robertson

>Dr. Trattler: Let me start by saying
>thanks for the website and all
>the great information you relay.
>Your time and efforts are greatly
>appreciated. Would you mind providing
>follow up comments to your statement
>that the S3 platform is not
>much of an upgrade? Two
>respected LASIK Centers here in Houston
>(Mann-Berkeley Eye Center and Baylor Vision)
>both use VISX lasers. Mann-Berkeley
>has already upgraded to the S3
>and Baylor Vision's upgrade is pending.
> From the layman's view (mine),
>it would seem that an auto-tracking
>laser would be superior to one
>that makes no correction for small
>eye movements. I've just read
>some posts from one Doctor here
>on your website who raves about
>auto-tracking and says she wouldn't use
>anything else (Dr. Wong, I believe).
> I've read a post of
>yours on a LASIK Internet NewsGroup
>where you said your procedure locks
>the eye, or words to that
>effect, so an auto-tracker doesn't help
>your procedure. Perhaps this is
>why you don't consider it much
>of an upgrade? How do
>accomplish this? Thanks in advance
>for your reply.

>Rick Robertson

I am extremely happy with the VISX laser, which has provided my wife with better than 20/20 vision in both eyes (she had laser 3 years ago, and was -6.5 preop)
The S2 was a very nice upgrade, because the laser company changed the way the VISX laser treated the cornea. Instead of being just a broad beam laser, the VISX S2 breaks down the laser into smaller spot sizes. The S2 provides a smoother ablation compared to the S1, so that everyone upgraded their laser.
I spent some time at our National ophthalmology meeting with the new VISX laser. The S3 upgrade =is an upgrade that improves the way that the laser works in the office. Some of the features include a new set of buttons and new lights. As well, for high volume centers, the new computer system allows for the entry of multiple patient treatments (currently, with every treatment, we have to inert a digital card with the patients treatment information). The upgrade also includes a new chair that swivels faster from one eye to the other. I think that all of these enhancements are nice, but unnecessary for my practice. And they of course do not affect outcomes - which is the most important thing in my book.
Now - the one upgrade that I am impressed with is the tracker. The tracker is state of the art. I can not compare the VISX tracker to that of other lasers, but it is supposed to be atleast equivelent to the others.
For some doctors - the tracker will make a big difference. Most doctors perform LASIK by first using the micokeratome to make the flap, and then removing the micokeratome, and tell the patient to fixate on the red blinking light. This technique is called self-fixation. In this situation, a tracker can be helpful, because the tracker will help maintain centration of the laser treatment.
On the other hand, about 10-15% of US doctors use a microkeratome called the Moria. The Moria had a second setting called "low vaccuum" - so that after the flap is made, the surgeon can switch to low vaccuum. This setting allows the surgeon to hold the eye still for the laser treatment. So for myself and others, the S3 is not a helpful upgrade, and as a patient, whether the doctor is using an S2 versus and S3 would potentially not be significant.
I would add that I am not saying that self-fixation is better than a tracker, but for myself and potentially other surgeons using the Moria, the tracker is not a useful addition.

I hope this helps

Bill Trattler, MD
Miami, FL

I went to the VISX website as well to see if there was any other info about the S3. There is actually a power point presentation that compares the clinical results of the S2 versus the S3 - and you can view it at this link:

http://www.visx.com/index.php3/podium.html
and then click on - S3 active trak

If you look into this slide presentation, you will see that there is really no difference in clinical outcomes between the S2 and S3 with the same surgeon.

So - as I always like to say - it is the surgeon rather than the type of laser that is most important in providing the best LASIK results.

I hope this helps

Bill Trattler, MD
Miami, FL

Thank you very much for your detailed explanation. Now I understand much better. I think I've got a lot more to learn before I'm ready to go forward with LASIK. For me, it has taken a good bit of time to just determine what the right questions are. Again, I really commend you for your efforts here on your website. I wish I lived in Florida to consult with your directly as a potential candidate.

Rick Robertson

The Summit Apex Plus and Summit Infinity lasers produce identical outcomes because the laser beam is the same with both units. I know this because I am a former user of the Summit Apex Plus system and did not upgrade to the Infinity platform due to the lack of any true benefit for patients.

The Summit Apex Plus system is good. It is a broad beam laser (first generation) without a tracker.

I now use the LADARVision laser (small flying spot laser beam with laser tracker) and know the outcomes are better. How do I know the outcomes are better? Because I have to do fewer retreatments with the LADARVision system. To date, 85% of the eyes treated with our LADARVision system see 20/20 or better or whatever the patients were able to see with glasses before surgery. This 85% figure includes individuals with large prescriptions (near/far sightedness with and without astigmatism). Our retreatment rate is about 1-2%. Our retreatment rate with the Summit Apex is 2-4%. The LADARVision system has not produced any documented central islands in my experience or in its FDA trials. The Summit Apex Plus rarely produces central islands (my bet is that it was about 1-2%).

The Bausch and Lomb Technolas 217 has advertisements that 87% of eyes saw 20/20....Keep in mind that these patients included a narrow range of myopia and astigmatism....The 87% did not include high degrees of nearsightedness, astigmatism, and did not include any farsighted eyes.

Just my insights and observations.

Shannon Wong,MD
Austin Eye Clinic
Austin, TX
www.austineye.com

Shannon The Summit Apex Plus rarely produces central islands (my bet is that it was about 1-2%). Do you mean 1-2% of people that have refractive surgery done with the Summit Apex Plus?

In my observation, I'd say that I observed about 1-2% of patients had clinically significant central islands with the Summit Apex Plus. Of these, 100% went away with time and 0% needed or required surgical intervention.

Shannon Wong, MD
Austin Eye Clinic
www.austineye.com
Austin, TX