Dr Chynn Gives Details on LASEK vs. Alegretto / Intralase

Mike P. writes:

Sorry I couldn’t attend the consultation that I’ve schedule. I actually decided to have my LASIK done at Gotham Lasik.

Dr. Bonanni is the only Lasik surgeon in NY and NJ  to have the most advanced technology; the WAVELIGHT ALLEGRETTO and Intralase lasers that provide for a true custom bladeless procedure.
The ALLEGRETTO WAVE is the only laser FDA approved to treat and prevent the halo and glare that other lasers may cause.

 

Dr. Chynn responds:

Here are a few points you may not know, Mike:

 1. Dr. B. will cut flap in your eye with a laser, I do not cut flaps anymore

 Therefore, you are risking the following complications (which you can google) by having a flap cut w the intralase, risks which you would totally avoid if you avoid the flap:

•  interface inflammation / diffuse lamellar keratitis (DLK)
• flap wrinkles and striae, leading to diplopia (double vision)
• incomplete flaps, irregular flaps, buttonhole flaps, etc
• getting hit in the eye years later and having the flap come up
• chronic pain and photophobia (light sensivitity) after intralase

2. Being the “only Lasik surgeon in NY and NJ  to have the most advanced technology” is not actually something to be proud of, the fact is that he is the only guy in 2 states to have bought the platform of allegretto + intralase.

 This is the US, where people, including surgeons, have free choice in their purchases, and the power of a free-market economy is that usually, the best product wins (allow me to use my MBA for something)!

 For example, you may not like Microsoft, but their Office Suite is a great product, which is why it today dominates.

 Just like the iPod is a great music player, and that is why it dominates–the other products with tiny market share have tiny market share because almost nobody chooses their product (over iPod)

 In the US, Allegretto has about 1% market share of all eyes lasered–VISX, the company whose laser I bought, has about 80%–meaning that more eyes have been lasered on a VISX laser in the US than ALL OTHER BRANDS COMBINED.

 The REASON that VISX is the dominant laser is that the great majority of US surgeons believe it will consistently provide the best results for their patients. 

FYI, this is DESPITE the fact that the VISX laser is actually about $100,000 more to buy than allegretto, and costs over $300,000 more per year to operate (because the company charges me about $1000 to shoot a pair of eyes in royalty fees even after I own it, in contrast to allegretto). 

If allegretto were a superior platform, especially since a surgeon could save about $1 MILLION dollars in costs operating it for 5 years vs. VISX, then it would have 80% market share and VISX would have 1-3%, not the reverse. 

“WAVELIGHT ALLEGRETTO and Intralase lasers that provide for a true custom bladeless procedure” - this statement is actually factually inaccurate and deceiving, for 2 reasons: 

1. Intralase keeps billing itself as bladeless, because consumers then think they are not getting cut.  I have seen many patients come to me AFTER THEY HAVE A MESSED UP FLAP IN THE INTRALASE PROCEDURE, for help to see better, and I tell them they have an irregular flap which is causing visual distortion, and they say, “oh, no, the doctor said my procedure was going to be BLADELESS so I can’t have a flap in my eye.”  This is pretty much misleading advertising, as the whole selling feature of Intralase is to REDUCE but NOT ELIMINATE flap complications because you cannot eliminate flap complications if you still cut a flap w a laser

 2. Allegretto is NOT A TRUE WAVEFRONT CUSTOMIZED LASER. The company has done a remarkable job, like Intralase, in partially deceiving the public. If you look in Webster’s dictionary, the word CUSTOM MEANS you are shooting a different ablation for each and every different eye–with no 2 ablations identical. 

This is what the VISX CustomVue WaveScan provides–a customized ablation for every eye (see www.personalbestvision.com). 

You know this is the case, as the data from the wavescan map is saved in a flash drive, which is inserted into the laser to drive the ablation for the UNIQUE pattern for your eye!

 Allegretto was forced by FDA to change their labeling to “wavefront optimized”–adding the word “optimized” because it is NOT A TRUE INDIVIDUALIZED WAVEFRONT PROCEDURE.

Tthis means the map it takes is kind of BS, as that data is not what is shot on your eye–rather, the allegretto laser tries to make EVERY EYE REGARDLESS OF HOW IT MAPS INITIALLY into an prolate configuration (vs oblate)–like this is some magical shape or something (which it is not–if it were, how could I make thousands of patients BETTER than 20/20 after a VISX CustomVue procedure, when I am making their corneas prolate).

So, if a patient wants a TRUE CUSTOM WAVEFRONT PROCEDURE, they CANNOT have it done on an Allegretto, as that laser doesn’t do that!!!

“The ALLEGRETTO WAVE is the only laser FDA approved to treat and prevent the halo and glare that other lasers may cause.”

 Again, this is misleading.

 BECAUSE the allegretto was late to market, its FDA application of course included some people who had already received the laser (and guess what–they by definition received it on a non-allegretto laser, because that laser was not out at yet).

 So, of course some of their data includes retreatments, so they would get the appropriate FDA labeling after study completion.

Since VISX is the OLDEST EXISTING EXCIMER LASER COMPANY IN THE US AND THE WORLD, started from patents by Steven Trokel MD at Columbia where I went to medical school, its early studies would not have pre-lasered patients in them.

But actually, its latest FDA study data show that most VISX postoperative patients have BETTER night vision satisfaction than they had preoperatively w glasses and contacts, which is amazing!

In general, you are lucky you got me on a weekend, as I normally don’t have time to respond to this stuff in such detail

My office staff will generally just tell the patients that if they were in the position of trying to get info on the best place to be lasered they should at least come in to our center for a free consultation before they decide on where to go, as then at least they will have the FACTS to make a valid assessment.

I actually don’t care that much where they go, as you know I’m doing over 1,000 cases a year.

What I DO care about is patients choosing to have other procedures (like i-LASIK) on other platforms (like Allegretto) with ERRONEOUS FACTS.

As long as I get at least the OPPORTUNITY to give them the CORRECT FACTS then I am comfortable with them going wherever and to whomever they wish, because I can be reassured that they have made a really INFORMED DECISION.

So - shop around, but make sure you also come by our center before you buy.

 Emil William Chynn, MD FACS MBA

This entry was posted on Wednesday, August 6th, 2008 at 8:05 am and is filed under Why LASEK and Epi-LASEK are safer than LASIK, CustomVue WaveFront. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.