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of impact, no intense pressure, no tense moments. In my experience, it can be that quick and effortless for the patient, our staff, and myself. An important feature of the FS200 laser is that there are essen- tially two pumps running simultane- ously to ensure continuous active suction. This is a major reassurance to me as it helps prevent suction loss during treatment. The system is designed to create the most consistent flaps. I meas- ured some of the patient interface hardware dimensions of both the FS200 laser and the IntraLase (Abbott Medical Optics, Santa Ana, Calif.). The cone glass surface that applanates the cornea has 30% more surface area (Figure 1), while the ex- ternal diameter of the suction ring is 10% shorter for the FS200 laser compared to the IntraLase. Because the applanation diame- ter is larger, I can always get a per- fectly centered 9 mm flap. This is important especially in treating hyperopic patients where I need the full 9 mm diameter. Because of the shorter external diameter, I have an easy time placing the suction ring in eyes with smaller palpebral fissures or compact orbital anatomy. With canal venting, I can minimize opaque bubble layer (OBL) overall (Figure 2). There are some important steps to consider when using the FS200 laser. The FS200 has two foot switches. One is for suction, and the adjacent foot switch activates the energy (Figure 3). There are two joy- sticks (Figure 4)—one for the patient bed and the other to control the laser head position. The laser head is a little larger so the patients' faces need to be turned slightly more to avoid nose contact while the cone settles into the suction ring (Figure 5). These differences are not a big deal—it's like being in a car and knowing the difference between the EW Chicago 2012 7 Figure 4. The lower right joystick controls the patient bed position before docking. The upper one controls the laser head position during the docking maneuver Figure 5. The applanation cone has just been withdrawn from the suction ring, which has been removed from its position on the eye. The cone had been nestled in the center of the ring, which was adherent to the conjunctiva while the flap was being created Figure 6. The identification of the edge of a perfectly centered flap is made easier with the excimer's integrated slit lamp brake and the accelerator or the transmission and turn signal controls and adjusting the rear view mirror—but you have to take note of the differences. In my experience, there was a minimal learning curve—it's just learning to operate a different device, much like driving different brands of automobile. Alcon was very helpful in train- ing our clinic personnel on the new device. We had a training session the night before we operated on our first patients. In that night session, two Alcon trainers came out and we op- erated on pig eyes. We learned im- portant steps in transitioning to the FS200 laser, and the trainers even stayed with us the following day and during the next session as well with our live patients. Surgeries were uneventful. We liked it so much, we acquired another FS200 laser for our other refractive surgery center in Eastern Iowa. Finally, one of the main reasons we acquired the FS200 lasers is that they complete a matched set with the WaveLight Allegretto Wave Eye-Q 400 Hz excimer lasers (Alcon) we acquired in 2008. The technolo- gies are meant to be companion units, so after femtosecond laser flap creation, the patient bed electroni- cally pivots over for the excimer laser portion of the procedure (Figure 6). Before, we had one room for the IntraLase and one room for the excimer laser. Now everything is seamlessly integrated. Overall, what I have now is more confidence. The new FS200 laser satisfies our triad needed for ac- quisition of new equipment—in my practice it's fast, safe, and precise. Dr. Davison is in private practice, Wolfe Eye Clinic, Marshalltown and West Des Moines, Iowa. Contact information Davison: 800-542-7956, jdavison@wolfeclinic.com New technologies enhancing patient outcomes

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