Dr. Joseph J. K. Ma

Advanced Surface Ablation: ISA®


SMILE, ICL, Other Refractive Options

Eyes Over 40: Need for Reading Glasses

SMILE, ICL, Other Refractive Options

Laser Vision Correction Alternatives

In many of the more complex cases, laser vision correction may not be the optimal solution based on your ISA® Customized Surgical Consultation.

Fortunately, advancements and research in refractive surgery have produced a number of safe and effective surgical alternatives to laser vision correction. Based on our rigorous proprietary in-depth ISA® Customized 13-D Diagnostic Set, our Surgeon will identify and recommend the specific option and relevant parameters that are best suited for your unique needs at your ISA® Customized Surgical Consultation.

Having performed a high volume of complex laser vision alternative procedures, and owing to over a decade of sub-specialty experience in complex refractive, corneal and cataract surgery, our Surgeon is uniquely qualified to correct complex cases.


Promising new technology:

Although SMILE is a promising use of modern femtosecond laser technology, it does not currently extend the range of corneal laser vision correction. The current treatable range is slightly less than LASIK, since it cannot allow for the treatment of very low or very high corrections without significant modification in technique, and it is not quite as flexible as ASA, since additional tissue is necessary for the cap in a SMILE procedure. Although SMILE may be considered safer than LASIK in some patient profiles, since it still requires a lamellar corneal dissection, it is not considered quite as safe as modern Advanced Surface Ablation for either irregular, at risk, or thinner corneas.

Nevertheless, there are certain case uses which may benefit from this technology, and for these patients, we will recommend SMILE. Any enhancements after a SMILE procedure though will require either Advanced Surface Ablation or LASIK, and there are some restrictions with respect to the accuracy of astigmatic treatments due to the potential for cyclotorsion. Like any nascent technology, as the technology for SMILE improves, there will likely be more cases that may benefit from this technology.


1) Standard Refraction is determined using traditional refractive methods, Wavefront imaging is not yet available for SMILE, Topographic-Guided results are not yet available for SMILE

2) Femtosecond laser creates lenticule

3) Lenticule is dissected manually with an instrument

4) Lenticule is manually removed

Femtosecond Laser Technology

Our Surgeon is one of the first surgeons currently practicing in Canada with pioneering experience in Femtosecond laser technology since the first generation was introduced clinically in 2002. It is an extremely accurate, ultra-fast laser that functions at one quadrillionth (*10-15) of a second that allows tissue to be separated without damaging the surface and surrounding tissue. Our clinic currently uses the most recent and most sophisticated generation of Femtosecond lasers that can now go beyond creating a simple flap and is the basis for both SMILE as well as Femtosecond assisted lens-based surgeries.

How Femtosecond Laser Technology Works

This generation of lasers delivers rapid pulses of light through the surface of your cornea to a customized set of pre-programmed depths and positions within the cornea to create a microscopic bubble at each site. The laser moves across your eye creating a layer of microscopic bubbles that connect to form a custom sculpted corneal flap or corneal lenticule that compensates for natural variation in your corneal thickness, and the shape and size of your eye.

ISA® Blade-Free Implantable Collamer/Contact Lens (ICL)/Phakic Intraocular Lens

These are artificial lenses that can be placed inside the eye in front of the natural lens to correct for high degrees of nearsightedness, farsightedness and astigmatism. The surgical procedure involved is similar to the second step in ISA® Customized Laser Refractive Cataract Surgery, but without the removal of the patient’s natural lens. Retaining your natural lens preserves your eye’s natural ability to focus.

This is the safer approach to vision correction in some cases and can result in better vision than ISA® Customized LASIK for these patients.

ISA® Customized Laser Refractive Lens Exchange (RLE)

RLE is for patients with high levels of nearsightedness or farsightedness who have early lens opacities. RLE is performed the same as ISA Customized Laser Cataract Surgery.

This is a 10-15 minute procedure that replaces the natural lens with an artificial lens and will prevent any future need for cataract surgery. The RLE procedure itself is more predictable than cataract surgery because minimally opacified lenses require less energy (typically ultrasonic energy) to remove.

RLE is typically customized to concurrently treat for presbyopia using ISA® Customized Bespoke Blended Vision, using a customized selection of appropriate of lenses and technologies.

ISA® Customized Bespoke Blended Vision

Blended Vision is the use of one eye for distance vision and the other eye for intermediate vision. It involves using intraocular lenses and laser vision techniques to optimize the result depending on the patient’s refractive error and visual requirements.

ISA® Customized Arcuate Keratotomy (with or without Femtosecond Laser)

This is a corneal procedure used in combination with any intraocular lens used for RLE to correct for astigmatism at the time of surgery. It involves the creation of typically paired corneal channels that act to flatten the cornea and therefore decrease astigmatism in the location of those channels. These channels can be created with a Femtosecond Laser for increased accuracy, consistency, corneal structural integrity and a decreased chance of infection.

Pocket Inlays

Pocket inlays can also be used to correct for various forms of refractive error that are not treatable by the current laser vision technologies. This procedure involves using a Femtosecond Laser to create pocket inlays.

Conductive Keratoplasty

Conductive Keratoplasty involves using radio frequency energy to heat the cornea at specific sites to cause discrete tissue shrinkage. This results in a steeper cornea to either correct for farsightedness or create a multifocal cornea, when alternative measures would result in suboptimal results.