First Experiences Using The "Elita" Femtosecond Laser System For Flaps In Femto Lasik

Since its deployment into our clinical routine in autumn 2024 we used the "ELITA" (Johnson & Johnson Vision, USA) femtosecond laser for Femto Lasik and "SILK" (Smooth Incision Lenticule Keratomileusis) intrastromal procedures. The "ELITA" system is a new platform, able to deploy very low energy spots at extremely high speeds into the stromal tissue. This should enable the surgeon for superior quality of tissue delineation within stromal structures.

We evaluated our findings in the first 30 patients (59 eyes) receiving Femto Lasik treatment during late 2024 and early 2025 in a private practice setting in northern Germany. All Lasik Treatments in this study were performed in one hand by a clinically experienced surgeon (Dr Christian Ahlers).

In this study we evaluated the human adaptation process to this new procedure, especially the applanation performed during the docking process. We describe our learning curve, clinical findings as well as our solutions for challenges occurring during this phase.

Flap configuration, thickness and size were evaluated using the Slit lamp examination and photography as well as MS39 anterior segment OCT system. We evaluated the possibility to perform cyclotorsion correction after flap preparation using the 1050RS Amaris System (Schwind Eye Tech Solutions, Kleinostheim, Germany).

Femto Lasik Treatment could be completed in all 59 eyes. Starting with standard factory settings we had some issues with OBL (Opaque bubble layer) at the very beginning, in 8 patients causing challenges with the eye-tracker used in the Amaris system. Reducing the spot energy eliminated this problem. Using speculums in addition to the Patient interface also lead to issues especially in patients with limited orbital space or deep lying eyes in the first Patients. Therefore, we changed to a speculum free docking procedure from patient 16 onwards.

Flaps created with the "ELITA" system are well centered. Separation quality is excellent and was even better in lower energy settings. Reducing energy settings also eliminated issues with OBL we had in the very beginning.

The ability to recenter or change flap parameters immediately after the docking procedure gives new possibilities and enhances the overall procedure safety. Flaps created with the "ELITA" System are highly reliable in terms of thickness and size. The visual acuity one day after Lasik treatment was excellent.