{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:14:05Z","timestamp":1788952445716,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Opaque bubble layers (OBLs) are a common intraoperative complication during flap creation in femtosecond laser-assisted LASIK (FS-LASIK). This study aims to evaluate how cone and flap sizes can be optimized to minimize OBL risk in VISUMAX 800 FS-LASIK. Methods: This was a retrospective chart review of patients who underwent LASIK with the VISUMAX 800. Eyes were grouped by cone size and laser settings into S cone\/M settings and M cone\/L settings, in addition to OBL status (OBL vs. non-OBL). Generalized estimating equations were used to account for inter-eye correlation. Flap\u2013cone edge gap was quantified from intraoperative images using FIJI (version 2.17.0, ImageJ). Results: OBL developed in 17 of 226 eyes (7.5%). The majority of OBLs (15\/17) occurred in the M cone with L setting group. Eyes that developed OBLs had larger WTWs (p &lt; 0.001) and larger mean flap diameters (p &lt; 0.001). Among eyes with M cones and L settings, image analysis revealed that the average gap between flap and cone edge was significantly larger in the OBL group (p = 0.007). Conclusions: Our findings support the use of VISUMAX 800 in FS-LASIK and suggest that OBL formation may be associated with the distance between flap and cone edges, with larger average flap\u2013cone gaps observed in eyes that developed OBL.<\/jats:p>","DOI":"10.3390\/jcm15186980","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:19:16Z","timestamp":1788949156000},"page":"6980","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flap Optimization Using VISUMAX 800 Femtosecond Laser for Laser-Assisted In Situ Keratomileusis"],"prefix":"10.3390","volume":"15","author":[{"given":"Abdullah","family":"Virk","sequence":"first","affiliation":[{"name":"College of Medicine\u2014Phoenix, University of Arizona, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4984-3348","authenticated-orcid":false,"given":"Sanjana","family":"Molleti","sequence":"additional","affiliation":[{"name":"Hoopes Moshirfar Research Center, Draper, UT 84020, USA"},{"name":"Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Hanna","family":"Pawlowski","sequence":"additional","affiliation":[{"name":"Hoopes Moshirfar Research Center, Draper, UT 84020, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Randle M.","family":"Uyeda","sequence":"additional","affiliation":[{"name":"College of Medicine\u2014Phoenix, University of Arizona, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1099-0495","authenticated-orcid":false,"given":"Jason D. H.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Loma Linda School of Medicine, Loma Linda, CA 92350, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2567-8331","authenticated-orcid":false,"given":"Phillip C.","family":"Hoopes","sequence":"additional","affiliation":[{"name":"Hoopes Moshirfar Research Center, Draper, UT 84020, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1024-6250","authenticated-orcid":false,"given":"Majid","family":"Moshirfar","sequence":"additional","affiliation":[{"name":"Hoopes Moshirfar Research Center, Draper, UT 84020, USA"},{"name":"John A. Moran Eye Center, University of Utah, Salt Lake City, UT 84112, USA"},{"name":"Utah Lions Eye Bank, Murray, UT 84107, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"393","DOI":"10.2147\/OPTH.S99394","article-title":"Femtosecond lasers for laser in situ keratomileusis: A systematic review and meta-analysis","volume":"10","author":"Huhtala","year":"2016","journal-title":"Clin. 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