Bladeless LASIK versus using a Blade, How do I know what is best?

If you are a patient that is considering having the LASIK procedure, you will want to know what the difference is between creating the corneal flap for LASIK with a microkeratome blade versus using a laser to create the flap.  How do you make the best choice?   A Microkeratome is an instrument that uses a blade to create the flap for your LASIK procedure.  For many years it was the only choice for patients who wanted to have the LASIK procedure.  In 2001 the FDA approved the Intralase laser to create the corneal flap.  Dr. Holzman was one of the first surgeons in the Washington DC Metropolitan area to start using the Intralase laser to create the flap.  Dr. Holzman has not looked back to using the Microkeratome since.  Dr. Holzman is a prudent believer and proponent of staying on top of new technologies.  Throughout his career he has embraced all of the new technologies for laser vision correction early on.  LADAR vision, LTK, CK, Intacs, Custom Wavefront lasers, EX 500 and the IFS laser. Technology is ever evolving and it is important to know what is out there and what will best suite the needs of your patient to help them achieve their best corrected vision.  Read the article below from  This article explains the benefits of all-laser LASIK very clearly.  

Bladeless LASIK: Creating a
LASIK Flap With Precision

By Marilyn Haddrill, with contributions and reviews by
Vance Thompson, MD, and Brian S. Boxer Wachler, MD

In bladeless or all-laser LASIK for corrective eye surgery, lasers have replaced mechanical cutting tools (microkeratome) associated with conventional LASIK.

Instead, bladeless LASIK uses two different kinds of lasers:

  • Femtosecond laser. This laser directs laser energy precisely to create a thin, hinged flap, which then is lifted temporarily from the eye’s surface or cornea.
  • Excimer laser. Energy from this type of laser is applied to the newly exposed eye surface, where tissue is removed in a precise pattern to alter the cornea’s shape.

In all LASIK procedures, including bladeless forms, the flap then is put back in place to serve as a natural “bandage” for better comfort and healing.

Once an eye is reshaped by LASIK, it should have an improved ability to focus light rays onto the retina for significantly sharper vision.

Both microkeratome-based and bladeless LASIK generally have good outcomes with few complications, as reported in clinical trials leading to FDA approvals of both types of systems.

Types of Bladeless LASIK, Beginning With IntraLase

The first femtosecond laser approved for bladeless LASIK in the United States was the IntraLase laser, which gained FDA approval in 2001. IntraLase Inc. later introduced several new models of this laser with advanced features.

Advanced Medical Optics (now Abbott Medical Optics) in 2007 acquired IntraLase, which was incorporated into the company’s CustomVue excimer laser platform. This new, integrated system is marketed now as iLASIK.

The IntraLase femtosecond laser also can be used in combination with any other approved excimer laser for bladeless LASIK procedures.

Considering Complications: Blade Versus Bladeless

While LASIK complications are relatively rare, sometimes they are associated with the oscillating blade used with traditional microkeratomes. Metal blades might create uneven flap edges, resulting in abnormal corneal surfaces and vision defects such as irregular astigmatism.  Metal blades also have been associated with incomplete or improperly formed “buttonhole” flaps that can cause vision-threatening scars. Many eye surgeons report these types of complications are far less likely with laser-created flaps.

As an alternative to microkeratomes, bladeless LASIK creates flaps through infrared laser energy that inserts a precise pattern of tiny, overlapping spaces just below the corneal surface.

The femtosecond laser used in bladeless LASIK procedures operates at extremely high speeds (pulses of one quadrillionth of a second), allowing tissue to be targeted and divided at a molecular level without heat or impact to surrounding tissue.

Some study results show that bladeless LASIK results in significantly fewer overall LASIK complications. The tradeoff for extra safety with the use of bladeless LASIK is higher cost.

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