Blade or blade-free: The LASIK debate

All LASIK surgery involves creating a thin, hinged “flap” into the cornea of the eye so the vision correction can be done. In traditional LASIK, a small, fine blade called a microkeratome cuts the flap. In blade-free procedures, the flap is created using an ultrafast femtosecond laser. There are highly respected ophthalmologists who use both, but we prefer to use only blade-free technology. This is why.

First, a little anatomy lesson. Your cornea is the clear front surface of your eye, directly in front of your iris and pupil. It has two very important roles: it’s where light enters your eye, and it also has up to 75 per cent of your eye’s focusing power. For these reasons, it’s very important to keep your cornea as safe as possible during surgery.

So why make a flap at all? The surgeon uses two different lasers during the LASIK procedure. The first laser is used to create a corneal flap. This laser is known as a femtosecond laser. The surgeon has to create a flap to access the deeper corneal tissue which is reshaped by a second laser known as an excimer laser. The surgeon then replaces the flap to its original position.

Bladeless systems are marketed under different names, which can be confusing for people researching their options. At Corvue, we use the iLASIK system which includes the Intralase femtosecond laser. Other FDA-approved systems include Femto LDV, Technolas, Victus, and VisuMax.

Now onto why we only perform blade-free LASIK.

Safety. Bladeless laser-made cornea flaps are more predictable. The corneal thickness is uniform, which can reduce the risk of creating a hole in the centre of the cornea. There’s also a reduced risk of corneal abrasions and surgery-induced astigmatism.

Correction of stronger nearsightedness. Since the laser can create a thinner flap, the surgeon may be able to correct higher levels of nearsightedness than would be possible if he or she was using a blade.

Customization. The femtosecond laser can give the surgeon more options in size, shape and orientation of your corneal flap, to adjust for each client’s unique eye.

Decreased healing time. The flap that’s created in a bladeless LASIK procedure may have cleaner edges, which means it will fit more snugly after the surgery, reducing healing time and minimizing the risk of movement while the cornea heals.

It generally costs a bit more money to have blade-free LASIK, but we believe the benefits outweigh the costs in every case.