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Bladeless LASIK: Femtosecond Laser Eases LASIK Fears

Are you interested in vision correction surgery but are fearful of having a bladed surgical instrument near your eye? If so, then bladeless LASIK may be the solution you are looking for.

In bladeless LASIK — also called blade-free LASIK, all-laser LASIK, or femto LASIK — your LASIK surgeon uses two types of lasers for the vision correction procedure.

First, an ultra-fast femtosecond laser is used to create a thin flap in the cornea (the clear front surface of the eye. Then, an excimer laser is used to reshape the underlying corneal tissue to correct your vision. The flap is then returned to its original position.

The femtosecond laser eliminates the need for a bladed surgical tool (called a microkeratome) to create the corneal flap. No surgical blade of any kind is needed in all-laser LASIK.

Generally, anyone who qualifies for LASIK surgery is a good candidate for bladeless LASIK. Also, some studies have suggested that all-laser LASIK may decrease the risk of certain LASIK complications associated with the use of a microkeratome.

Bladeless Lasik Slide 1: Pulses of FS energy are focused in the cornea to begin making the flap. Bladeless Lasik Slide 2: FS laser created precise edge to enable surgeon to lift flap. Bladeless Lasik Slide 3: Surgeon lifts flap and folds it over the hinge. Bladeless Lasik Slide 4: An excimer laser reshapes the cornea with a process called photo-ablation. Bladeless Lasik Slide 5: The flap is returned to its original position and is smoothed so it adheres to the corneal stroma. Bladeless Lasik Slide 6: LASIK flattens the central cornea allowing light to focus on the retina for clear vision.

The bladeless LASIK procedure: step-by-step.

Types Of Bladeless, Femtosecond Laser LASIK

Bladeless LASIK has been available in the United States since 2001, when a company called IntraLase gained FDA approval of its first femtosecond laser designed for use in LASIK surgery.

Brand names like IntraLase LASIK and IntraLASIK were soon being used to differentiate bladeless LASIK from conventional LASIK that required a bladed microkeratome to create the corneal flap.

In 2007, Abbott Medical Optics (AMO) acquired IntraLase and began marketing the femtosecond laser flap technology alongside its excimer laser platform for wavefront-guided custom LASIK (CustomVue). AMO has since integrated its latest femtosecond laser and customized laser treatment into a new LASIK platform called iLASIK, which currently is the leading brand of bladeless LASIK in the United States.

Other femtosecond laser platforms that are FDA approved for blade-free LASIK procedures performed in the U.S. include:

  • Femto LDV (Ziemer Ophthalmic Systems)
  • Technolas (Technolas Perfect Vision GmbH)
  • Victus (Technolas Perfect Vision GmbH and Bausch + Lomb)
  • VisuMax (Carl Zeiss Meditec AG)

Each of these systems has its own features and benefits, and all systems produce comparable outcomes.

Advantages Of Femtosecond Laser LASIK

Best Candidates

mild/moderate myopia, hyperopia and/or astigmatism, adequate corneal thickness

  • Procedure time: about 10 minutes per eye
  • Typical results: 20/20 vision without glasses or contact lenses
  • Recovery time: a few days to several weeks for vision to stabilize
  • Cost: about $2,000 to $3,000 per eye

In addition to putting patients at greater ease (knowing that no blade will be used on their eye) advantages of bladeless, femtosecond laser LASIK include:

  1. More predictable corneal flap thickness
  2. Decreased risk of corneal abrasions during surgery
  3. Decreased risk of induced astigmatism after LASIK

Also, in some cases, a femtosecond laser may make it possible to create a thinner corneal flap, which could enable the surgeon to safely correct higher amounts of nearsightedness.

The femtosecond laser also gives the LASIK surgeon more options in flap size, shape, and orientation, for a more customized LASIK procedure for each patient's needs.

Finally, a femtosecond laser can create a corneal flap that has edges that enable the flap to fit more securely in place after the LASIK procedure, potentially reducing healing time and decreasing the risk of dislocation of the flap after surgery.

Femtosecond Laser Flaps: What Could Go Wrong?

Complications during and after LASIK occur infrequently, regardless whether you choose to have the corneal flap created with a femtosecond laser or a microkeratome.

Flap complications that can occur with a femtosecond laser as well as a microkeratome include:

  • Incomplete flaps
  • Flap dislocation
  • Flap striae (wrinkles in the flap)
  • Diffuse lamellar keratitis, DLK (inflammation under the flap)
  • Epithelial ingrowth (cells from the surface of the cornea growing under the flap)

One potential LASIK complication that usually is specific to bladeless LASIK is a condition called transient light sensitivity syndrome (TLSS). This is characterized by rapid onset of photophobia without changes in visual acuity or other clinical signs.

TLSS typically occurs two to six weeks after bladeless LASIK surgery, and fluorescent lights can worsen the light sensitivity symptoms. But the condition is not sight-threatening and it usually can be successfully treated with short-term use of steroid eye drops.

Ask your LASIK surgeon for more specific information about the relative risk of LASIK complications with bladeless LASIK vs. LASIK with a microkeratome flap for your particular eye anatomy and degree of refractive error.

How Much Does Bladeless LASIK Cost?

In 2015, the average retail price for LASIK surgery in the U.S. was $2,077 per eye, according to a leading vision care industry analyst.

Generally, you can expect to pay about $200 to $300 more per eye for all-laser LASIK, compared with the cost of LASIK when the corneal flap is created with a microkeratome.

Other factors that can influence the cost of bladeless LASIK include your geographical location, the type of facility where you have the procedure performed, and whether you choose to have a custom (wavefront) LASIK treatment.

When shopping for LASIK eye surgery, cost is only one of the factors you should consider. More important is the expertise of the LASIK surgeon and the policies the practice has to minimize the risk of LASIK complications and maximize your satisfaction with your LASIK outcome.

Before agreeing to LASIK surgery, schedule a consultation with your prospective LASIK surgeon to ask questions and make sure you are comfortable with the doctor and the LASIK facility.

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Page updated July 2018