Gary Kawesch, MD
San Jose Ophthalmologist
Recent answer posted by Gary Kawesch, MD
Q: Is bladeless lasik the "gold standard"?
Bladeless LASIK, also known as all-laser LASIK, IntraLase LASIK, or no-blade LASIK, involves the use of a Femtosecond laser to create the corneal flap. The alternative method is to use a microkeratome, an automated mechanical surgical instrument which contains a surgical blade.
Both work well... there are studies which show less risk of dry eye, and a lower overall risk of flap complications such as a free cap, incomplete or buttonhole flap, or irregular flap with the bladeless approach. Studies also show bladeless techniques will produce a more predictable flap thickness.
For the "average" patient with normal corneal curvature and normal corneal thickness, the risk of flap complications using a standard mechanical microkeratome (with a blade) is quite low. This is the "standard of care" in the eye surgical community. The Intralase and other femtosecond lasers, by reducing certain risks, is beyond the standard of care. It is in many ways better. Not all surgeons have the equipment necessary to offer bladeless LASIK. Approximately 50% do, and that number seems to be growing. Certain patients, with very steep, very flat, or very thin corneas, have an elevated risk of flap complications when a blade is used, and bladeless LASIK is a VERY good way to go in these cases.
There are some disadvantages to bladeless LASIK. Primarily, cost is the major one. The femtosecond laser is expensive, and manufacturers charge surgeons a large fee every time (for every eye) they use it. Surgeons will generally pass this cost along to the patient. Additionally, surgery time is slightly longer, and the eye may be a bit redder for a few days than with a mechanical microkeratome. There is a slight increased risk of additional corneal inflammation postop with the bladeless technique, though steroid anti-inflammatory drops generally are effective at dealing with this.
In summary, yes, I feel bladeless LASIK is better, and I have been offering it to my patients for over 5 years now. But, it comes at an increased cost. And each patient needs to evaluate whether that increased cost is worth it to reduce what is already a fairly low risk. For many patients, it is well worth the additional cost.
| Board certification | |
| Education | Undergraduate: B.S. degree in Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, Phi Beta Kappa, summa cum laude, 1984 Medical School: Doctor of Medicine degree, University of California, Los Angeles, School of Medicine Honors: Alpha Omega Alpha, Lazar Medical Scholarship, California Community Fund Scholarship, Thornton Medical Scholarship, UCLA Alumni Association Scholarship, and the Adams-Baxter-Dongray Scholarship, 1988 |
| Post-medical school training | Internship Huntington Memorial Hospital, Pasadena, CA, 1988-1989 Residency: Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, CA, 1992 |
| Aesthetic medicine experience | 17 years (post-medical training) |
| Medical or professional license | CA |
| Requesting an appointment with Gary Kawesch, MD using RealSelf.com is free & confidential. Consultation fee: Free Eye Exam when mentioning Realself.com | |
| Location | Laser Eye Center of Silicon Valley 606 Saratoga Avenue 606 Saratoga Avenue San Jose, CA United StatesView map |
| Additional Office Locations | Pleasanton Office/Surgery Center Laser Eye Center of the East Bay 5790 Stoneridge Mall Road Pleasanton, CA 94588 |