Is Bladeless Lasik the "Gold Standard"?

I was googling Bladeless LASIK and found information saying the incidence of dry eye complications from Lasik may be reduced with Bladeless LASIK. Can a doctor explain more about this procedure and why this is the case.  Is it the gold standard for vision correction?

Doctor Answers 3

Bladeless LASIK

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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.

San Jose Ophthalmologist

Bladeless Lasik is Now the Gold Standard

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Without a doubt, having your LASIK procedure performed using the bladeless technique is the preferred method, and has been for several years. You will hear different terminology regarding this technique: bladeless LASIK, all laser LASIK, bladeless SBK and others are all referring to the same technique, which is using a femtosecond laser to create the flap, which is the important frist step of LASIK. I began performing Laser Vision Correction in 1994 with PRK, then moved to the mechanical LASIK method, but have been exclusively been performing all laser LASIK since 2003 with amazing results! Many of the discount centers will attempt to talk you out of all laser lasik because they are trying to save costs.....don't fall for this!

Anthony J. Kameen, MD
Baltimore Ophthalmologist

Bladeless is better LASIK

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To say bladeless LASIK is the gold standard, or the standard of care are strong statements subject to interpretation. What I can say is that since introducing bladeless LASIK in 2001 we have progressed to a point that in the last several years we only offer bladeless to our patients because we believe it is a much better way to do LASIK.

There are several reasons for this. First as you say there has been shown to be less dry eye problems due to the increased gentleness of the procedure. There are also less risks of other serious complications such as loss of suction resulting in a partial or abnormally cut flap. These complications do occur with a microkeratome but are virtually nonexistent with the all laser method.

Studies have been performed that show the results are better with the blade free method which may have something to do with how exact the cutting of the flap has been with the laser as compared to a blade.

Finally there is the accuracy of depth which is far greater with the all laser procedure than the blade procedure. All of these reasons probably account for the fact that now about 50% of all LASIK is blade free. The only reason not to have all blade free is cost, and it seems that the extra cost is worth it for all of these reasons. Since blade free is so much more common, you can find centers to offer this at no or little additional cost from standard LASIK.

Jon Dishler, MD, FACS
Greenwood Village Ophthalmologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.