"No Touch" Alternative to Lasik?

Question

there is a posting on realself about someone getting "no touch" laser eye surgery. they said its different from lasic in that the eye isnt cut. can you explain this technique and whether its better than lasic

Emil William Chynn, MD, FACS, MBA · Answer

this is basically a BS marketing term designed to confuse the consumer, which i therefore resent.

	the only true "no touch" technique is not even PRK, as you have to remove the epithelium somehow, and normally that's by touching it. when i was a medical student at Columbia in the late 1980s, where PRK and the eximer laser that is used to perform ALL these types of surgery was invented and patented by the way, MDs were experimenting with "no touch" PRK, where you use the laser to photoablate the epithelium, rather than remove it manually.

	this didn't work out very well, as epithelial thickness varies a lot between individuals, and there's really no way to measure this accurately. so if you put a too-low number into the laser to remove the epithelium, you would leave some behind, so you would either then get an undercorrection (because some of the subsequent laser treatment would be used up removing residual epithelium, not to permanently remove and reshape the cornea to correct the rx), or you would have to do "laser-scrape" or manually scrape off the leftover laser with a blade, which pretty much eliminates the point of using the laser to remove epithelium in the first place. or you would put in a too-high number for epithelial removal, and you would be removing cornea instead of epithelium at the end of that part of the treatment, which would cause over-corrections

	the closest thing we have to "no-touch" is LASEK, where i remove the epithelium in one clean sheet after using a dilute alcohol solution to loosen it, and then laser without cutting a flap

	there's another similar BS misleading marketing term out there, which i want to clarify and hopefully eliminate. this is "bladeless LASIK" or "blade-free LASIK". this term is used by the company or doctors who use the IntraLase laser to CUT A FLAP IN YOUR EYE USING THE LASER. yes, it is "bladeless" but YOUR CORNEA IS STILL GETTING CUT AND A FLAP IS BEING MADE AND SO YOU CAN STILL HAVE ALL OF THE COMPLICATIONS YOU GET WITH A REGULAR LASIK WHERE THE FLAP IS CUT WITH A METAL BLADE, although the incidence of SOME of these complications is reduced in IntraLase (but not the chance ofy your flap coming up years later if someone pokes you in the eye, as your eye doesn't "remember" what method was used to cut that flap)

	i've actually met MANY patients who had "bladeless LASIK" and who come to me with a flap complication, like an irregular flap, or striae or wrinkles in the flap, or debris under the flap, or DLK or inflammation under the flap, and SWORE to me that they DIDN'T HAVE A FLAP CUT INTO THEIR EYE because that's what it SOUNDED to them like when they were sold this procedure, and i have to actually CONVINCE them, sometimes by getting their LASIK surgeon to send over their records, to PROVE to them that, yes, a flap was cut, and yes, you DO have a FLAP-RELATED COMPLICATION (that i can fortunately often fix by doing a noncutting LASEK procedure over their messed-up LASIK)

	Emil William Chynn, MD, the most blunt laser surgeon in NYC--but some people like my honesty!:)

Jon Dishler, MD, FACS · Answer

No touch laser eye surgery is not LASIK.  It is a variant of PRK which is the older and original laser vision correction.  In PRK the surface epithelium is removed and then the laser treats the eye which leaves a large raw area that has to heal over 5-7 days.  In LASIK a flap is made, and the eye only has to heal at the "seam" which happens in a matter of hours.  This is the reason for the rapid recovery and minimal discomfort of LASIK as opposed to PRK.
For the PRK procedure, there are varying ways of removing the skin or epithelial layer of the eye.  It can be removed mechanically with a rotating brush, chemically with alcohol, or using the same laser that is later used for the vision correction.  This last method is the so called "no touch" because only a laser touches the eye.  In reality, sometimes the laser will not remove all of the outer layer evenly and a manual "scrape" still needs to be done before the actual treatment.  No matter which method is used, there is still the time needed to regrow a new surface layer and during that time the vision is blurry and there is some discomfort.
There are cases where PRK is preferable to LASIK, but which PRK method is used does not have a significant effect on the recovery or result.  The no touch technique is an option for PRK, but it is not LASIK.
Blade free LASIK is no touch with a blade where a separate femtosecond laser is used to create the flap.  This advanced method should not be confused with "no touch" PRK laser eye surgery.

"No Touch" Alternative to Lasik?

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"No Touch" Alternative to Lasik?

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Everything you need to know about LASIK

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