What is Bladeless LASIK?

Dr. Matthew Sharpe- Founder of SharpeVision

By Dr. Matthew R. Sharpe

February 28, 2022

The term “bladeless LASIK” is a bit of a blast from the past. As a high-volume LASIK surgeon over the past 24 years, I performed probably over 30,000 procedures using a microkeratome from 1998 to about 2006 or 2007. Since about 2006 or 2007, I completely stopped using the microkeratome because the femtosecond lasers offered an improvement, in my opinion. The microkeratome is a device in which a disposable blade is placed to perform the LASIK flap. The device could be described as a tiny deli slicer. It is very precise, but not as precise as all laser LASIK in which a femtosecond laser is used.

The LASIK Flap

The LASIK flap is an essential part of the benefit of having LASIK. Bladed LASIK can work very well, and the results are the same, but the risk is slightly higher in my opinion than LASIK performed with a femtosecond laser. To describe LASIK, think of lifting up the sod on your lawn (flap creation).  Then you shape the dirt under the sod (excimer laser shapes your underlying cornea). Then the sod is put down exactly where it was: the lawn looks pretty good right away. This is similar to LASIK, where we preserve the surface skin layer and do the excimer laser which shapes the curvature of your eye to the amount that you need to see clearly without glasses. The LASIK flap is then re-positioned back in position, and your vision is fairly clear the next day (some fogginess is expected at first but improves for at least a few weeks). The LASIK flap also can be made with a femtosecond laser, which is what we have exclusively done at SharpeVision Modern LASIK since we began the practice in 2012. I personally had not used a microkeratome for about six years prior to that event. There are still some practices that offer a microkeratome, but it is not in my opinion the best possible device to make the flap for LASIK. I will go into this more in the next paragraph.

Transition from blade to bladeless LASIK

The femtosecond laser was developed in the 1990s and was approved for making the LASIK flap in 2001. It initially took about 90 seconds to create the flap and took a lot of energy. It didn’t lift very easily and had more “opaque bubble layer” or OBL, which is a result of all the tiny gas bubbles created by the laser that accumulated in the cornea. They go away quickly, but make it harder to see the underlying pupil and iris. I waited to adopt the femtosecond laser until the second or third generation femtosecond laser. The laser improved in speed, clarity, and consistency of flap creation.

Bladeless LASIK Surgery

Blade-free LASIK or “All Laser LASIK” incorporates a femtosecond laser to make the flap. This has several benefits in my opinion. The first benefit is that the flap that is created is very consistent in thickness, and it’s typically thinner than the microkeratome flap that is created. The thickness may have some effect on a long-term complication called corneal ectasia. This is when the cornea changes or stretches slightly over time that can blur your vision. Bladeless laser eye surgery also can potentially have a benefit that allows the LASIK flap to be created in any size, location, different depths with great precision. It also allows the sides of the flap to be created vertically (think of a manhole cover) which confers a benefit in terms of stability. I also believe the vertical side cut may decrease the risk of another complication called epithelial ingrowth that potentially can occur if the flap is lifted for an enhancement procedure (a touch up or adjustment that is required in about 2% of patients).

Bladeless LASIK versus Blade LASIK

Bladeless LASIK Blade LASIK
More precise depth More variation in depth
Side cuts stable Meniscus cut this on edge
Consistent depth Variability in depth
Fewer complications More complications
Psychologically more accepted Psychologically more reluctance

What is Custom Bladeless LASIK?

Custom bladeless LASIK is the same thing as bladeless LASIK but with custom excimer (the second laser). Keep in mind that we use two different lasers, so this is mixing terms a little bit. There is custom laser that is performed with the laser that shapes your cornea (excimer laser), and there is bladeless LASIK that is referring to the first laser that creates the LASIK flap. See what I mean in my wavefront guided LASIK blog post:

Bladeless LASIK Complications

Part of the beauty of bladeless laser eye surgery is that there are extraordinarily few complications. I have done over 10,000 procedures with my Ziemer femtosecond laser and have never lost suction during the laser flap creation. This creates incredible confidence and safety for the patient. In the worst case scenario, if there is a problem performing bladeless laser eye surgery, the procedure can always be converted to PRK, in which we do not make a flap. A complication with the LASIK flap in my office is approximately one in 5000 procedures. It is also very rare to be unable to create the LASIK flap in the first place. This is even less likely, where I cannot get the device into the eye to create the flap. It generally is an anatomic difficulty in which someone with a very deep set eye or very small eyes may not allow enough exposure to create the flap. In this rare circumstance, I convert the procedure to PRK surgery so that the patient can still enjoy the excellent lifestyle allowed with clear uncorrected vision.

Bladeless LASIK: Definitely the Way to Go

In summary, Bladeless LASIK is a time tested superb technology that allows your LASIK surgeon to safely create the this flap that comprises the first of two lasers used in LASIK. It’s comforting to know that this procedure has been used for over twenty years and in millions and millions of patients. Make your appointment for your free comprehensive exam to see if you’re a candidate for blade-free LASIK. It’s the best way, and the only way, we do LASIK at SharpeVision!

Dr. Matthew Sharpe- Founder of SharpeVision

Dr. Matthew R. Sharpe

Dr. Matthew Sharpe is an Ophthalmologist specializing in refractive surgery and the owner SharpeVision MODERN LASIK & LENS, with offices in Seattle, Austin, and Chicago. Dr. Sharpe is a world traveler, pianist, marathon runner, motorcyclist, and fluent French speaker. He enjoys every second of life, but finds he is happiest at home cheering on The Ohio State Buckeyes with his wife, three children, and four dogs.
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