Blade Free or Bladeless All Laser LASIK for Flap Creation
Reviewed by Brad Spagnolo, M.D.
Bladeless LASIK or Blade Free LASIK is LASIK is a type of eye surgery called “lamellar eye surgery” because it is performed between the layers of the cornea. LASIK is actually a three-step procedure:
The first step is to create a thin layer, or “flap”, under which the laser energy for the Laser Vision Correction is to be applied. Creating the “flap” can be accomplished using either a precise instrument called a microkeratome, or can be created using a femtosecond laser.
The second step is to carefully fold the “flap” over and allow the inner layer of the cornea to be visible so that the laser energy can be applied.
The third step is to gently replace the “flap” back into its original position where is adheres without the use of sutures as a result of the extraordinary bonding properties of the cornea.
The microkeratome method of creating the LASIK flap was initially developed and used for many millions of LASIK surgery procedures. It has evolved to a level of consistency and precision with a solid level of safety and efficacy when performed by an experienced LASIK surgeon for properly selected patients. It does require that the LASIK surgeon be proficient in the use of the instrument in order to obtain the best results. The use of the femtosecond laser allows the LASIK flap to be created by the LASIK surgeon using a laser in the hope that it will produce either better results or greater levels of safety for LASIK patients. Obtaining greater LASIK safety by creating the flap with a laser rather than with a microkeratome is NOT a trivial task given the well-established solid long-term track record found with the microkeratome for LASIK flap creation. Creating a LASIK flap requires the skill of the LASIK surgeon whether he or she chooses to use a microkeratome or a laser. While one would think that a "laser flap" or "blade free lasik" or "all laser lasik" certainly must be superior, patients must understand that all surgery has side effects and the possibility of complications. The peer review publications on whether "blade free lasik" or "all laser lasik" is actually safer and more effective do not necessarily substantiate its benefits. The LASIK surgeon interviews and opinions presented in the March 1, 2009 Ocular Surgery News Asia/Pacific-Europe Edition support the position that, as always, it is the decision of the LASIK surgeon as to what type of technology to use to achieve the best possible results for each individual patient-so leave the choice of a "laser flap blade free all laser lasik" vs. a "microkeratome flap" to the eye surgeon of your choice.