Blade or No Blade? A Comparison Between Traditional and Bladeless LASIK Surgery

Posted by: Manhattan LASIK Center

LASIK (laser-assisted in situ keratomileusis) is the most well-known form of laser vision correction and has transformed the vision of an estimated 10 million Americans since it was first approved by the FDA in 1999. LASIK can be used to successfully treat refractive eye conditions including myopia (near-sightedness), hyperopia (far-sightedness), and astigmatism. 

If you require laser vision correction and have carried out research into LASIK, you may be aware that there are now two options available. These are traditional and bladeless LASIK. Which should you choose? To help you decide which is right for you, we have put together this comparison between traditional and bladeless LASIK surgery.   

How Are Traditional And Bladeless LASIK Different?

The primary difference between traditional and bladeless LASIK lies in the creation of the flap. The flap is a vitally important element of laser vision correction. It is created in the top layer of the cornea, called the epithelium, and is lifted to access the tissue beneath. It is this underlying tissue that is reshaped using the LASIK laser, ensuring that light can be refracted by the eye correctly so that after healing, the patient can see clearly with little or no need for glasses or contact lenses. 

Traditional LASIK involves the use of an instrument called a microkeratome. This microkeratome has a tiny oscillating blade that is used to manually make the incision that will form the hinged flap. Suction is then used to hold the eye in place, and the LASIK laser vision correction is performed using laser technology. At the end of the procedure, the flap is replaced back over the cornea and left to heal. There is no need for any sutures. 

Bladeless LASIK is named because there is no microkeratome used. Instead, the incision needed to create the flap is made using a high-energy, femtosecond laser. This laser emits pre-programmed short pulses of energy that form the incision. Once the flap has been created, the flap is lifted so that LASIK can be performed on the underlying tissue. 

Advantages Of Traditional LASIK

Proven history. One of the biggest advantages of traditional LASIK is that the technique has a proven track record of success. It is now more than 20 years old and overall success rates are very high. The latest research has indicated that LASIK has a 99% success rate in achieving 20/40 vision or better, with 90% achieving 20/20 vision or better. Complication rates are also extremely low. Meanwhile, bladeless LASIK, while also successful, has a shorter history. 

Cost. Mechanical microkeratome systems are fairly inexpensive to purchase and maintain. Traditional LASIK is also less expensive for patients than bladeless treatment. Not all LASIK surgeons have invested in the advanced laser system needed for bladeless laser, which is also significantly more expensive to buy.

Speed. Many people are surprised to learn that while both procedures are fairly short in terms of the time it takes to perform them, traditional LASIK can be performed slightly quicker than bladeless LASIK.

Advantages Of Bladeless LASIK

Fewer flap-related complications. Issues relating to the flap are one of the most common complications that arise from traditional LASIK laser vision correction. This is because the mechanical microkeratome system can malfunction as a result of lost power, jammed mechanical parts, or loss of suction. If this happens, it can cause a range of issues with the flap including a partial/incomplete flap, a flap without a hinge (known as a free cap), or other irregularities with the shape of the flap which can impair healing. These complications are extremely rare in bladeless LASIK. 

Flexible hinge position. In traditional LASIK the hinge for the flap always occurs in the same location. However, every patient is unique and for some, it may be more appropriate to customize the hinge position. This is only possible using bladeless LASIK. 

Greater precision. Many experts argue that the level of precision and accuracy, as well as predictability, is far greater in bladeless LASIK. This is because the laser can be pre-programmed with the specific measurements needed, which is then carried out with no room for manual error. Issues that can arise with traditional LASIK include irregularities in the flap edge and uneven flap thickness. These can lead to flap-related complications (see above). 

Swift recovery. Research has identified that the recovery rate for patients who have undergone bladeless LASIK is faster and usually smoother. In fact, many patients can return to work within 24 hours of their treatment. This swift recovery makes bladeless more convenient for many busy patients. 

Both traditional and bladeless LASIK is highly successful and effective treatments for combatting the effects of refractive errors, with Bladeless LASIK being the safer, more predictable procedure. To help you to determine which is right for you, please contact our team who will be happy to discuss both options with you in order to find the most suitable solution.