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Laser-assisted refractive surgeries have been around for decades, and iLASIK is one of the many aiming to improve upon the traditional LASIK procedure.
The iLASIK procedure is designed to be low impact since it uses a femtosecond laser rather than a microkeratome blade to create the corneal flap. This means iLASIK is a good option for people who have high fluid pressure in their eyes, with or without glaucoma, and people who have thinner corneas.
Since iLASIK can make a thinner, more personalized corneal flap, you are at a lower risk of side effects involving flap detachment, infection, or scarring. As a result, iLASIK is more expensive per eye, and it can take a little longer in the operating room.
The iLASIK procedure is very similar to traditional LASIK as far as preparation and recovery. Johnson & Johnson reports that 94 percent of patients gain 20/20 vision or better after their eyes have fully healed. Patients are at risk of certain side effects associated with the procedure, including transient light sensitivity syndrome (TLSS), which is a problem unique to the IntraLase laser devices.
The best way to know if you would benefit from iLASIK is to talk with your optometrist or ophthalmologist.
What Is iLASIK?
The lasers necessary for laser-guided refractive eye surgeries were invented in the 1970s. With the development of the excimer laser, procedures like photorefractive keratectomy (PRK) and enhanced PRK allowed for clearer vision for some serious eye conditions, but were limited in use. Some eye surgeons wanted PRK to expand into the cosmetic surgery market, but this was rare.
In the 1990s, laser-assisted in situ keratomileusis (LASIK) was developed based on PRK. Then, the movement to improve refractive errors with laser surgery became popular worldwide.
Since it was approved by the United States Food and Drug Administration (FDA) in 1996, variations on this outpatient procedure have developed to reduce side effects and healing time. One of the more popular developments is bladeless LASIK, also called all-laser LASIK.
Since different companies have created different combinations of laser devices used for bladeless LASIK, each group of devices has a different procedure name. The iLASIK procedure was the first type of bladeless LASIK developed.
Johnson & Johnson created the iLASIK procedure to shape the cornea without using anything other than laser technologies. This makes their version of bladeless LASIK less invasive, which can improve healing time and reduce side effects for many people.
Who Benefits From iLASIK?
The iLASIK procedure and other types of bladeless LASIK use femtosecond lasers to create a small flap in the cornea, allowing the excimer laser to reshape the underlying tissue. Eye surgeons have found that using a laser, rather than a microkeratome, is slightly faster and less invasive. Although improvements to the microkeratome blade have made traditional LASIK a safe, low-impact procedure, iLASIK and other all-laser LASIK operations still typically have fewer complications.
Bladeless LASIK also allows for more people to choose refractive surgery. Traditional LASIK is often restricted to people who have thick-enough corneas. If you naturally have thin corneas, you are not a good candidate for LASIK. All-laser LASIK procedures allow for people with thinner corneas to gain clear vision. However, these procedures are still not for everyone.
- iLASIK, patented by Johnson & Johnson.
- Femto LDV, patented by Ziemer Ophthalmic Systems.
- Victus, patented by Bausch + Lomb.
- VisuMax, patented by Carl Zeiss Meditec AG.
Femtosecond laser technology allows for the flap in the cornea to be created very quickly and very minutely, which helps recovery time and reduces the time spent in the operating room. Other benefits include:
- More predictable thickness to the corneal flap.
- More customizable corneal flap size.
- Lower risk of corneal abrasions during the procedure.
- Lower risk of induced astigmatism after the procedure.
- Greater accuracy in reshaping the cornea.
The Pros & Cons of iLASIK
Bladeless LASIK devices have been approved by the FDA since 1999. Many eye surgeons report that they are trained in and use both a microkeratome and a femtosecond laser, depending on what their patient needs.
Ophthalmologists report that they counsel potential patients on the pros and cons of both all-laser and traditional LASIK. Some surgeons prefer a microkeratome, while others prefer the femtosecond laser.
Some surgeons report that, while they will use either option to create a corneal flap, they have had more harmful side effects, like flap dislocation, when they used a microkeratome. For other surgeons, the femtosecond laser requires more suction on the eye and a few more seconds in the operating room, so they prefer the microkeratome for patient comfort and reduced side effects like dry eye.
The iLASIK procedure is a good option for more people. You might benefit from iLASIK if:
- You have thinner corneas.
- You have undergone a prior refractive surgery.
- You have high fluid pressure in your eyes or glaucoma. iLASIK can reduce the risk of rising fluid pressure in the eye.
- You have a higher rate of aberrations in your cornea.
There are downsides to iLASIK, including:
- It is more expensive than traditional LASIK by about $300 per eye.
- It might take longer, depending on your eye surgeon’s experience with the devices.
- There is a higher risk of transient light sensitivity that will go away after six months.
The iLASIK Procedure
The iLASIK procedure was developed from traditional LASIK and follows a similar format.
- Preparing for the surgery: You will visit an ophthalmologist or optometrist to get a full eye exam before the procedure. This ensures you have no underlying conditions like cataracts or glaucoma, which will disqualify you from refractive surgery. Once your doctor evaluates your eye health, they will also map your cornea so they can program the lasers to accurately work with your eyes.
- During the surgery: You will receive numbing eye drops and, in some cases, a short-acting sedative to relax you during the surgery. Another device will hold your eyelids open so the lasers can work without you blinking.
The IntraLase femtosecond laser will create a very small flap on the front of your cornea. Then, the STAR S4 IR Excimer Laser removes tissue from the inside of the cornea, so your refractive error is corrected.
Johnson & Johnson reports that 94 percent of patients see 20/20 or better at a six-month postsurgical follow-up appointment. This is based on clinical studies involving this specific combination of devices.
- After the surgery: Although your eyes will heal quickly after iLASIK, you will not be able to drive yourself home, so it is important to arrange transportation. You should rest your eyes for a day, and if you were given a sedative, you should relax while the medication wears off. Your doctor will prescribe eye drops to keep your eyes moist and reduce the risk of infection.
You will have several follow-up visits over the next few months, with the first scheduled for the day after your surgery. This allows your eye doctor to make sure everything is in the right place, and your corneas have been reshaped correctly. They will also monitor any excessive pain or other symptoms that may need treatment.
You may feel pain or discomfort, as if something is in your eye, for up to three days after the operation. You may also have itchy eyes, blurry vision, light sensitivity, or dry or watery eyes for a few days while your cornea heals. This is normal, but if symptoms do not go away within a week, contact your eye surgeon.
Full healing takes about three months, on average. Keep your eyes clean and do your best to keep particles out of them.
Risks & Side Effects Associated With iLASIK
Like any surgical procedure, there are potential risks and side effects associated with iLASIK. This outpatient procedure is very low-impact, and you should recover much of your sight within one to two days of the operation.
You may experience some side effects for up to six months, including:
- Halos or glares around lights.
- Partial or incomplete flap from the laser incision.
- Flap dislocation or a high rate of scarring, which obstructs vision.
- Wrinkles in the flap.
- Inflammation under the flap.
- Epithelial cell growth, or cells from the surface of the cornea growing under the flap.
Transient light sensitivity syndrome (TLSS) is a specific condition associated with all-laser LASIK operations like iLASIK. After IntraLase became the standard device for iLASIK, medical studies found that about 1 percent of people who underwent bladeless LASIK developed TLSS.
This does not impact your visual acuity, so your refractive error is still considered corrected. But TLSS can make you feel less satisfied with the iLASIK procedure since it is uncomfortable.
Eye doctors report that they could treat TLSS with an aggressive dose of steroids, and many instances were not bad, just mildly disruptive. However, some doctors reported that patients returned for follow-up appointments wearing a baseball cap and two pairs of sunglasses because their sensitivity to light was so intense. Although light sensitivity could occur in the first few days after iLASIK, TLSS is a syndrome that develops two to six weeks after the procedure.
After several reports, Johnson & Johnson found that the problem was associated specifically with early versions of the IntraLase device. Once the problem was identified, eye doctors began to diagnose and treat the condition more consistently. The manufacturer worked to reduce the risk with further generations of IntraLase.
The current risk of developing TLSS is less than 1 percent. Despite the low risk, it is important to go to all your follow-up appointments to be sure you do not develop this condition.
How to Decide if iLASIK Is Right for You
There are several individual factors that can make iLASIK a good option for you or that make traditional LASIK a better choice. Work with your optometrist or ophthalmologist to weigh the pros and cons, including specifics on costs, side effects, and recovery times.
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‘Blade Versus Bladeless’ LASIK Debate. (June 2016). All About Vision.
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What Is iLASIK treatment? iLASIK, Johnson & Johnson Vision.
Transient Light Sensitivity Is a Minor Complication of IntraLase Use. (October 2004). Healio, Ocular Surgery News.