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Traditionally, LASIK was performed using a blade, but the bladeless option is becoming more common. The primary difference between the two LASIK types is how the surgeon creates the corneal flap. (Read More)
How Does LASIK Work?
LASIK is a type of eye surgery. It is the most common laser eye surgery performed for farsightedness, nearsightedness, and astigmatism.
This surgery works to reshape the cornea, so when light enters the eye, it focuses on the retina properly. This allows for clearer vision.
On average, it takes about 15 minutes to perform LASIK on both eyes. People can start to notice a difference in their vision without contact lenses or eyeglasses within as little as 24 hours after the procedure.
The LASIK Procedure
The procedure is largely the same for LASIK with a blade and without a blade.
After getting the person into position, the surgeon administers anesthetic eye drops to promote comfort during the procedure. In some cases, a medication to help the person relax is administered. Then, the surgeon creates a flap in the cornea using a femtosecond laser or a microkeratome. With both approaches, the corneal flap is very thin.
The surgeon moves the hinged flap back so they can access the cornea. Using an excimer laser, the surgeon removes some of the corneal tissue. This type of laser is highly specialized, and it can remove tissue in microscopic amounts using a cool ultraviolet light beam. This allows the surgeon to precisely reshape the cornea.
When the surgery is performed for nearsightedness, the surgeon works to flatten the cornea. They make the cornea steeper when they are working to correct the vision of someone with farsightedness.
When performing LASIK for astigmatism, the surgeon aims to create a more normal shape for the cornea. This is accomplished by smoothing the abnormal aspects of the shape.
After the surgery, the patient is allowed to rest for a short while. It is possible to experience some itching or burning, but this is temporary. The patient undergoes a short post-operative examination and then can go home.
People cannot drive after this surgery, so they should prepare with a ride home.
The Difference Between Blade and Bladeless LASIK
The tools used to create the corneal flap are the difference between blade and bladeless LASIK.
The blade type of this procedure uses a microkeratome. This is a surgical instrument that allows for precision. It has an oscillating blade that lets the surgeon cut a hinged, thin flap in the cornea.
The bladeless type of the procedure uses a femtosecond laser. This high-energy laser is used to create the corneal flap.
After creating the flap using the blade or bladeless technique, the remainder of the LASIK surgery is the same. The surgeon uses the excimer laser to reshape the cornea in both types of LASIK.
The preparation and aftercare instructions are the same for both types of LASIK.
LASIK surgery using a microkeratome to create the corneal flap has been used longer than the bladeless type. In 2001, bladeless LASIK started being performed in the U.S.
There are certain considerations with each type of LASIK surgery. In regard to microkeratome-created flaps:
- The risk for complications, such as detached flaps, is low.
- There is a risk for flap thickness variation.
- It is better for improving errors from a previous LASIK surgery.
- It requires less suction, so it may be more comfortable.
- The risk of “buttonholes” in the flaps is higher compared to bladeless.
- It is a better choice for people with glaucoma.
- It does not take as long to perform as the bladeless version.
In regard to femtosecond laser-created flaps:
- The risk of edema is higher compared to the blade type.
- There is no flap thickness variation.
- Post-surgery vision is usually better compared to the blade type.
- The risk of flap complications is lower compared to the blade type.
- People may experience temporary light sensitivity.
- Most people will never need touch-up surgery.
Safety and Risks
The risks of LASIK surgery are generally the same for both the blade and bladeless type of the procedure.
In the U.S. over the past 10 years, millions of people have had LASIK and the risk of experiencing severe complications is low. However, it is still important to know what these are to make an informed decision.
The possible complications of blade and bladeless LASIK include:
- Infection and inflammation.
- Bulging of the cornea.
- Corneal flap problems that might require additional treatment.
- Worsened vision.
- Undercorrection or overcorrection of the refractive error.
- The refractive correction decreasing over time.
- Permanent vision loss (extremely rare).
There are certain side effects that people may experience after LASIK surgery. These are temporary for most people, but they can become permanent in a minority of people. They include:
- Pain or discomfort.
- Blurry or hazy vision.
- Halos, starbursts, or glare around lights.
- Reduced vision sharpness.
- Sensations of dryness or scratchiness.
- Poor night vision.
- Light sensitivity.
- Small red or pink patches on the white part of the eye.
Blade vs. Bladeless LASIK Effectiveness
Both types of LASIK are considered to be effective for improving vision. The femtosecond laser creates a little bit better quality vision and fewer complications. However, the best choice for an individual depends on various factors, such as their overall visual and general health.
One study shows that bladeless LASIK may be the superior choice. By exploring the clinical results, the researchers determined that the people who underwent bladeless LASIK did better at each stage compared to the people who had blade LASIK. On day one post-op, 68 percent of the bladeless recipients achieve 20/16 vision. The study concluded that the results remained similar at one week post-up and at one month post-op.
All people who are considering LASIK should talk to their doctor about which type is best for them. The surgeon will evaluate the benefits of each type and assess the person’s individual health to help them make the best decision.
The LASIK Procedure: A Complete Guide. All About Vision.
Bladeless LASIK: Femtosecond Laser Eases LASIK Fears. All About Vision.
Complications and Side Effects. UNC School of Medicine Ophthalmology.
A Look at LASIK Past, Present, and Future. American Academy of Ophthalmology.
Blade vs. Laser: Is There a Difference in Outcomes? Review of Ophthalmology.