Is bladeless Lasik or eye refractive surgery better than traditional laser surgery for the eyes?

Nearsightedness (myopia), farsightedness (hyperopia) and astigmatism are common eye problems that involve loss of visual acuity. Although wearing prescription eyeglasses or contact lenses help improve vision, many people opt for refractive surgery involving lasers, commonly known as Lasik or laser-assisted in situ Keratomileusis. This procedure is traditionally performed by an ophthalmologist who is trained in using microkeratome (a disposable blade) to reshape the outer surface of the eye (cornea), which results in improvement of visual clarity.

There has been much controversy regarding the advantages of employing "bladeless Lasik" or "all laser" compared to a microkeratome. Traditionally, the microkeratome is used to create a hinged flap on the cornea, which is lifted to allow the application of laser to help correct vision. Newer technology, however, allows the use of femtosecond laser, which is of high energy, to create the flap without the use of a blade. Femtosecond laser or bladeless Lasik systems include IntraLase (iLasik), Femtec (2010 Perfect Vision), Visumax (Carl Zeiss Meditec), and zLASIK (Ziemer Ophthalmic Systems).

What Is Bladeless Lasik?

Bladeless Lasik is a type of eye refractive surgery that uses all laser technology to treat eye refraction problems such as myopia, hyperopia, and astigmatism. In contrast to traditional Lasik surgery, which uses a blade (microkeratome) for the initial phase of the surgery to create flaps in the cornea before laser is introduced, bladeless Lasik uses high-energy femtosecond laser to cut the flap instead. Some eye surgeons, however, do not like how the term "bladeless" implies that it is safer than traditional eye surgery, when in fact, they are both as safe as the other.

What Are the Advantages of Bladeless Lasik?

Eye surgeons differ in their opinion regarding the advantages and disadvantages of using bladeless Lasik, depending on their expertise and professional experience. While some surgeons prefer to use the microkeratome in creating corneal flaps because the procedure takes a shorter time, others prefer using bladeless Lasik technology.

Dr. Vance Thompson, a refractive surgery director of the Sioux Valley Clinic and assistant professor in ophthalmology at the University of South Dakota School of Medicine, use both technologies but prefer to use bladeless Lasik for most of his patients. He cites the following advantages:

1. Fewer complications. According to Dr. Thompson, most refractive eye surgery complications such as unattached (free caps), improperly created flaps, or partial flaps are associated with microkeratome flaps. Vision distortion and damage to the eye tissues also tend to occur more with the use of the blade.
2. Better flap quality. Although some eye surgeons believe that it is the surgeon's own expertise that determines the outcome of surgery rather than the technology employed, Dr. Thompson considers laser flaps to be more predictable because lasers create flaps with same thickness regardless of the curve of the patient's cornea, while blades can create "buttonholes" in the cornea.

What Are the Disadvantages of Bladeless Lasik?

Dr. Brian Boxer Wachler, an eye surgeon at the Boxer Wachler Vision Institute in Los Angeles, and named one of the best US ophthalmologists by the Consumers' Research Council of America, names some of the possible disadvantages of bladeless Lasik:

1. Flap swelling. Dr. Boxer believes that using IntraLase to create a flap increases the risk of edema or swelling of the corneal flap, which can impede clear vision after surgery for as long as a week. This swelling does not occur with traditional Lasik flaps.
2. Transient light sensitivity. Temporary increase in light sensitivity occurs with the use of lasers but not in microkeratome surgery.
3. Cost. Bladeless Lasik costs more than blade flap surgery.
4. Increased eye pressure. Dr. Boxer, prefers to use microkeratome surgery over bladeless Lasik in people who have glaucoma, an eye condition characterized by increased eye pressure, because IntraLase involves a high degree of eye suction, which can worsen the condition.

What Research Has Been Done on Bladeless Lasik?

While eye surgeons vary in their medical opinions regarding bladeless Lasik, research and clinical studies have also shown varied results:

• A 2005 study reported by the U.S. Navy Medical Center showed that bladeless Lasik resulted in faster healing times and better visual outcomes in spite of transient light sensitivity.
• In contrast, investigators of the Mayo Clinic (2006) found no significant differences in visual outcomes between patients who underwent bladeless Lasik or microkeratome surgery. A follow-up study published in 2010 in the American Journal of Ophthalmology was not able to demonstrate any difference in visual outcomes, either.
• A 2007 study (Journal of Refractive Surgery) showed that visual quality was better in patients who had bladeless Lasik compared to those who underwent blade flap surgery.
• A 2010 study (Journal of Cataract and Refractive Surgery) showed that people who underwent bladeless Lasik had increased risk for developing a complication involving an inflammation beneath the flap (diffuse lamellar keratitis). However, those who had microkeratome flaps had more epithelial defects involving the eye surface.

Considering all the advantages and disadvantages of bladeless Lasik based on various medical opinions and research, it may be reasonable to conclude that it is a safe and procedure for treating refractive eye defects. Although eye surgeons may prefer different ways to perform refractive eye surgery, it is best to discuss bladeless Lasik as an option with your eye care practitioner.