Lasik Q & A

Blade Vs. Bladeless in LASIK Surgery

Many people that feared going “under the knife” for certain types of LASIK eye surgery may be surprised to find that the new bladeless technology provides dubious results. The Mayo Clinic recently conducted a comparison study on the use of femtosecond lasers (those used in the new bladeless LASIK surgeries) versus the use of the traditional mechanical microkeratome used in regular LASIK surgeries. Their findings were surprising in that the use of a femtosecond laser did not yield significantly better results in LASIK patients. In fact, patients who underwent the regular microkeratome based LASIK surgery had results that were virtually indiscernible from those of the bladeless patients after the six-month recovery period.

These findings are especially significant in light of recent claims that the bladeless laser procedure provides not only better results but also yields fewer complications or side effects than the microkeratome-based operation. Because of the importance of these results and their possible impact on public opinion, they are to be presented to the ARVO (or Association for Research in Vision and Ophthalmology) for future action.

With this revelation in mind, potential LASIK surgery patients now have a choice to make: the tried and true mechanical microkeratome surgery, or the bladeless new femtosecond surgery? Both procedures can treat a variety of patients with conditions ranging from nearsightedness to farsightedness to astigmatism. In each surgery and for each affliction, the surgeon reshapes the corneal surface.

With traditional surgeries that use the mechanical microkeratome, a trained surgeon cuts a flap in the cornea to reshape its surface. With femtosecond-based surgeries, the surgeon cuts the flap using a new laser. Because it removes the hands-on aspect of the surgery, this operation is also alternately called the “all laser” surgery.

Initially, it was reported that the new bladeless surgery was more efficient and yielded better results. The results of the Mayo Clinic’s study effectively refute this by showing that, at the end of the recovery period, there are negligible differences in the vision improvement, side effects, or overall success rates of patients of both types of surgeries.

Nevertheless, many eye surgeons that perform LASIK procedure still prefer the bladeless surgery. They contest that it is safer because of its ability to reduce the margin of error inherent in mechanical microkeratome surgery. Though the results of the study do not reflect these beliefs, proponents of the bladeless surgery insist that it is the better method. They insist that the laser’s controlled precision reduces the risk of over or under correcting and cite the laser’s ability to map the cornea as advantages over microkeratome.

On the other hand, even prior to this study the standby microkeratome surgery reported a relatively low risk level. Some rare but serious negative results included total vision loss or dramatic impairment following the surgery, but these conditions occurred in less than one percent of all patients that completed the procedure.

Results of the study imply that the surgeries are both relatively safe but share similar risks. The results reported were based on the long-term recovery of LASIK patients. In other words, odds are at the end of either procedure you will have the same results, for better or worse. Bladeless femtosecond surgery does have the benefit of speed; because of the automated precision of the laser, the procedure typically takes less time. Also, many people shiver at the concept of someone literally cutting their eye, while other people are uncomfortable with the idea of a laser looming over them. Ultimately, if you believe that both methods are truly equal, then the decision of which to undergo comes down to comfort and personal preference.

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