Blade vs Bladeless LASIK

Evidence Based
Vision Center is funded by our readers. We may earn commissions if you purchase something via one of our links.

Which is Better: Blade or Bladeless Lasik?

If you are considering LASIK eye surgery, you might be wondering whether you should get blade or bladeless LASIK. Blade or bladeless LASIK refers to how the eye surgeon creates the corneal flap. Other than the flap creation, the surgeries are essentially the same.

Bladeless LASIK is a newer technique. In modern LASIK surgery, many surgeons are choosing bladeless over traditional LASIK. However, this does not necessarily mean bladeless LASIK is always the better choice. Both forms of LASIK have advantages and disadvantages.

No matter which option you choose, LASIK is considered extremely safe and delivers excellent visual outcomes. 


Zocdoc helps you find the top-rated LASIK specialists in your area and provides real patient reviews. Browse LASIK Specialists near you


The U.S. Food & Drug Administration (FDA) approved traditional LASIK in 1999 and bladeless LASIK in 2001.

Brief Overview of LASIK Procedures

Before starting the procedure, the surgeon instills anesthetic eye drops to numb your eyes. You may also receive some medication to help you relax, especially if you are feeling nervous or anxious. 

Then, the surgeon places a lid speculum to hold your eyes open during the entire procedure. At this point, you should not be able to feel any discomfort since your eyes are numb.

The surgeon then places a suction ring onto your eye to hold it in place while they cut the corneal flap. The suction ring puts pressure on your eye, but the discomfort only lasts several seconds. Depending on whether you are receiving blade or bladeless LASIK, the surgeon creates the corneal flap using a microkeratome blade or a femtosecond laser.

Then, the surgeon carefully lifts the flap, which has a hinge, so it can easily be put back into place once the procedure is finished. The surgeon uses an excimer laser to reshape your cornea based on the measurements taken before surgery. After completing this step, the surgeon replaces the flap and smooths it out. The entire process only takes about 15 minutes for both eyes.

diagram showing six steps of lasik eye surgery

What is Bladed LASIK?

Bladed LASIK, otherwise known as traditional LASIK, uses a surgical blade to create a corneal flap. This blade is called a microkeratome. Many people are deterred by the idea of a surgical blade but are surprised to learn that the procedure is not much different from bladeless LASIK, as described in the overview above.

PROS
  • Often costs less than bladeless LASIK.
  • Lower risk of diffuse lamellar keratitis, a complication that causes inflammation underneath the corneal flap.
  • Less suction time required, which may be more comfortable for the patient. 
  • Maybe a better option for some enhancement procedures, especially if you received traditional LASIK originally.
CONS
  • Higher risk of decentration, which means the laser is not centered correctly on the eye. This can cause irregular astigmatism.
  • Higher risk of flap complications such as flap wrinkles or irregular flaps.
  • Higher risk of higher-order aberrations, which are light-related distortions that cause glare, halos, ghosting, and starbursts.

What is Bladeless LASIK?

Bladeless LASIK uses a femtosecond laser to create the flap. It is also known as “all-laser” LASIK. Common equipment used during bladeless LASIK surgery includes iLASIK and Intralase. An increasing number of surgeons favor bladeless LASIK over bladed LASIK for its consistent results and excellent visual outcomes.

PROS
  • Creates more consistent corneal flaps, resulting in fewer flap-related complications.
  • Creates thinner corneal flaps, allowing the surgeon to correct higher prescriptions with less corneal tissue.
  • Lower risk of dry eyes.
  • Better overall quality of vision.
  • Better night vision with less glare and halos.
  • Lower risk of surgically-induced astigmatism.
  • Vision improves slightly faster after surgery.
CONS
  • Higher risk of diffuse lamellar keratitis, a complication that causes inflammation underneath the corneal flap.
  • Higher risk of light sensitivity, but this side effect is usually temporary.
  • Some surgeons charge more for bladeless LASIK, while others charge the same price as traditional LASIK.

Can I Combine Blade or Bladeless LASIK With Other Types of LASIK?

The short answer is, yes. Think of LASIK as a procedure that involves two steps. The first step is flap creation, and the second step is corneal reshaping. 

The options for flap creation are:

  • Microkeratome blade
  • Femtosecond laser

The options for corneal reshaping are:

  • Conventional LASIK bases the treatment on your prescription. The laser corrects your vision by flattening your cornea, which may result in a higher risk of night vision problems such as halos or glare.
  • Wavefront-optimized LASIK improves upon some drawbacks of conventional LASIK. Instead of simply flattening the cornea, wavefront-optimized techniques maintain your cornea’s natural curvature.
  • Wavefront-guided LASIK is a customized LASIK procedure that minimizes higher-order aberrations, resulting in higher-quality vision.
  • Topography-guided LASIK is another customized LASIK procedure that uses a topographer to map out your cornea in detail. These measurements allow the surgeon to customize a treatment that delivers sharper vision with fewer light distortions.

The options for flap creation and corneal reshaping may be combined in various ways. Your eye surgeon can help you determine which options are best for you. 

Generally, a bladeless LASIK procedure combined with customized LASIK surgery costs more than other options. Additionally, you can combine any of these procedures with monovision LASIK, which is an option to correct your near vision if you need reading glasses.

Find Top LASIK Specialists In Your Area.
Read Real Patient Reviews.
Book Appointments Quickly & Easily
.

Zocdoc is the leading digital healthcare marketplace for in-person or virtual care. Join the millions using their service to book an appointment with a LASIK specialist in your area.

Author: Melody Huang, O.D. | UPDATED June 2, 2020
Resources

Chuck, Roy S., et al. “Refractive Errors & Refractive Surgery Preferred Practice Pattern.” Ophthalmology, 2017, doi:10.1016/j.ophtha.2017.10.003.

Cosar, Cemile Banu, et al. “Comparison of Visual Acuity, Refractive Results and Complications of Femtosecond Laser with Mechanical Microkeratome in LASIK.” International Journal of Ophthalmology, vol. 6, no. 3, 18 June 2013, pp. 350–355., doi:10.3980/j.issn.2222-3959.2013.03.18.

Eydelman, Malvina, et al. “Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) Studies.” JAMA Ophthalmology, vol. 135, no. 1, 23 Nov. 2016, pp. 13–22., doi:10.1001/jamaophthalmol.2016.4587.

Moshirfar, Majid, et al. “LASIK Complications.” EyeWiki, 20 Jan. 2015, eyewiki.aao.org/LASIK_Complications.

Vastardis, Iraklis, et al. “Femtosecond Laser versus Mechanical Microkeratome-Assisted Flap Creation for LASIK: a Prospective, Randomized, Paired-Eye Study.” Clinical Ophthalmology, vol. 8, Sept. 2014, pp. 1883–1889., doi:10.2147/opth.s68124.

Zhang, Yu, et al. “Comparison of Corneal Flap Morphology Using AS-OCT in LASIK With the WaveLight FS200 Femtosecond Laser Versus a Mechanical Microkeratome.” Journal of Refractive Surgery, vol. 29, no. 5, 1 May 2013, pp. 320–324, doi:10.3928/1081597x-20130415-03.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

arrow-right