Jump to topic
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.
The U.S. Food & Drug Administration (FDA) approved traditional LASIK in 1999 and bladeless LASIK in 2001.
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.
Jump to topic
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.
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.
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:
The options for corneal reshaping are:
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.
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.