Laser LASIK

By Dominick Benedetto, MD

Patients who are considering LASIK have many psychological barriers to overcome, not the least of which is the issue of safety. LASIK is a surgical procedure that reshapes the cornea (the front surface of the eye) beneath a constructed surface flap. The procedure is analogous to shaving down a bump in the floor beneath a surface rug (flap). Fortunately, this is a painless procedure performed with topical anesthesia. The surface flap, like a rug, can be constructed with an oscillating microscopic blade, as most flaps are created, or in a “bladeless’ procedure with a laser known as “Bladeless LASIK” or “All Laser LASIK”.

No matter how you view the procedure, a precise incision must be made into the surface of the cornea. No one will dispute the public’s whimsical love affair with the laser and its fear of the blade. However, one should understand that either way the incision is made it is a surgical intervention, which carries some, but fortunately minimal, risk.

For the completely novice lasik surgeon the laser is more precise and less dependent upon a surgeon’s skill and therefore safer in the public’s mind. However, like the experienced carpenter familiar with his tools, the more experienced surgeon can use either method to achieve an excellent result.

As with any highly technical device, there is constant evolution in equipment design. New, improved models of both blade flap makers and laser flap makers are constantly entering the marketplace, which benefit patient safety.

When a patient is considering blade or “bladeless” LASIK, he should know that, at the present time, there are no studies which clearly indicate superiority in visual outcome or safety for either method.

Beware of any hard sell of either technique.

Beyond visual outcomes and safety, there are other things to consider such as price, and there is a substantial price to pay for “bladeless” technology. Using a laser to make a flap can increase the cost of LASIK as much as 25%. In addition, there is an increase in the procedure time from 5 minutes per eye with blade LASIK to 30 minutes per eye with “bladeless” or “All Laser LASIK”, as well as an increase in the total time at the surgery center from one to two hours. Clinically, “All laser LASIK” can cause greater inflammation in the cornea, necessitating greater frequency of post-operative drop therapy, which can delay excellent visual recovery in the short run by 1-2 weeks.

All things considered, however, perception accounts for 99% of the decision process. And if cost is not a consideration, either alternative can produce excellent results in experienced hands. For some patients one or the other procedure may have a distinct advantage and your consulting surgeon should be able to help you navigate through the decision making process.

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