“Blade Versus Bladeless” LASIK Debate

Those interested in LASIK eye surgery to correct vision may wonder about “blade versus bladeless” references regarding how the procedure is performed. What is the blade and bladeless? And what are the advantages and disadvantages of each type of LASIK procedure?

In the traditional LASIK, an instrument known as a microkeratome cuts a thin, hinged flap in the clear surface of the eye (cornea). The flap is then lifted to implement energy lasers that reshape the eye to correct vision. The replacement of the flap in LASIK promotes faster healing.

Another method of creating a flap LASIK, introduced in 1999, uses a type of high-energy laser (or IntraLase femtosecond laser) instead of a blade.
IntraLase is often marketed as “bladeless” or “all laser” LASIK, although eye surgeons in favor of more traditional microkeratomes could argue that both procedures mean that penetrates the surface of the eye. (See also: how is performed LASIK).

In 2007, Advanced Medical Optics (AMO) acquired IntraLase “bladeless” technology. IntraLase joined the company CustomVue excimer laser platform, now being marketed as iLASIK.
Two respected eye surgeons debate Blade Vs. Bladeless LASIK

In this debate eye surgeon, Brian Boxer Wachler, MD, Boxer Wachler Vision Institute in Los Angeles, and Vance Thompson, MD, Sioux Valley Clinic director refractive surgery (Sioux Falls, SD) and assistant professor of ophthalmology at the University of South Dakota School of Medicine, have agreed to help clarify the views on the pros and cons of the road in front of bladeless LASIK flaps. These surgeons used both techniques, but differ in their views on what method should be emphasized LASIK procedures without complications. Both belong to eye surgeons AllAboutVision.com ’s editorial advisory board.

Some LASIK surgeons favoring microkeratomes have objected to the term “bladeless” IntraLase in advertising. If the term “bladeless” LASIK is used?
Thompson: I agree with that term. It is very important that there is truth in advertising, and the truth is that it is not used blade. In reality, however, this technology usually referred to as “all laser” LASIK.

Boxer Wachler: Technically IntraLase is bladeless. Hence, the term is probably reasonable. Some people were not satisfied with the floor, “bladeless,” because this implies that the microkeratome, which uses a knife, the patient is scarier. This was perceived by some as “hitting below the belt” because the implication that a microkeratome is more risky somehow, when in fact it is not.
Advantages of laser hair or scalp in LASIK Blade

Dr. Boxer Wachler, what are the advantages of modern microkeratomes (blade) compared with IntraLase (laser) as responsible for the LASIK flap?

Boxer Wachler: I am for what is best for the patient, but I use the microkeratome much more often than I IntraLase. Microkeratomes make the procedure to go much faster and are much more comfortable for the patient. From aspiration in a microkeratome procedure takes about three seconds, while the use of suction IntraLase takes about 15-20 seconds at its fastest. In addition, you use less suction in the eye with a microkeratome. I prefer to patients to be as comfortable as possible, which is why I prefer the microkeratome.

Dr. Thompson, what are the advantages of IntraLase (laser) along microkeratomes (leaves)?

Thompson: I use both, and I patients about both.

But I like to use technology more secure for the situation. When U.S. Food and Drug Administration approved the laser maker flap (IntraLase in 1999), blade or microkeratome flaps were the main source of my vision-threatening complications in LASIK - whether they were free plugs (single flaps), partial flaps, or buttonholes ( the correct way flaps) or epithelial Slough (damaged eye tissue). [See also: LASIK risks and complications.] I just found that, although the vast majority of cases leaf lapel ha ido well, if not go well - is ugly.

Therefore, I liked the idea of a laser manufacturer flap. You do not have to worry about buttonholes, partial flaps and without caps. Just brought much more inner peace to a very important part of the procedure, which is creating the flap. It also brought more inner peace for my staff. Our operating room today are much more pleasant.
Flap quality with the blade or Bladeless LASIK

What is your opinion of the overall quality of flaps, whether created with the blade or bladeless LASIK?

Thompson: Flap predictability is better with a laser flap.

Boxer Wachler: I share my own personal experience. I had not had a free (separately) flap occur in five years, while using today microkeratomes. Buttonholes (in the form of eyelet flaps) rarely happen, but these have occurred with the IntraLase as well. In other words, flap complications are rare but can occur either with or microkeratome IntraLase technologies. The most important aspect is that the patient is in the hands of an expert surgeon. Remember, we’re talking about instruments and tools are only as good as the surgeon who is using. It’s like golfer Tiger Woods and a weekend that both use the same top golf clubs. That cree that you will achieve better results with the same golf clubs?

Thompson: I have not heard of a buttonhole flap IntraLase occur. I suppose that any surgeon doing a flap with a blade or a laser could make a buttonhole if they are harsh in lifting the flap. But a laser does not make a buttonhole, because you get the same thickness flap with a laser does not matter what the curve of the cornea. With a knife, the curve over the cornea that is, the thinner the central flap. This increases the possibility of a buttonhole dramatically.

What would you tell patients about possible complications involving the blade or bladeless LASIK?

Boxer Wachler: If the surgeon is using a modern, present-day microkeratome, there is no real advantage in the use of IntraLase to create a flap. It has been argued that microkeratomes create a meniscus flap (thin in the middle). But there has been no consensus data showing that a flap flat (the same thickness in the center and outer edges) is better. There can be drawbacks to the IntraLase flap, such as increased risk of additional oedema (swelling) of the flap. This is because of all the additional laser energy needed to make the flap. This may delay the crispness and clarity of vision of a few days a week. That’s not the case with a flap with the microkeratome.

Thompson: I would like to tell a patient that the risks of a flap or part of a hole in a flap or a flap complication would be more traumatic with a microkeratome and less with a laser. A blade makes a thin flap flap in the center, meaning it is thicker at the edges (meniscus). A laser flap is the same thickness at the center as it is on the periphery (flat).

Studies have shown that there can be no greater rate of induction of higher-order aberrations (distortion of vision) with the blade flaps versus laser flaps because of the flap, and this was based on multiple clinical trials.

Boxer Wachler: But with IntraLase, there is a question of sensitivity to light transient. It is a low risk factor, but the only risk to the IntraLase.

Thompson: What is a vision threatening complication, and what is a nuisance? Transient sensitivity to light is much less of an issue that a hole in the middle of a flap.

Boxer Wachler: Holes in the middle of flaps have occurred in the loins IntraLase as well.

Is there ever a circumstance where the use of knives or bladeless LASIK approach that normally would not be his first choice for creating a flap?

Thompson: In complicated cases where the patient has had previous refractive surgery and has had a sheet flap complication, I do not use a laser flap. In corneal surgery, water bubbles that form during the creation of laser flap can crawl through the incision made earlier by the blade and get flap between the cornea and the lens focused laser. That is where sometimes I have to say that patients have had complications flap sheet that I must try to solve them with the same technology.

In addition, if the cost is a real problem for somebody and they are willing to accept the increased risk with the blade flaps, I will make a flap sheet for them. There is a $ 300 per eye difference.

Boxer Wachler: If the patient wants a flap IntraLase fact, there will be a fee for him, but is not a problem to do so if that is what a patient really wants and this will help them sleep better at night. I do not use IntraLase under certain circumstances, however. Patients who have glaucoma would be better with microkeratomes, because the time of suction and the degree of suction is lower. [Note: The degree of suction in the eye used in a LASIK procedure can be viewed by some as a risk factor for patients of glaucoma, which can have high internal or intraocular pressure of the eye that could worsen during any procedure LASIK.]

Thompson: The leaf lapel manufacturer raised intraocular pressure much more than the laser manufacturer flap, so that many feel it is safer to conduct a laser flap in patients with glaucoma.

What would you tell patients about the overall safety of the road or bladeless LASIK procedures?

Boxer Wachler: The reality is that LASIK is one of the safest procedures in all of medicine, with the microkeratome, or with IntraLase.

Thompson: With regard to the clinical significance, it may be difficult to tell the difference between a blade well done microkeratome overlaps with modern technology and a laser flap well done. The complications are the main difference between these two technologies. Of those who see me for a second opinion if his eyes had been adversely affected by LASIK, 99 percent have a sheet flap complication.LASIK