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All-Laser LASIK (Bladeless LASIK) Femtosecond Laser

All-laser LASIK is an advanced form of LASIK eye surgery that uses two separate lasers — a femtosecond laser for the first step of the procedure (creating the corneal flap) and an excimer laser to reshape the underlying corneal tissue and improve vision.

In conventional LASIK, the corneal flap is created with a bladed instrument called a microkeratome. All-laser LASIK eliminates the need for a surgical blade and offers greater precision and control, reducing certain LASIK risks and flap complications.

Advantages of All-Laser LASIK

The use of a femtosecond laser instead of a mechanical bladed instrument to create the corneal flap in LASIK surgery relieves a good deal of anxiety many people have about undergoing the procedure.

One recent study found that, when given the choice, 81 percent of LASIK candidates chose all-laser LASIK over conventional LASIK with microkeratome flap.1

Other clinical studies have identified a number of advantages of all-laser LASIK compared with LASIK where the flap is created with a bladed microkeratome. These advantages include:

  • A higher percentage of patients attaining 20/20 or better visual acuity after all-laser LASIK.2
  • Less risk of dry eyes after all-laser LASIK.3
  • Better adherence of the flap to the underlying cornea after all-laser LASIK.4

It should be noted, however, that many LASIK surgeons still prefer using a bladed microkeratome to create corneal flaps during LASIK.

They point out that a microkeratome can create a flap faster than a femtosecond laser, which can be a factor in patient comfort. And in the hands of a skilled surgeon, complications from flaps created with a microkeratome are very rare.

The All-Laser LASIK Procedure

Like conventional LASIK, all-laser LASIK is a two-step procedure:

Step 1: Flap Creation

A thin flap of corneal tissue (approximately 20 to 25 percent of the corneal thickness) is created using a femtosecond laser.

The flap, which remains attached to the cornea on one end by a small hinge of tissue, is folded back, exposing the underlying cornea to be reshaped with an excimer laser (see step 2 below).

Step 2: Laser Re-Shaping

With the underlying cornea is exposed, the LASIK surgeon positions the excimer laser close to the eye and begins the corneal re-shaping process.

The excimer laser delivers a series of computer-programmed pulses of high-energy ultraviolet (UV) light to the cornea. These energy pulses vaporize ("ablate") microscopic amounts of corneal tissue to reshape the front of the eye, enabling it to focus light more accurately.

The excimer laser treatment usually takes less than a minute. The surgeon then repositions the corneal flap over the treatment area. The flap bonds to the underlying cornea relatively quickly, with no need for stitches.

After surgery, you will be given medicated eye drops to use for several days to reduce swelling and decrease the risk of infection.

Who is a Good Candidate for All-Laser LASIK?

Like conventional LASIK, all-laser LASIK can correct a wide range of nearsightedness, farsightedness and astigmatism.

In some cases, because femtosecond lasers can create very thin flaps, a person whose corneal thickness is "borderline" for conventional LASIK with a microkeratome flap may be a good candidate for all-laser LASIK.

The ideal candidate for all-laser LASIK is over age 21, with healthy eyes and stable vision. Good candidates also must have realistic expectations about their vision after surgery and should fully understand and accept the risks associated with LASIK eye surgery.

To be certain you are a good candidate for all-laser LASIK, schedule a pre-operative consultation and eye exam by an experienced refractive surgeon.

Does All-Laser LASIK Eliminate the Need for Reading Glasses?

The need for bifocals or reading glasses is due to a normal age-related vision change called the presbyopia condition. The underlying cause of presbyopia is a loss of flexibility in the lens inside the eye.

All-laser LASIK cannot treat the underlying cause of presbyopia, but it can reduce the need for bifocals or reading glasses in the same way contact lenses can—through the use of multifocal LASIK or monovision LASIK. These types of laser surgery for presbyopia can be effective forms of presbyopia treatment, although not as widely used as multifocal IOLs.

Risks and Complications of All-Laser LASIK

LASIK is safe and effective, and research suggests that less than one percent of LASIK patients experience serious vision problems after surgery.

All-laser LASIK reduces the risk of several potential complications related to flap creation, and therefore may be safer than conventional LASIK.

Still, no surgery, including all-laser LASIK, is risk-free. The following complications have been reported after all-laser LASIK:

  • Dry eye
  • Blurred vision
  • Fluctuating vision
  • Glare or halos around lights
  • Overcorrection or undercorrection
  • Decreased quality of vision
  • Infection

Most LASIK complications are temporary and decrease in severity with time. Permanent visual complications can often be resolved with a second LASIK procedure, called an enhancement.

How Much Does All-Laser LASIK Cost?

Due to the added expense of a femtosecond laser, all-laser LASIK will increase your LASIK surgery cost.

Expect to pay approximately $400 more per eye for all-laser LASIK compared with conventional LASIK with a microkeratome flap.

According to a leading vision care industry analyst, the average cost for custom all-laser LASIK in 2009 was approximately $2,300 per eye (including wavefront-guided LASIK technology).

Despite the added cost, most people who opt for all-laser LASIK feel it is worth it — due to its advanced technology, the lower risk of flap complications and the peace-of-mind of knowing that no surgical blade will touch their eyes during the procedure.

Laser Cataract Surgery

Femtosecond laser technology is also under intense investigation for use during cataract surgery. The technology is now approved in the United States for certain steps of the procedure. Laser-assisted cataract surgery may potentially provide for more accuracy and better visual outcomes for cataract patients.

1. IntraLase: Coming of age. Cataract & Refractive Surgery Today. 2005:117-120.
2. Femtosecond laser shows advantages over microkeratome in large series of LASIK patients. Ocular Surgery News. Published online September 14, 2009.
3. Dry eye associated with laser in situ keratomileusis: Mechanical microkeratome versus femtosecond laser. Journal of Cataract & Refractive Surgery. October 2009.
4. Comparison of Flap Adhesion Strength Using the Amadeus Microkeratome and the IntraLase iFS Femtosecond Laser in Rabbits. Journal of Refractive Surgery. November 2008.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

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