Bladeless LASIK in Ft Collins & Loveland

Serving Patients in Colorado and Wyoming

What is the Flap All About?

technology bladeless eye surgery

The Advantages of a Bladeless LASIK Laser Eye Surgery Flap

Creating the corneal flap is the first step to LASIK.  This is one of the most important and critical parts of the entire LASIK surgery.  

In LASIK surgery, a thin flap is created in your cornea.  This is lifted, an excimer laser is used to reshape your cornea to restore focus, and the flap is repositioned.  If not created properly, the flap can be too thin and weak or too thick and deep.

Creating the LASIK Surgery Flap

There are two ways to create a LASIK flap.  The first and older method uses a mechanical micokeratome (the razor) and the second method utilizes the femtosecond laser (the laser).  The femtosecond laser is preferred due to its accuracy and outcomes.

Mechanical Microkeratome

At our center, microkeratomes are no longer used.

The microkeratome uses an oscillating razor that travels across your cornea on a gear track to create a thin flap.   Many in the early years of laser surgery had LASIK surgery with this device.  Originally, I used the Chiron ACS Sharpener.  Later we upgraded to the Hansatome and finally we purchased the Amadeus microkeratome.

In the end, even the Swiss made Amadeus became no match for the laser so it now sits unused in a box at our eye laser center.  I call that box, “the museum.”

What is Bladeless LASIK Surgery?

Bladeless LASIK surgery is one of the great advances in LASIK.  It became possible with the invention of femtosecond lasers.  This has made the use of the razor (mechanical microkeratome) increasingly obsolete except at the discount laser eye centers.  Most of the discount centers recommend the razor but can send you somewhere else to get the laser instead.  Perhaps you will prefer to start somewhere that recommends and specializes in bladeless LASIK surgery.

The femtosecond laser uses a series of very short, invisible pulses to create your flap.  The most modern of the femtosecond lasers, like the Intralase IFS fire so quickly that they make very small spots of lasers very close together to create an exquisitely smooth laser surface.  The older femtosecond lasers like the Intralase 60 hz like we used to have can’t work at this level.  The small spot size of the faster lasers allows for a smoother bed to the LASIK flap.

“The smoother surface gives better optical quality for your vision.”

Laser vs. the Razor for LASIK Surgery

The razor makes a flap that that is thicker at the edges and thinner in the center.  To make sure that flaps don’t get too thin in the center, a surgeon has to use a thick flap.  This makes your eye lose more of its strength.  In addition, the flap is thicker at the edges, right were we worry most about losing strength and causing ectasia.

Bladeless LASIK surgery Safety

The laser is much better at making a flap that is of uniform thickness and precision.  It remains thin near the edges where we want most to preserve the strength of your cornea.  The edges stick down more firmly, again adding more strength.  This is a safety advantage for bladeless LASIK.

The precision of the lasers allows me to make your flap thinner, leaving more of your eye untouched, again with the extra strength.  The Visx IFS allows me to undercut the flap edge, making, you guessed it, the edge of the flap stronger.

What does Bladeless LASIK Cost?

The costs involved in creating a bladeless LASIK flap are higher than the razor because of the costs of the femtosecond laser and the cost of the individual patient interface required for each eye.  The extra expenses are reflected in a higher procedure cost for bladeless LASIK, but the added advantages in precision and safety are worth the investment.

 Your LASIK Surgery

When it is time for your LASIK Surgery it is worth making a flap about the flap. Make a careful study to find a good LASIK surgeon in your area who recommends and focuses on bladeless LASIK with a late generation femtosecond laser like the Visx IFS or the Alcon FS 200. Real friends don’t let their friends cut corners (pun intended) with their LASIK. Please contact me if I can help you with any additional questions.

Comments

  1. My question is about the lasik flap. What would happen if years after my procedure the lasik flap came (completely off) and was lost forever. What would happen to my vision and how would this effect me? What could be done?

    • Jay,
      That would not be a desired outcome. Fortunately, it would be very difficult to achieve. There are some extremely rare conditions where the flap needs to be removed. In those circumstances, if the flap creation was high quality so that the flap bed is smooth, the epithelium covers the flap bed and the vision is usually surprisingly good. I have never had to remove a flap nor have I ever seen a patient in consolation that has had this done elsewhere.
      Gary

  2. Dr Gary Foster, I would like your opinion to help me decide between two laser eye centres in my area. I am interested in getting the custom bladeless lasik.

    Centre 1: Recommends and focuses on microkeratome lasik. On a monthly basis, about 90% of their flaps are made with the blade. They say that there is absolutely no advantage to bladeless lasik for relatively normal eyes like mine. They do have the latest femtosecond laser, Alcon Wavelight FS200 and allow the patient to choose bladeless lasik if they really want it, but charge an additional $500 for the bladeless option. The surgeon is extremely experienced, with impressive credentials, university and hospital affiliations.

    Centre 2: Recommends and focuses on bladeless lasik. 100% of their flaps are made with the laser. They stopped doing microkeratome lasik about 7 to 8 years ago. They have the latest Intralase iFS 150 femtosecond laser. Their price for bladeless lasik is $800 more than Centre 1 (even with the additional $500 for the bladeless option factored in). The surgeon is extremely experienced, with impressive credentials, university and hospital affiliations.

    I am thinking that Centre 2 might be better for me because their surgeon gets more practice with the femtosecond laser on a daily basis, and as a result might be more skilled and experienced with that technology. I am just not sure if the $800 additional cost is justified, since both centres are providing the same procedure with the newest technology and an experienced surgeon.

    • Travis:
      There are important parts of the decision that only you can discern like where you feel trust and rapport. I can say that I have stopped doing mechanical microkeratome flaps because I feel the femtosecond laser is better and I feel all my patients deserve those benefits, even if the surgery doesn’t pose a higher than average amount of risk. I have upgraded to the Alegretto 500 from the 400 and use the latest IFS laser. I charge a bit more than my competitors across town but believe we offer a great value for what our patients receive. From this you will understand that one of the two centers you described better reflects my values and philosophy for quality of care. If you call a couple of optometrists in town and your primary care physician and ask about the two centers, you may also receive some valuable insights into integrity of the two centers.
      God Bless,
      Gary Foster