Blade Free LASIK

Blade Free LASIK

How is Blade Free LASIK different from conventional LASIK? In conventional LASIK, a high speed oscillating blade, which is part of an intricate mechanical instrument known as a Microkeratome (Moria, Zyoptix XP, Hansatome and so on), is used to create the LASIK flap. While microkeratome technology has improved a lot in recent years, it is still the achilles heel of the LASIK procedure, in terms of its safety, accuracy and predictability. Most of the complications around LASIK are because of the microkeratome. These include free caps, incomplete caps, irregular flaps and buttonholes.

Femtosecond Laser for Blade Free LASIK
The femtosecond laser fires ultrashort pulses (in time and space) within the cornea, to create a cleavage plane

In recent years, a new laser-called a femtosecond laser-is used to create a LASIK flap. The femtosecond laser is a type of “ultrashort” laser which converts a tiny amount of corneal tissue into a gas bubble. The laser lays down a whole layer of shots on the cornea, which means that a tiny, thin layer of cornea is separated from the underlying cornea, thus creating a corneal flap. There is no need for a blade to create the flap, hence it is also called bladeless or Blade Free LASIK.

Various femtosecond lasers are available, including the Intralase, Ziemer, and VisuMax lasers. The Intralase is the first and most common femto-laser for blade free LASIK. In recent times, the VisuMax has also emerged as an even superior alternative to Intralase.

With a femtosecond laser, most of the complications of microkeratomes do not occur, and LASIK can be performed with a great deal more accuracy and flexibility. Furthermore, the corneal flap thickness, which is critical in ensuring the long term safety of LASIK, can be accurate to a standard deviation of about 4 microns, compared with approximately 20 microns for a microkeratome. Finally, the flap created with a femtosecond laser induces fewer aberrations than a microkeratome created flap. This means that there is even more clarity of vision after the Blade free LASIK  procedure.

There are two further advantages to the Blade free LASIK procedure. The first is that it is inherently more sterile than a microkeratome, as the only thing that touches the eye (“the contact glass”) is completely disposable, and fully sterile. With a microkeratome, the blade often is reused by surgeons without proper sterility, and second the handle of the microkeratome and cord cannot be sterilized at all. The second advantage is in the architecture of the side cut incision. With a microkeratome the flap simply rests on the underlying cornea. With a femtosecond laser, a deep groove can be created in the underlying cornea, which locks the flap in the underlying cornea, much like a manhole cover fits onto a gutter. In fact, with our new generation of lasers, we can even create an inverted bevel side cut, which means an even better fit (studies indicate that there is more strength to such side cuts). The risk of the flap displacing after surgery is much less likely.

The No Blade procedure is more expensive than conventional LASIK, because it involves two lasers, and a license fee that must be paid to the laser manufacturer for each use. Blade Free LASIK is offered at Vadodara (Baroda), Ahmedabad, Mumbai (Bombay), Hyderabad and Surat.

In fact, at New Vision Laser Centers, we go one step further. We also perform a procedure known as SMILE. In SMILE, the femtosecond laser is used to carve out a lenticule within the cornea, and this lenticule is removed through only a small side cut on the cornea. This minimally invasive procedure has several advantages: The first is that there is no flap, so there is no flap to get displaced. Second is that the side cut is very small, so there is no cutting of corneal nerves, and therefore less dry eyes post the procedure. Third, there is probably the least interference with the normal corneal architecture and strength. Fourth, there is much less overall laser energy used in SMILE compared with Femto-LASIK, or conventional LASIK. Therefore there is more stability in the results of SMILE compared with older procedures.

New Vision Laser Centers is one of the pioneers of the SMILE (also known as ReLEx) procedure worldwide, and actively participated in its development. We offer it in Hyderabad, Mumbai and Vadodara.

Next : SMILE-The latest Advance