All-Laser LASIK (Bladeless)

All-Laser LASIK (Bladeless): Experience Enhanced Precision and Safety

"All Laser" LASIK along with Custom LASIK are advanced technologies that are additional enhancement to LASIK surgery.  During an "all laser" LASIK , a femtosecond laser will create a corneal flap of a precise thickness and diameter with a lower suction level than a standard mechanical microkeratome. All-Laser LASIK is also referred to as bladeless LASIK since the procedure is performed without using a mechanical blade.

Who is a Good Candidate for All-Laser (Bladeless) LASIK?

Determining if All-Laser LASIK is the right vision correction procedure for you requires a comprehensive evaluation by an experienced surgeon. However, generally speaking, good candidates for this advanced procedure typically meet criteria similar to traditional LASIK, along with some specific considerations:

• Age: Candidates are usually 18 years of age or older with a stable vision prescription for at least one year.
• Stable Prescription: Your nearsightedness, farsightedness, or astigmatism should have remained relatively unchanged.
• Overall Eye Health: You should have healthy eyes, free from diseases like severe dry eyes, keratoconus, glaucoma, or cataracts, which could affect healing or outcomes.
• Sufficient Corneal Thickness: While All-Laser LASIK can often create a thinner, more precise flap than traditional methods, adequate corneal thickness is still essential for a safe procedure and a healthy residual stromal bed beneath the flap.
• Realistic Expectations: Understanding the potential outcomes, risks, and recovery process is crucial.
• Specific Anatomical Considerations: The precise nature of the femtosecond laser may make All-Laser LASIK a preferred option for certain corneal shapes or patients where a mechanical microkeratome might be less predictable.

A qualified surgeon from the Trusted LASIK Surgeons® Directory can perform a thorough examination to confirm your candidacy and discuss the best approach for your unique eyes.   

The All-Laser (Bladeless) LASIK Procedure: Step-by-Step

The All-Laser LASIK procedure is a quick and precise process, typically completed in under 15 minutes per eye. Here's a general overview of what to expect:

1. Preparation: Numbing eye drops are applied to ensure comfort. Your eye area is cleansed, and a speculum is used to gently keep your eyelids open.
2. Femtosecond Laser Flap Creation: Using an FDA-approved femtosecond laser (such as the  IntraLase™, VisuMax, or WaveLight FS200), the surgeon creates a thin, precise corneal flap by directing rapid pulses of light just below the surface. This takes only seconds and is painless. You may feel a slight pressure and your vision may dim briefly.
3. Flap Lift: The surgeon then gently lifts the laser-created flap to expose the underlying corneal tissue (stroma).
4. Excimer Laser Reshaping: An excimer laser, pre-programmed with your specific vision correction needs, is used to precisely reshape the stromal tissue. This part of the procedure is also painless and takes only a short amount of time, depending on the degree of correction needed. You will hear a clicking sound and may notice a mild odor.
5. Flap Repositioning: Once the laser reshaping is complete, the surgeon carefully repositions the corneal flap. The flap adheres naturally without the need for sutures.
6. Healing Begins: The procedure is complete, and the natural healing process begins immediately as the flap starts to re-bond to the underlying tissue.

Your surgeon will provide detailed instructions on what to do immediately following the procedure.  

Bladeless All-Laser LASIK offers laser vision correction surgeons optimal precision and total control, which makes creating the corneal flap safer and more predictable than standard microkeratomes that use mechanical blades and require higher suction during this procedure.  (A microkeratome is a precision surgical instrument with an oscillating blade designed for creating the corneal flap prior during LASIK).

To view the "All Laser LASIK" video please click on the "play" button below to begin playing the video. 

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What to Expect After All-Laser LASIK 

Recovery from All-Laser LASIK is typically rapid, with many patients noticing significant visual improvement within 24 hours. However, it's essential to follow your surgeon's post-operative instructions carefully for optimal healing and results:

• Immediately After: You may experience some mild discomfort, burning, tearing, or light sensitivity. Your vision will be blurry or hazy. You'll likely wear protective shields or glasses. Arrange for transportation home.
• First 24 Hours: Rest is crucial. Keep your eyes closed as much as possible. Use prescribed eye drops to prevent infection and inflammation and to promote lubrication. Avoid rubbing your eyes.
• First Few Days: Discomfort typically subsides quickly. Vision will improve rapidly but may still fluctuate slightly. Continue using your eye drops as directed. You can usually resume most normal, non-strenuous activities.
• First Week: Vision continues to clear. You will have follow-up appointments with your surgeon to monitor healing. Avoid eye makeup and strenuous activities like heavy lifting or intense exercise.
• Weeks and Months Following: Visual acuity continues to stabilize, and your vision may continue to refine. Most patients achieve their final outcome within a few months.

Your surgeon will advise you on when you can safely return to work, driving, sports, and other activities. 

Benefits of Choosing All-Laser (Bladeless) LASIK  

All-Laser LASIK, utilizing femtosecond laser technology for flap creation, offers several potential advantages compared to traditional LASIK which uses a mechanical blade:

• Enhanced Precision: The femtosecond laser creates corneal flaps with exceptional accuracy in terms of diameter, depth, and shape. This precision contributes to more predictable outcomes.
• Increased Safety Profile: Eliminating the mechanical blade reduces the risk of certain flap complications that can occur with traditional LASIK, such as incomplete flaps or irregular flap shapes.
• Customizable Flap Creation: The laser allows surgeons to tailor the flap dimensions and edge profiles to the individual patient's eye anatomy, potentially optimizing flap stability.
• Potential for Thinner Flaps: In some cases, the precision of the femtosecond laser allows for the creation of thinner flaps, potentially preserving more corneal tissue in the stromal bed, which can be beneficial for certain patients.
• Reduced Incidence of Dry Eye Symptoms: Some studies suggest that the specific design of laser-created flaps may result in less disruption to corneal nerves compared to blade-created flaps, potentially leading to a lower incidence of post-operative dry eye symptoms.
• Facilitates Custom Treatments: The precise and predictable flap created by the femtosecond laser is an ideal foundation for subsequent customized excimer laser treatments that correct higher-order aberrations.

These benefits contribute to the high success rates and patient satisfaction associated with All-Laser LASIK.

Potential Risks and Side Effects of All-Laser LASIK

While All-Laser LASIK is considered very safe, as with any surgical procedure, there are potential risks and side effects to be aware of. Serious complications are rare, occurring in less than 1% of cases³. Potential considerations include:

• Temporary Discomfort: Mild burning, itching, or the sensation of something in the eye are common immediately after the procedure but subside quickly.
• Temporary Vision Disturbances: Glare, halos, starbursts, or light sensitivity, particularly at night, can occur temporarily. These often improve over weeks or months.
• Dry Eyes: While potentially less frequent than with blade LASIK, post-operative dry eye symptoms can still occur and may require treatment with lubricating eye drops.
• Under or Overcorrection: The degree of vision correction may be slightly more or less than intended, potentially requiring glasses, contact lenses, or an enhancement procedure (touch-up) later.
• Flap Complications (Rare): Although the risk is reduced compared to blade LASIK, rare flap-related issues such as microscopic debris under the flap or inflammation can still occur and are typically treatable.
• Infection or Inflammation (Very Rare): As with any surgery, there is a small risk of infection or significant inflammation. Following post-operative instructions and using prescribed drops carefully is essential to minimize these risks.

Your surgeon will discuss all potential risks and benefits with you during your consultation. 

How Does Custom LASIK Enhance All-Laser LASIK? 

As noted above there are two enhancements to LASIK: All laser (or bladeless LASIK) and Custom LASIK and PRK.  Custom LASIK, PRK and ASA procedures use technologies that provide more exact measurements of your cornea so that the laser used to reshape your cornea can be more precise.  Custom LASIK helps to better preserve the integrity of the structure of your eye and leads to better correction of your vision. In addition, because the corneal flap is made at a uniform depth and shape, you are more likely to have a shorter recovery time and less discomfort from All-Laser LASIK surgery.

To see how All-Laser LASIK and Custom LASIK advanced technologies work together, please click the play button on the video below.

The success of your All-Laser (Bladeless) LASIK procedure depends significantly on the skill, experience, and judgment of your surgeon. Even with the precision of femtosecond laser technology, the surgeon's expertise in evaluating your eyes, planning the procedure, and managing post-operative care is paramount.

The Trusted LASIK Surgeons® Directory features surgeons who are rigorously screened based on their extensive experience, professional accomplishments, and recognition by their peers in ophthalmology. By choosing a surgeon featured in our directory, you are selecting a professional who has demonstrated a high level of expertise in laser vision correction procedures, including All-Laser LASIK. These surgeons have the knowledge to determine if All-Laser LASIK is the best option for you and to perform the procedure with the highest standards of care.

Connecting with a Trusted LASIK Surgeons® ensures you receive a thorough evaluation and a personalized treatment plan tailored to your unique needs, maximizing your potential for achieving excellent vision outcomes.  

All laser LASIK helps you to choose laser vision correction surgery with more confidence.

There are several femtosecond lasers that have been approved by the FDA for bladeless LASIK. 

The first FDA-approved method for all-laser LASIK, the IntraLase™ laser (originally by IntraLase, now part of Johnson & Johnson Vision), was introduced in 2001.  IntraLASIK uses the IntraLase™ laser to create the corneal flap, after which your LASIK surgeon uses a different laser (an excimer laser) to reshape your cornea to correct your vision. Since then, other femtosecond lasers have also been approved by the FDA for use in the United States for creating the bladeless LASIK flap, including the Femto LDV laser made by Ziemer, the VisuMax laser made by Carl Zeiss Meditec, the WaveLight FS200 laser made by Alcon, the TECHNOLAS Perfect Vision 520F laser made by Bausch + Lomb, and the newer ELITA Femtosecond Laser also from Johnson & Johnson Vision). 

Frequently Asked Questions About All-Laser (Bladeless) LASIK

Q: What is All-Laser LASIK? All-Laser LASIK, also known as Bladeless LASIK, is a type of LASIK where a femtosecond laser is used instead of a surgical blade to create the corneal flap.

Q: How is Bladeless LASIK different from traditional LASIK? The main difference is how the LASIK flap is created: using a precise femtosecond laser in All-Laser LASIK versus a mechanical microkeratome blade in traditional LASIK. The step of reshaping the cornea with an excimer laser is the same.

Q: What are the benefits of using a laser for the LASIK flap? Using a femtosecond laser for flap creation can offer increased precision, control over flap dimensions (thickness, diameter), lower suction during the procedure, and potentially a safer and more predictable flap compared to manual blade creation.

Q: What vision problems does All-Laser LASIK correct? Like standard LASIK, All-Laser LASIK is performed to correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism.

Q: Is All-Laser LASIK safe? Yes, All-Laser LASIK is considered a very safe and effective procedure. The precise nature of laser flap creation may contribute to enhanced safety for this step of the surgery.

Q: What is the recovery time after Bladeless LASIK? Visual recovery after All-Laser LASIK is typically rapid, much like standard LASIK, with significant improvement often seen within 24-48 hours.

Q: Are the lasers used in All-Laser LASIK FDA-approved? Yes, various femtosecond lasers used for bladeless LASIK flap creation have been approved by the FDA for this purpose.

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