The procedure of Lasik was mechanical with microkeratome, which is a handheld device and it consisted metal razor blade that is oscillating, to cut the necessary corneal flap. Usually the patients of Lasik do expect the procedure is performed as blade free, since they are unaware that the microkeratome makes use of the blade, which is highly precise for thin flap creation.
During the last 20 years of evolution of the Lasik, a lot much advancement have been taken place in the technology of Lasik, right from Standard Lasik to the Advanced Aspheric Lasik, bypassing even Customized Lasik. The technology has been much improved and launched newer technologies iFS (Femtosecond Laser) and SBK Lasik to make the flap with the finest quality, which perform the surgery procedure as a blade free procedure and the result is much reduced or eliminated complications. Another technology called Thin Flap Lasik enables the surgeons to create thin flaps thereby leaving better ground or perform the correction through Lasik and the result is the better corneal strength. When the affordability becomes a priority and if Thin Flap Lasik becomes unaffordable, conventional flap Lasik can be the feasible recommendation. Both the treatments are more or less the same and the only small variation is the flap thickness. But, in certain cases, where the thickness of the cornea is the concern, as it becomes inadequate, then the only procedure that can be recommended is thin flap.
The newer technology, INTRALASE Lasik Laser or in simple terms, Blade Free Laser creates the flap, more precisely, reliably and most safe than the Lasik procedure with blade. And with the help of Blade Free Lasik technology, the surgery with Lasik Laser is improved, since the blade of the mechanical microkeratome device is replaced with a computer guided laser, which is capable to deliver the outcome with micron-level accuracy. The Blade Free Lasik or the IntraLaseFemotsecond Laser is 100% blade free and it stands as the first laser technology that is bladeless to create corneal flap with much more accuracy today. This step is the performed prior to firing the Lasik laser for refractive error correction. To the surgeon, it becomes very handy to create the corneal flap of accurate and exact centration, depth, and diameter, hinge location and reshape with overall accurate architecture, enabling this technology to be far more precise and accurate compared to the previous hand-held blade.
iFS 150 today is the fifth generation technology in bladeless procedure that is 100% blade free and highest advancement Lasik technology in the technology of flap making. It enables the surgeon to create a thinnest flap of cornea to reshape to the accurate hinge location, centration, depth, diameter and overall architecture that made this procedure to be far more precise and accurate than before.
We, at the Lasik laser center help the Lasik patient to choose appropriate and suitable medical centre to select the 100% blade free surgery. We ensure to guide the patient to reach a good and dependable center that can be amalgamation of right Lasik and blade free laser technology available at the rates, most reasonable. Our expertise and experience in Lasik technology guidance, we can assure 100% laser blade free, comfort and safe correction for vision, through our medical centers.
The IntraLase or iLasik, which is a 100% blade free Lasik eliminates the complications, such as severe light threats that are common with the blade associated procedures, virtually. Hence the post procedure symptoms, such as halo, glare or dry eye problems can be reduced to a greater extent. Additionally, the procedure of IntraLase enables the procedure to get much better visual outcomes.
The cost of the 100% blade free Lasik surgery, along with the Advanced Aspheric Wavefront Customized Technology is made available at lowest cost, 75,000 INR for both the eyes.
You May Be a Right Candidate…
The eye patient can be a good candidate for the Lasik patient, when their general health requirements along with the age are fulfilled and so good candidates for the Blade Free Lasik or iLASIK procedure.
The basic criteria to fulfil for the Lasik surgery are the following.
- You have overall good general health.
- You have no other existing disease to the eyes.
- You have completed 18 years of age.
- You have got the prescription, indicating stable vision, for at least past one year.
Blade Free Lasik or iLASIK OR IntraLase – Benefits
- Fewer requirement of retreatment
- Better strength of cornea
- Safety improved
- Improved vision
- Flaps created more accurately thinner
- The resulting thinner cornea to have the possibility of Lasik correction of vision
- Highest and improved degree of precision and predictability
- Reduced or minimized symptoms of dry eye
Tissue Saving Lasik Treatment Plan
The procedure of Lasik laser surgery involves two steps. The first step is creation of the flap, followed by the second step to reshape the surface fo the cornea for correction of the number. The Lasik laser technology enables the correction of the nearsightedness through cornea flattening, correction of the farsightedness through reshaping the cornea to be steeper. The correction of astigmatism can be done through reshaping the irregular cornea by smoothing into a better symmetrical shape.
Tissue Saving Plan Up To 40 to 50 micron
Tissue saving up to 40 to 50 micron is made possible with the flap making step, through the reduction of the thickness of the flap.
When SBK technology or Femtosecond Bladeless Technology is considered creation of the ultra thin flap can be up to 80 to 90 microns, whereas the flap can be of 130 to 150 microns, with the standard flap making technology.
Tissue Saving Plan Up To 20%
The overall tissue saving up to 20% can be made possible by reshaping the surface of the cornea to correct the number. The saving of 20% of tissue is enabled by using the tissue saving algorithm, which is a very effective way for reducing the depth of ablation, for laser refractive surgery. The algorithm helps the surgeons to control the removal of tissue to as little as 0.25 microns at an instant through high energy ultraviolet light pulses (1 micron = 1/1000 mm).
The current systems that are available in today’s market can correct 1 dioptre of number, by consuming 12 to 18 microns, for ablating or reshaping the inner layer of cornea called stroma. This consumption of tissue can be reduced to 20%, by using the tissue saving treatment plan, for reshaping the cornea. There are also chances that optical zone reduction can be done and correction of 1 dioptre of number consumes 9 microns of the tissue of the cornea.
INFORMATION BEFORE, DURING & AFTER LASIK SURGERY
Standard LASIK Surgery
Standard LASIK procedure has been performed mechanically with microkeratome or blade. The microkeratome is a standard handheld device with an oscillating metal razor blade that enables cutting the corneal flap at micro level, wherever is necessary.
Since LASIK has been developed, the technology was made available to the world. Later there were many developments witnessed by the technology. The technologies to name since 1991 are faster lasers, bladeless flap incisions, larger spot areas, wavefront-optimized, intraoperative corneal pachymetry. Bladeless or blade-free technology among these technologies stands out, because of its greater reduction of complications, naturally associated with any surgery performed with the blades. Bladeless LASIK procedure is introduced in the year, 1999 and approved recently in 2007, by the FDA. The surgery is quite similar to the microkeratome procedure, with the basic procedural difference of using high energy laser, instead of microkeratome to alter the cornea shape. The blade-free technology has transitioned the LASIK technology, starting from Standard Lasik to customized LASIK to Advanced Aspheric LASIK.
The blade-free LASIK procedure allows the surgeon to operate the eye within the dimensions of the flap, where the problem exists. It enables complete correction of the problem.
Blade Versus Blade Free Technology
There are certain conceptual differences between the two technologies.
- The first difference is the usage of the instrument to reshape the cornea, blade for with blade procedure and laser, such as femtolaser for blade-free technology procedure.
- While the blade procedure is performed, it may become loose during the process of cutting the flap of cornea. In such cases, flap may become fray and the result can be irregular flap creation, which may also end in potential complications. In case of blade-free, the laser can be programmed and even reprogrammed covering even micro level changes of the prescription.
- Thin flap creation ranges from 80 to 90 microns, which is far lesser than the standard flap making technology ranging from 130 to 150 microns. Blade free procedure saves the tissue of about 20% than the procedure with blade.
- Blade free or laser LASIK technology can take the support and guidance by computer program for more precise and accurate correction of cornea surface.
- Computer algorithms reduce the loss of the tissue as the tissue removal can be minimized even to 0.25 microns by the virtue of ultraviolet high energy light pulses.
- When the procedure is performed with a mechanical blade or microkeratome, it produces corneal flaps, which would be more of thinner at the central part. The bladeless procedure does in contrast to that. Flaps in bladeless procedure are more predictable and these are created with consistent thickness, throughout the area.
- When the procedure is held with the blade the precision and accuracy is totally dependent on the surgeon’s skill, however, it is not the case with the blade-free LASIK procedure and the movement and depth of the laser pulses is totally pre-programmed, according to the prescription of the patient. There is always threat associated with the skill because, human errors are quite common. It eventually decreases the rate of complications.
- On an overall, blade-free procedure provides versatility and higher precision and risks are minimal or even eliminated compared to blade oriented procedure.
- As the blade-free procedure has smoother flap interface, optical abnormalities are reduced. However, with blade procedure, irregular interface is possible, there by creating optical abnormalities.
Blade-Free Technology Procedures
The major balde-free LASIK technology procedures are SBK laser and iFS (Femtosecond Laser). These technologies are specialized to create the flap with finest quality using blade-free procedure. The major improvement in terms of outcomes of the procedure compared to the other previous procedures are minimized or eliminated complications and much faster recovery, because of no cut or mechanical incision made on the surface of the eyes. One more interesting technology is Flap Lasik, which leaves more ground enabling better corneal strength. Most widely used and available blade-free LASIK procedures are Intra-LASIK, iLASIK, Z-LASIK, Intralase, Femto LASIK, etc.
Tissue Saving Algorithm To Save Removal of Tissue
About 20% of tissue can be saved through tissue saving algorithm and it is considered as the best and effective way to reduce the depth of ablation, when laser refractive surgery is performed. The tissue removal can be reduced to as low as 0.25 microns at one instant, when the surgery is performed using ultraviolet high energy light pulses. It is a very effective algorithm as the current consumes at least 12 to 18 microns, while correction of 1 dioptre is performed towards reshape or ablation of the stroma or inner layer of the cornea, currently in the market.
1. IntraLase LASIK
It is one of the newer blade fee laser technologies enabled to create flap with more reliability and precision and stands safe compared to the standard LASIK procedures performed with blade. It is the first bladeless flap creating procedure approved by FDA. This is the pioneer blade-free technology that enables the surgeons to create corneal flap with greater accuracy. This procedure is also made available or accessible in the market with the name of iLASIK.
IntraLase procedure is started by controlling the first LASIK step through pre-programmed dimensions of the cornea. The process of correction of vision is started by liftying the flap and revealing corneal bed, which is quite smooth. The IntraLase laser is used to create a flap, which is bevelled-edge and distinctive, by the end of the flap creating process. The actual process takes not more than 20 seconds for each eye and the entire procedure is completed in about 30 minutes, for both the eyes.
After the surgery, the most common complications that are quite regular with standard LASIK procedure are eliminated. Eventually, various post surgery symptoms, like dry eye problems, glare or halo would be reduced. The visual outcomes are optimal than the previous standard procedures.
iFS is a latest and most advanced bladeless procedure, which is absolutely blade free, as it is fifth generation technology. The advancement is in the way that thinnest cornea can be created with this procedure. This is an advanced technology and hence it costs more about 75,000 INR.
3. Femtolaser Laser
Femtolaser creates the flap right from below the cornea’s surface, without any need for cutting it actually. This process is performed in series of the following steps.
- The process is started with positioning microscopic bubbles by ultra fast laser light pulses at a depth determined previously.
- Rows of bubbles are created beneath the surface of the cornea as it keeps moving back and forth in a uniform plane over the eye.
- Then these bubbles are stacked using femtosecond laser, around the predetermined diameter over the cornea, towards creation of the flap edges. Stacking of bubbles is done at specific and predetermined angles, which are unique to each of the eye, according to the shape.
- After this 30 second process, the flap is lifted gently by the doctor, the second step is started. Once the treatment is completed, the flap would be carefully positioned back to its position.
Femto LASIK surgery is a stichless procedure also and it is very quick. This procedure takes total 2 to 4 hours, right from arrival to the hospital to discharge. It needs 2 to 7 days period to recovery and get back to the work and day to day activities.
4. Other Procedures
Other bladeless procedures include zLASIK, Visumax and Femtec.
All these procedures are performed with standard and advanced technologies. As the technology is improved, discomfort keeps reduced to the patient. Basically, LASIK does not hurt the eye of the patient. Bladeless process also does not hurt, except a small discomfort. The discomfort may continue for 3 to 4 days after the surgery. And this mild pain or discomfort is well controlled through medication. In case any severe discomfort or pain is experienced, you need to contact your LASIK centre immediately.
Are You An Eligible Candidate?
Candidates for blade-free LASIK procedure are almost the same as the candidates eligible for the procedure with the blade. Patients with the following criteria fulfilled are eligible to undergo the blade free LASIK procedure.
- The patient has crossed age of 18 years.
- The patient suffers with no eye related diseases.
- The overall general health must be normal, with no chronic diseases.
- Stable vision has been reached and continued for at least one year, according to the prescription.
Blade-free technology is an optimistic LASIK technology procedure that allows various benefits as the following.
- Improved safety
- Only minimal requirements needed for requirements
- Enhanced quality of vision
- Improved cornea strength
- Minimal or reduced dry eye symptoms
- Corneal flaps to be more accurate and thinner
- Improved predictability
- Highest degree of precision
- Possibility of correction post surgery
- Better sleeping nights
- Corneal sensitivity improved
- Faster procedure
- More secured and stronger LASIK flaps
- Increased patient comfort
- Customization of treatment can go to any extent
- Wide range of prescription covered, like astigmatism, up to +6D, Hyperopia up to +6D and Myopia, up to -12D
- Minimized regression chances
Apart from these direct benefits, there are also procedure oriented advantages with the bladeless procedures. According to the studies, higher inducing rate of vision distortions or higher order aberrations are possible after flap is made with blade and this rate is lesser with bladeless procedure. technically, this condition can be controlled through multiple clinical trials.
- Creation of flap is longer process with the bladeless or IntraLase procedure compared to with blade procedure and it eventually increase swelling or edema of the flap. This swelling is caused because of the additional laser energy applied during creation of the flap. It may also delay crispness of vision and clarity than ideal healing conditions. This specific risk is however lesser when flap is created with the microkeratome.
- Another risk can be transient light sensitivity associated with the laser energy. Though this risk is not caused from all the bladeless laser procedures, but technically possible and unique to the IntraLase procedures.
Finally, Blade or Bladeless Procedure?
There are pros and cons with both the procedures and hence usually, most of the surgeons prefer to perform both the procedures. Selection of the procedure is generally chosen based on certain criteria.
Laser eye surgery procedure with blade is usually preferred because of the following reasons.
- Some of the surgeons are interested to go for microkeratome or blade oriented procedure, because it can be performed much faster than the bladeless procedure, such as IntraLase. The patient feels more comfortable with is procedure, as it lasts for nearly 3 seconds, compared to 15 to 20 seconds length procedure with bladeless procedure.
- Microkeratome procedure involves lesser suction procedure than with the bladeless procedure.
- When the cost of the surgery is a concern and when the patient cannot allocate enough budget for bladeless costlier procedure, the procedure is preferred to perform with blade.
- In case the patient had undergone Radial Keratotomy, bladeless procedure is not suitable and surgeons prefer to perform the procedure with microkeratome. It is because Radial Keratotomy procedure leaves scarring and continues for long. This scarring may interfere with the transmission of bladeless laser towards the cornea. So, procedure with blade is suitable in such instance.
Laser eye surgery procedure with bladeless technology is preferred, under the following conditions.
- When safety is considered as an utmost thing, bladeless procedure is chosen. So, for free caps, buttonholes, epithelial slough or partial flaps this technology is preferred.
- People, who have irregular cornea, such as steep, unevenly shaped or steep, are suitable to undergo the bladeless procedure. the more the cornea shape irregular, the more the microkeratome unsuitable. It increases the risk of imperfect flap creation. So, bladeless procedure can program accurately to create accurate shape of the flap, in such cases.
- When the cornea is more curve shaped, bladeless is preferred, because the flap would be thinner, when the cornea is more curved and it eventually increase buttonhole chances dramatically.
- In case the patient can afford the cost, which is more than the procedure with the blade, this procedure is chosen.
- Patients, who suffer from glaucoma, are more suitable with the bladeless procedure, as it does not involve the process of suction, unlike with the blade procedure. Suction or increased eye pressure could worsen the condition of glaucoma for the patients as blade flap maker usually increase the intraocular pressure, much more compared to the laser flap maker microkeratome.
One fact that is worth noting here is that the majority of the LASIK patients, who walk into the LASIK medical centres for retreatment have undergone blade oriented procedure and suffer from blade flap complications. More than the difference of these technologies, skill and expertise of the surgeon play vital role both in success and failure of the LASIK laser eye surgery procedure.
Post-Operative Instructions After Blade-Free LASIK
The overall success of any surgery depends on multiple factors, such as the standards followed during the surgery, expertise & skill of the surgeon, severity of the medical problem, pre-operative preparation and post-operative care. Here are the important instructions to follow carefully by the patient to prevent arising new risks and complications.
- You have to refrain and control yourself from touching the eyes operated
- Keep blinking the eyes as you do normally, right after the first day of the LASIK so that dry eye symptom can be minimized or prevented.
- Soreness, watering and irritation within the eye is quite normal during first few hours of the procedure. So, don’t get panic or don’t try to rub the eyes with physical pressure. The vision starts replenished after few hours of the procedure. However, if these symptoms are severe, don’t hesitate to contact your LASIK centre, immediately.
- You need to make sure that the eyes are well protected either with eye shield or glasses, while sleeping, so that accidental rubbing the eyes can be prevented.
- Your medication and drops must be followed without fail or missing every day.
- Since there can be considerable pressure applied to the eyes during the blade-free procedure, there may be additional irritation or pain experienced. However, this symptom also will be faded slowly in a few hours. Slight glare, blurring and halos are also possible, but will be cleared later.
- During the first month of the surgery, avoid eye make-up, rigorous physical activities, like playing sports, swimming, etc.
- Always wear the sunglasses, when you step out of your entrance door and habituate this procedure for a few months after the procedure, typically, until your eyes feel comfortable with the exposure to the sun.
- You need to be careful during shower after the surgery. Shower should be taken with neck down and continue the same for at least 1 week.
- Food intake can be normal after the surgery.
- At least for two weeks, drinking and smoking must be avoided.
So, Which One To Prefer?
As mentioned with many examples, bladeless LASIK procedure is superior to the bladed procedure. however, there are also certain advantages with bladed procedure. selection of the appropriate procedure is purely the choice of surgeon and the surgeon considers various factors, such as the severity of the problem, expertise in the respective technology, other eye related issues and many more factors.