Traditional LASIK makes use of a microkeratome to cut a thin hinged flap in the cornea. The flap is then folded back to reveal the stroma – the middle layer of the cornea. A high precision laser, called the excimer laser, is used to reshape the corneal surface so as to correct any refractive error. The flap is then repositioned to act as a natural bandage. Since the microkeratome used to create a flap is in fact a surgical blade, the procedure is also known as blade LASIK.



A more recent innovation, introduced in 1999, makes use of a high energy laser (IntraLase or femtosecond laser) to create a flap during surgery. As opposed to traditional LASIK, IntraLase does not employ a surgical blade, and hence the procedure is often marketed as "bladeless" or "all laser" LASIK. The term itself has raged a debate among eye surgeons, as to whether it should be used in IntraLase advertisements or not. Several surgeons assert that the term "bladeless" implies that traditional LASIK, which makes use of a surgical blade (microkeratome), is a scarier proposition, when in fact it’s not.

The creation of the flap is an important part of the laser eye surgery procedure. It’s true that flap predictability is better with a laser flap, that is, with bladeless LASIK. Moreover, there is a reduced possibility of flap complications, such as partial flaps, flap dislocation, free flaps etc. However, an expert surgeon wielding a contemporary microkeratome can very well match the finesse of bladeless LASIK. Although the chances are rare, there is an issue of transient light sensitivity as well – a unique risk associated with bladeless LASIK. Moreover, the bladeless LASIK procedure costs an extra $300 per eye, when compared with traditional LASIK.

All said and done, LASIK itself is one of the safest refractive surgery procedure. Whether it’s blade or bladeless, it largely depends on the eye surgeon of your choice. If the surgeon has loads of experience carrying out microkeratome procedures, it’s better to have it that way. If otherwise, you may go in for the relatively new bladeless LASIK surgery.

Finding a LASIK surgery that you are confident about will be able to give you more information about blade and bladeless LASIK.