LASIK Controversy

A debate rages among opthalmologists the world over. Even though the LASIK procedure has been in use less than ten years, there are already developments that threaten to turn colleagues against one another. The burning question that arose in 1999 is whether microkeratome use or all-laser surgery is the superior procedure.

Both procedures use the excimer laser to reshape the cornea and correct the refraction of the eye. In the original version of LASIK eye surgery, a microkeratome, which is a surgical blade, is used to create a flap in the cornea over the pupil. In "all-laser" LASIK surgery, a femtosecond laser is used to create the corneal flap. The procedure and the laser used are sometimes referred by the brand name IntraLase.

Proponents of all-laser LASIK imply in their marketing that the femtosecond laser is superior to the microkeratome. They state that the corneal flap is the same thickness throughout when a laser is used and thinner in the center when a microkeratome is used. These surgeons say that there is greater chance of making a hole in the center of the flap when using a blade.

One of the microkeratome LASIK proponents arguments is the the term "bladeless" used by all-laser proponents implies that blades are not as safe as lasers. The word "blade" was turned into a scare tactic to coerce potential patients. All-laser fans say that using the term "bladeless" is just truth in advertising.The microkeratome-favoring ophthalmologists claim that flap failures occur with equal regularity using both methods. These LASIK surgeons are concerned that lasers create additional risk factors due to increased inflammation, increased suction time, creation of bubbles in the cornea, microadhesions in the flap, increased recovery time and intensified light sensitivity. The patient may need to wear sunglasses indoors and use more steroids for a longer period to hasten recovery.

While IntraLase was more likely to produce initial vision problems with light sensitivity and discomfort in the first day postoperatively, these same LASIK patients reportedly also had better long-term visual outcomes and ability to see contrasting images.Surgeons who use both procedures say that microkeratome use in LASIK eye surgery is up to three times faster than laser-cutting the corneal flap. There is less suction in microkeratome use, and therefore, less pain.

There is a significant cost difference between all-laser and microkeratome LASIK. All-laser is more expensive.A small study by the European Society of Cataract and Refractive Surgery produced results comparing outcomes of blade and bladeless LASIK flap makers. This study generally found no clinically significant difference in outcomes between the blade or the laser. One surgeon consulted insists that if a patient has previously suffered from a flap failure, the only way to fix it is to use a microkeratome. The femtosecond laser cannot be used in the repeat surgery.

It seems that the results end up pretty much the same either way. Microkeratome is faster than IntraLase. All-laser LASIK eye surgery is more consistent in flap thickness. IntraLase causes more initial light sensitivity and pain, but there is less chance of flap failure than with microkeratome use, according to some surgeons.
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