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Creating LASIK Flaps: Femtosecond Laser vs. Mechanical Microkeratome
- Posted
- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: December 13, 2024
At Blue Fin Vision® Eye Clinic in London, we understand that patients considering laser eye surgery, particularly LASIK, often have questions about the different techniques used. One of the most significant debates in the field of refractive surgery is the choice between femtosecond laser and mechanical microkeratome for creating LASIK flaps. In this comprehensive guide, we’ll explore both methods, their advantages and disadvantages, to help you make an informed decision about your LASIK procedure.
Understanding LASIK Flap Creation
LASIK (Laser-Assisted In Situ Keratomileusis) is a popular laser eye surgery procedure that involves creating a thin flap in the cornea, reshaping the underlying tissue with an excimer laser, and then repositioning the flap. The creation of this flap is a crucial step in the LASIK process, and it can be accomplished using two primary methods:
- Mechanical Microkeratome
- Femtosecond Laser
Let’s delve into each of these methods to understand their unique characteristics and how they compare.
Mechanical Microkeratome: The Traditional Approach
What is a Mechanical Microkeratome?
A mechanical microkeratome is a precision surgical instrument that uses an oscillating blade to create a corneal flap. It has been used in LASIK procedures for decades and has a proven track record of safety and effectiveness.
How Does It Work?
The microkeratome is attached to a suction ring on the eye. As it moves across the cornea, its blade cuts a thin flap of tissue. The entire process typically takes less than 30 seconds.
Advantages of Mechanical Microkeratome
- Speed: The flap creation process is very quick, usually taking less than 30 seconds.
- Cost-effective: Microkeratomes are less expensive than femtosecond lasers, potentially making the procedure more affordable for patients.
- Smooth stromal bed: Some surgeons believe that microkeratomes create a smoother stromal bed, which can be beneficial for the laser ablation step.
- Less inflammation: There’s a lower incidence of inflammation (such as transient light sensitivity syndrome) compared to femtosecond lasers.
Disadvantages of Mechanical Microkeratome
- Less predictable flap thickness: There can be more variation in flap thickness compared to femtosecond lasers.
- Higher risk of certain complications: Issues like free caps, incomplete flaps, or buttonholes are more common with microkeratomes.
- Limited customisation: Microkeratomes offer less flexibility in terms of flap diameter and shape compared to femtosecond lasers.
Femtosecond Laser: The Modern Approach
What is a Femtosecond Laser?
A femtosecond laser is an infrared laser that emits ultra-short pulses of light to create the corneal flap. This technology has gained popularity in recent years due to its precision and customisation capabilities.
How Does It Work?
The femtosecond laser uses rapid pulses of laser energy to create microscopic bubbles at a specific depth within the cornea. These bubbles then connect to form the flap. The entire process typically takes about 15-30 seconds.
Advantages of Femtosecond Laser
- Precision: Femtosecond lasers offer greater accuracy in flap thickness and diameter.
- Customisation: Surgeons can adjust flap parameters like thickness, diameter, and hinge position for each individual eye.
- Reduced risk of certain complications: Issues like free caps and buttonholes are less common with femtosecond lasers.
- Better for thin corneas: The precision of femtosecond lasers makes them a better choice for patients with thin corneas.
- Potential for better visual outcomes: Some studies suggest slightly better visual outcomes with femtosecond LASIK, particularly in higher degrees of myopia.
Disadvantages of Femtosecond Laser
- Cost: The technology is more expensive, which can increase the overall cost of the LASIK procedure.
- Longer procedure time: Creating the flap with a femtosecond laser typically takes longer than with a microkeratome.
- Potential for inflammation: There’s a slightly higher risk of inflammation-related complications like diffuse lamellar keratitis.
- Patient discomfort: Some patients report feeling more pressure during femtosecond flap creation compared to microkeratome.
Comparing Outcomes: Femtosecond Laser vs. Mechanical Microkeratome
When it comes to overall outcomes, both methods have proven to be safe and effective for LASIK flap creation. However, the femtosecond laser has emerged as the gold standard due to its significant advantages. Let’s explore the key differences:
Visual Outcomes
Most studies show comparable visual outcomes between the two methods. However, some research suggests that femtosecond LASIK may provide slightly better results, particularly in cases of high myopia.
Flap Predictability
Femtosecond lasers generally create more predictable flap thicknesses compared to microkeratomes. This is particularly important for patients with thin corneas or high refractive errors. The femtosecond laser’s ability to accurately cut thinner flaps has expanded treatment options for patients who were previously not candidates for LASIK due to corneal thickness concerns.
Complication Rates
The femtosecond laser significantly reduces the risks of flap complications compared to the mechanical microkeratome. While both methods are generally safe, they each have their own set of potential complications:
- Microkeratome: Higher risk of epithelial defects, free caps, and buttonholes.
- Femtosecond Laser: Slightly higher risk of diffuse lamellar keratitis and transient light sensitivity syndrome. However, these risks are generally outweighed by the reduced risk of more serious flap complications.
Recovery Time
Most patients experience quick visual recovery with both methods. However, some studies suggest that femtosecond LASIK patients may experience slightly faster visual recovery in the first few days after surgery.
Patient Considerations
Given the significant advantages of femtosecond laser technology, all laser eye surgery patients should enquire with their surgeon about whether they will be receiving femtosecond laser-cut flaps. This technology has become the preferred choice for many leading eye surgeons due to its precision, safety profile, and ability to cater to a wider range of patients.
Choosing the Right Method for You
At Blue Fin Vision® Eye Clinic in London, we believe that the choice between femtosecond laser and mechanical microkeratome should be made on a case-by-case basis. Factors to consider include:
- Your individual eye anatomy
- The degree of your refractive error
- Your corneal thickness
- Your lifestyle and visual needs
- Your budget
Our experienced surgeons will thoroughly evaluate your eyes and discuss both options with you to determine the best approach for your unique situation.
The Blue Fin Vision® Difference
At Blue Fin Vision® Eye Clinic, we pride ourselves on offering the latest in laser eye surgery technology. Our state-of-the-art facility in London is equipped with both femtosecond laser and advanced mechanical microkeratome systems, allowing us to provide the most appropriate treatment for each individual patient.
Our surgeons are highly experienced in both techniques and stay up-to-date with the latest research and advancements in LASIK technology. We believe in a personalised approach to eye care, ensuring that each patient receives the treatment that best suits their unique needs and circumstances.
Conclusion
Both femtosecond laser and mechanical microkeratome techniques have proven to be safe and effective methods for creating LASIK flaps. While femtosecond lasers offer greater precision and customisation, mechanical microkeratomes remain a reliable and cost-effective option.
At Blue Fin Vision® Eye Clinic in London, we’re committed to providing you with the highest standard of care in laser eye surgery. Whether you opt for femtosecond LASIK or traditional microkeratome LASIK, you can trust that you’re in expert hands.
If you’re considering LASIK and want to learn more about which flap creation method might be best for you, we invite you to schedule a consultation with one of our experienced ophthalmologists. Let us help you achieve the clear, glasses-free vision you’ve always wanted.
Remember, your eyes are unique, and so should be your treatment. Trust Blue Fin Vision® Eye Clinic to provide you with personalised, state-of-the-art care for all your laser eye surgery needs.
