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Bladeless Custom LASIK vs. Surface Ablation

Bladeless Custom LASIK vs. Surface Ablation


So, you are considering laser vision correction. For many patients, it can difficult be to find the best surgeon, and also the right laser eye surgery procedure.

"The process of choosing a procedure for vision correction of nearsightedness, farsightedness, or astigmatism can be simplified" says Dr. Jeffrey Martin, managing partner at North Shore Eye Care in Smithtown New York.

There are basically two techniques currently available in the United States for refractive laser vision correction: LASIK and surface ablation procedures (such as PRK or LASEK).


In LASIK, a flap is created in the superficial layers of the cornea. This flap used to be created with a microkeratome, a metal tool. They are now made more safely with femtosecond lasers that can create a more precise flap and offer increased safety. The diameter and thickness of the flap can be constructed to fit the unique needs of each patient. Some eye doctors still use microkeratomes, but femtosecond lasers like the Intralase® greatly reduce the risk of flap complications and are the preferred tool for this stage of LASIK surgery.

After the corneal flap is created, vision correction occurs under the flap. There are custom and non-custom platforms.

  • Conventional LASIK: In non-custom LASIK, the LASIK surgeon uses measurements from the exam and plugs them into the laser that corrects your vision. In this setting, each patient is seen as the number in his or her correction. There is no individual customization of the laser eye surgery procedure.
  • Custom LASIK: With Custom LASIK, the laser makes a custom map of each patient's visual system. This complex waveprint map is digitally transferred into the laser for vision correction. With custom treatments, iris registration is also available to match the vision correction ablation to the particular landmarks of the iris. In Dr. Martin's opinion, the blade-free custom LASIK option is the best option; as a result, the blade-free and custom techniques are all that are offered at his Long Island LASIK practice in Suffolk County, New York.

Surface Ablation

Some patients are not good candidates for LASIK, but still may be good candidates for surface procedures. These are patients that have thin corneas, irregular corneas, high refractive prescriptions, and some patients with corneal scars or dry eye. Of course, some patients are simply not candidates for any laser eye surgery procedure, but because surface ablation does not penetrate as deep in the cornea, it is sometimes possible when LASIK is not.

The flap in LASIK is 100 microns, so that thickness is included in the total depth of the correction. In surface ablation, the epithelium or skin layer of the eye is removed; the epithelial layer is only 50 microns, so this technique allows surgeons to conserve more tissue.

Surface ablation has been referred to as a few different names over the years.

  • PRK: PRK is the procedure where the epithelium is removed with dilute alcohol or a brush, and then the laser correction stage of the procedure is performed on the cornea. It takes five to seven days for the epithelium to re-grow. During this time, there is discomfort and blurred vision. PRK patients should take time off of work and not drive for about a week.
  • LASEK: With LASEK, another type of surface ablation, the epithelium or skin layer is loosened with alcohol and then peeled back. After the vision correction, this flap of epithelium is then placed back over the cornea. The healing is the same as PRK, with a week of discomfort and blurred vision.

To help the cornea heal after PRK or LASEK, a contact lens sometimes placed. In Dr. Jeff Martin's experience, there is no difference in healing or discomfort between PRK and LASEK, they are the same. Full visual recovery with surface ablation takes about one to three months.

The final visual result is equal between LASIK, LASEK, and PRK. With surface ablation, custom and non-custom platforms are available, but Dr. Martin feels that custom is more precise with better results. About 20 percent of procedures we perform are surface ablation.

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