Blade-Free or Bladeless All-Laser LASIK Eye Surgery

Bladeless LASIK procedure

All Laser Bladeless LASIK

All Laser Bladeless LASIK is the most common type of laser eye surgery for vision correction we perform at Eyecare Medical Group in Portland. LASIK is a type of eye surgery called “lamellar eye surgery” because it is performed between the layers of the cornea. In this advanced procedure, a “flap” is actually created using a femtosecond laser. LASIK is actually a three-step procedure:

  • During the first step, one of the EMG surgeons will create a “flap” under which the laser vision correction is to be applied. EMG surgeons have safely and effectively created LASIK “flaps” using a mechanical instrument called a microkeratome for over 14 years for many thousands of patients. Today, in order to provide the utmost in safety and efficacy, the LASIK surgeons at EMG create the LASIK “flap” with a femtosecond laser so that their surgery will actually be done as a bladeless All-Laser LASIK procedure.
  • The second step is to carefully fold the “flap” over and allow the inner layer of the cornea to be visible so that the laser energy can be applied. The actual application of the Allegretto Wave Eye-Q® Laser can take from 2-15 seconds depending on the amount of correction that you require.
  • During the third or final step, your eye surgeon will replace the “flap” into its original position and allow it to adhere in position. The LASIK flap is remarkable in that it heals in position without requiring the use of sutures or stitches.
  • During your LASIK consultation at Eyecare Medical Group, the eye surgeon and the staff will make a recommendation regarding the type of laser vision correction that will help you achieve the best possible results based on the type and amount of optical correction you require as well as the health and structure of your eyes and cornea.

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Understanding Possible LASIK Risks, Complications & Side Effects

LASIK is surgery. The LASIK Surgeons at Eyecare Medical Group take their obligation and commitment to patient well-being very seriously and feel it is important that each and every patient considering LASIK take the time to fully understand the possible risks, complications and side effects of LASIK. We will be reviewing these with you at your consultation in order to make certain that you have the opportunity to ask any and all questions and be sure that you are comfortable with how these might apply in your individual situation. We will take meticulous care before, during and after your LASIK surgery to minimize or avoid any risks, complications and side effects.  HOWEVER, LASIK is surgery and it is important for you to understand the limitations and possible complications of Laser Vision Correction. The following is an overview list of the possibilities:

Loss of Best Corrected Vision

While not common, it is possible that some patients can lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment. Ask us about the frequency or likelihood of this happening in your particular situation in our surgical experience in performing more than 10,000 Laser Vision Correction procedures since 1996.

Adverse Visual Symptoms

Some patients developed glare, halos, and/or double vision that could seriously affect nighttime vision, particularly in the early years of laser vision correction. Even with good vision on the vision chart, some patients could not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment. This can still occur in certain situations. We take every precaution to avoid these complications including careful evaluation of pupil size and using the advanced technology Wavelight Allegretto® Wave Excimer Laser to create a spherical aberration optimized corneal shape during your treatment. LASIK is surgery and it can still happen. Ask us about the frequency or likelihood of this happening in your particular situation in our surgical experience in performing more than 10,000 Laser Vision Correction procedures since 1996.

Dry Eye Symptoms (Some patients may develop mild, moderate, or even dry eye symptoms

As a result of Laser Vision Correction, your eyes may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort but can reduce visual quality due to intermittent blurring and other visual symptoms. Rarely, this condition may be permanent. Eye drop therapy with artificial tears and/or Restasis® eye drops may be necessary, as well as the use of tiny punctal plugs. Other procedures may be required. We take every precaution pre-operatively to avoid these issues including careful evaluation of your tear film quality and quantity. We may actually treat you for dry eye symptoms before your surgery in order to prevent these symptoms from ever occurring. Ask us about the frequency or likelihood of this happening in your particular situation in our surgical experience in performing more than 10,000 Laser Vision Correction procedures since 1996.

Results may not be as good with very high prescriptions

We will carefully review with you your expectations of laser vision correction and help you figure out whether you may still require glasses or contacts after the surgery. We may actually recommend alternative vision correction procedures such as lens implant surgery if we feel that you may not achieve your personal goals with LASIK surgery. Ask us about the frequency or likelihood of this happening in your particular situation in our surgical experience in performing more than 10,000 Laser Vision Correction procedures since 1996.

Full correction for some farsighted patients may diminish over time. For some farsighted patient, results may diminish with age.

If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops). We take every precaution to avoid this by carefully considering the manifest refraction, the cycloplegic refraction, and calculations for treatment to be performed. We may actually recommend alternative vision correction procedures such as lens implants for vision correction if we feel that you may not achieve your personal goals. Ask us about the frequency or likelihood of this happening in your particular situation in our surgical experience in performing more than 10,000 Laser Vision Correction procedures since 1996.

Somewhat limited long term data

Laser Vision Correction has only been available in the United States since 1995. The first laser was approved specifically for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery much beyond 15 years or so is not known.

Monovision risks

Monovision is one clinical technique used to deal with the correction of near vision and presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a patient with presbyopia has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. With LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This may result in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring a very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time). Some patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision before you have the surgery performed on your eyes. We want to make sure that you meet the driver’s license requirements with monovision. In addition, you should consider how much your presbyopia is expected to increase in the future. We will discuss when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.

Bilateral simultaneous treatment

We routinely perform LASIK on both eyes at the same time. However, you may choose to have LASIK surgery on one eye at a time. Although the convenience of having surgery on both eyes on the same day is attractive, in certain instances this may be riskier than having two separate surgeries. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your doctor do not have the advantage of being able to see how the first eye responds to surgery before the second eye is treated. Another disadvantage to having surgery on both eyes at the same time is that particularly for PRK, the vision in both eyes may be blurred after surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.

Even the best-screened patients under the care of most skilled surgeons can experience serious complications.

During surgery

A malfunction of a surgical device or other error, such as a poorly formed flap of the cornea may lead to discontinuation of the procedure or irreversible damage to the eye. Ask us about the frequency or likelihood of this happening in your particular situation in our surgical experience in performing more than 10,000 Laser Vision Correction procedures since 1996.

After surgery

Although quite rare, some complications, such as migration of the flap or inflammation or infection, may require another procedure and/or intensive treatment with drops. It is remotely possible that even with aggressive therapy; such complications may lead to temporary loss of vision or even irreversible blindness. Ask us about the frequency or likelihood of this happening in your particular situation in our surgical experience in performing more than 10,000 Laser Vision Correction procedures since 1996.

Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their laser vision correction procedure. At Eyecare Medical Group we will take every precaution and the time necessary to educate you and answer any questions that you might have in order to help you meet your personal vision correction goals.