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LASER EYE SURGERY: No Flap Laser or Surface Laser Ablation

Sometimes, there’s just something about the words “blade” and “eye” […]

By Published On: 27 February 20122.8 min read

Sometimes, there’s just something about the words “blade” and “eye” that don’t want to go together. No patient enjoys the thought of having any kind of flap cut into their eye — even though the procedure is relatively safe. However, there are risks of complications when using a microkeratome blade, especially if the flap is cut too thickly. You may just not like the idea of having a blade cutting a flap open to ready your eye for the laser portion of the procedure.

Cutting the Flap: Complications

In fact, there are several potential complications with cutting a flap for LASIK, particularly with the blade. The flap can be too thin, too thick, misshapen, incomplete, or cut off completely. All of these mishaps can result in complications with the eye, and vision problems. Additionally, the problem with cutting flaps is that they can become wrinkled if you rub your eye, or later on down the road, if you are involved in contact sports. Finally, the flaps do not always heal completely, and are weakened, and can become decentered.

A Safer Alternative

Eye surgeons and eye care professionals are turning toward surface laser ablation as a safer alternative. There are several reasons for this:

•    Surface laser ablation uses no blades. There is no cutting into the surface of the eye, reducing the chance of complications from the flap never healing properly, and other potential complications.
•    Surface laser ablation reduces the risk of postoperative dry eye. Because the nerve endings are not cut (as there is no cutting involved), your tear secretions are not as readily affected.

•    Surface laser ablation has positive treatment outcomes without the regular LASIK complications. This is a safer alternative, and, while no surgery is 100% safe, some of the normal risks are reduced with this procedure.

Above are images of eyes that have been freshly lasered with no flap.  Notice the irregular finish.  This gives an inferior vision result to Lasik in the first week or so, from which time this irregularity heals and the vision will finally match the Lasik result in most cases.


Surface laser ablation uses excimer lasers to reshape the surface of the cornea to correct vision. It is indicated for people with myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, and who have thin corneas.

Many people think this is the old PRK procedure. While it is similar in principle, the advancement of technology has greatly improved the procedure itself, as well as recovery times. Improvements include:

•    Being able to drive within 24-48 hours from surgery (with PRK, it took at least one full week, and up to six months to see full results of the procedure).
•    You would have less discomfort with surface laser ablation as it’s practiced today, thanks to improved excimer lasers, better post-operative contact lens “bandages” and comfort drops.

There are several types of surface laser ablation that can be used, to customize treatment to your specific vision needs: Epi-LASIK, where the epithelial cells are removed with a tiny separator, LASEK, where the epithelial cells are loosened with an alcohol solution and then removed manually, and trans-epithelial PRK, where the epithelial cells are ablated with the same laser that will be used to reshape your corneas.

Talk to Dr Jim Kokkinakis at The Eye Practice to determine which procedure is right for you.


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