Bladed vs. bladeless LASIK: still worth debating?

It isn't worth debating if bladed or bladeless LASIK is better because mountains of unbiased scholarly research involving millions of eyes confirm that bladeless LASIK is indisputably better.

Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 10/31/18 11:07 AM

My LASIK was done with a blade. I was in medical school, and I used the extra “miscellany” loan available to get LASIK instead of to buy petty things like food or gas. The interest rate for it was something insane like nine million percent. I had it done in 2004, and I’m still (this is true) making monthly payments on it. In hindsight, I probably could have gone about the whole enterprise in a more financially sound way.

It seems important to point that out right here at the start for a couple reasons. First, hopefully my disclosure that I handled my finances like toddler when getting LASIK will prove that my goal here is transparency over self-interest. Second, with a little inductive reasoning, you can conclude that my LASIK must have been awesome. Ive been so happy with my vision that LASIK surgery became my career. That’s like buying a house and liking it so much you decide to become a realtor.

And now that I’ve disclosed how great bladed LASIK was at the time, my hope is it will add more weight to the following sentence, which is the most important sentence of this article. It isn’t worth debating if bladed or bladeless LASIK is better because mountains of unbiased scholarly research involving millions of eyes confirm that bladeless LASIK is indisputably better. There are much more advanced microkeratomes (the blade used in LASIK) now than there were a decade ago. It doesn’t matter. None of them are as safe or accurate in visual results as bladeless LASIK.

There are a couple refractive surgeons who give talks about the equality of bladed and bladeless LASIK each year at the annual meeting for the American Society of Cataract and Refractive Surgery (ASCRS). It’s always one of the small lectures in a side room off of the main convention hall—kind of like a sad, off-Broadway musical. They’re viewed similarly to the way people view flat earthers. Sometimes their lectures will be attended (I’ve done this) by people who can’t resist the curiosity of it all. What diagrams or poorly designed study will be in this Power Point? Is there a self-awareness visible behind their body language showing they also don’t believe what they’re saying? Do they know that photo of the earth as a flat disk is photoshopped?

There are a lot of papers published about this in peer-reviewed literature. There are journals with editorial boards staffed by internationally respected refractive surgeons like the Journal of Refractive Surgery and (its one-upping friend) the Journal of Cataract and Refractive Surgery. You can Google the topic and those journals to find the results of these studies. My goal here is just to get you a behind-the-scenes view on the debate. Rather than wading through the articles and trying to come to conclusions, it seems like it may be more helpful to know the vibe of the discussion about this in the halls at the ASCRS meeting. And the peek behind the curtain, in this case, would show you there hasn’t been a debate happening on this topic since around 2008.

Verifiable facts shut down discussion on subjects because discussion isn’t necessary anymore unless you’re talking with conspiracy theorists. Otherwise, we can just assume we’re on the same page that the earth is round and bladeless LASIK is safer. I’d also add to the list of verifiable facts that high-interest loans, much like tattoos, should be carefully thought through, because they’re going to be with you for a very long time.

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