Paradoxically, the techniques that involve cutting (also referred to as a flap or corneal flap) are indeed more delicate to perform and can be anxiety-inducing for the patient. However, they are less painful in the aftermath and provide a quicker recovery than surface techniques without a corneal flap.
1- Classic Lasik with microkeratome: a sort of small microsurgical plane
At the Vision Laser Center we do not use this equipment, which carries more risk than femtosecond laser treatment.
2- Lasik with Femtosecond Laser
Appeared in the early 2000s: the corneal flap is performed with a femtosecond laser and not with a blade.
The procedure is sometimes called 100% laser because it uses 2 lasers but that does not mean that it is contactless: there is necessarily and whatever the femtosecond used a direct intervention phase on the operated eye.
Many brands of femtosecond laser exist which are used in different clinics. We use the ZIEMER Chrystal Line laser, a laser made in Switzerland renowned for its extreme precision.
We will say that the principle of these different femtosecond lasers is comparable, each Center and each surgeon keeping, according to their habits, their preference for this or that laser without this changing much in terms of results.
3-Let us also mention, apart from lenticular extraction, the ReLex technique
The Relex or Smile allow Lasik to be performed using only one laser for both steps. The method is mono-laser but not all laser.
The Visumax cuts a lens of corneal stroma which is removed with forceps instead of being volatilized by the Excimer laser.
The method depends on the quality of the surgeon because it involves a manual act of extracting this lenticule which requires good surgical skill, this phase not existing in Excimer Lasik. There are many cases described in the literature where the lenticule tears during manual extraction, which sometimes makes complete extraction impossible with postoperative side effects (residual defect, photosensitivity, etc.)
The indications and results are similar to Lasik with Excimer laser. This system does not change the contraindications to Lasik.
On the other hand, Smile does not allow personalized treatments or treatment for hyperopia.
This technique also poses the problem of touch-ups not yet resolved by the manufacturer. Indeed, touch-ups, if they prove necessary, are done with an Excimer laser in PKR, which is somewhat regrettable and contradictory.
For our part (and for most specialized surgeons in the world) we have not yet been convinced of the benefits of this technology given its current drawbacks, and we do not use it.