Femto-Lasik or bladeless LASIK is the new generation LASIK surgery. It allows safe and precise results with rapid visual recovery.

1. Cataract Surgery
Dr B Farpour
Geneva 2017
www.visionlaser.ch
FEMTO-LASIK or BLADELESS LASIK
Geneva refractive public education lectures
Courtesy of AAO
presentation support

2. Bladeless LASIK
• Light rays enter the eye through
the clear cornea, pupil and lens.
• These light rays are focused
directly onto the retina, the light-
sensitive tissue lining the back of
the eye.
• The retina converts light rays into
impulses, sent through the optic
nerve to your brain, where they
are recognized as images.
• 70% of the eye's focusing power
comes from the cornea and 30%
from the lens.
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How the eye works
Eye anatomy

3. Bladeless LASIK 3
How the eye works

4. Bladeless LASIK
Refractive errors
• Inability to see clearly is often caused by refractive error.
• Four types of refractive error:
 Myopia (nearsightedness)
 Hyperopia (farsightedness)
 Astigmatism
 Presbyopia
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5. Bladeless LASIK
• In myopia (nearsightedness),
there is too much optical
power in the eye.
 The distance between the
cornea and the retina may be
too long or the power of the
cornea and the lens may be
too strong.
• Light rays focus in front of the
retina instead of on it.
• Close objects will look clear,
but distant objects will appear
blurred.
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Refractive errors: myopia
Myopia, or nearsightedness

6. Bladeless LASIK
• In hyperopia (farsightedness),
there is too little optical power.
 The distance between the
cornea and the retina may be
too short.
• Light rays are focused behind
the retina instead of on it.
• In adults (but not children),
distant objects will look clear,
but close objects will appear
blurred.
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Refractive errors: hyperopia
Hyperopia, or farsightedness

7. Bladeless LASIK
• In astigmatism, the cornea is
curved unevenly — shaped
more like a football than a
basketball.
• Light passing through the
uneven cornea is focused in
two or more locations.
• Distant and close objects may
appear blurry.
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Refractive errors: astigmatism
Astigmatism occurs when light passes
through football-shaped cornea.

8. Bladeless LASIK
• Presbyopia is an age-related condition in which
your eyes gradually lose the ability to see things up
close, because the lens of the aging eye can no
longer change shape.
• When we are young, the lens in our eyes is flexible
and is able to change focus easily between near
and far objects, like an autofocus on a camera.
• At around age 40, this flexibility begins to gradually
decrease, making it more difficult to see objects up
close, unless the eye has nearsightedness.
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Refractive errors: presbyopia

9. Bladeless LASIK
What is refractive surgery?
• Refractive surgery is a group of outpatient surgical procedures used to
alter how your eye focuses light rays on the retina, thereby improving
vision and reducing dependence on glasses and contact lenses.
• In most cases, refractive surgery affects the shape of your cornea to
redirect how light is focused onto the retina. Popular procedures include
LASIK, LASEK and PRK.
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Refractive
surgery
procedure on
the cornea

10. Bladeless LASIK
What is refractive surgery?
• Most refractive surgery is performed on the cornea and affects only
the front of your eye, while the rest of your eye will change naturally
as you age.
• In some cases, refractive surgery procedures don’t reshape the
cornea; instead, the eye’s natural lens is either replaced or
enhanced by an implantable lens that helps correct vision.
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What is refractive surgery?

12. Bladeless LASIK
What is laser in situ keratomileusis (LASIK)?
• LASIK is an outpatient refractive surgery used to treat
nearsightedness (myopia), farsightedness (hyperopia) and
astigmatism.
• LASIK involves:
 creating a thin, hinged flap in the cornea, which is then gently folded
back to expose the internal structure of the cornea;
 using an excimer laser to precisely sculpt the exposed cornea to correct
your refractive error; and
 immediately repositioning the thin flap following the laser application and
allowing it to heal naturally.
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13. Bladeless LASIK
What is LASIK?
• For myopia, your corneal tissue is removed centrally in a lenticular
(lens-like) pattern, thereby flattening the central cornea and
reducing the eye’s focusing power to correct your refractive error.
• For hyperopia, your corneal tissue is removed around the edges,
thereby steepening the central cornea and increasing the eye’s
focusing power.
• For astigmatism, your corneal tissue is removed in a precise
elliptical pattern that steepens the cornea where it is too flat and
flattens the cornea where it is too steep, thereby accurately
correcting your refractive error.
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14. Bladeless LASIK
• Traditional LASIK uses a microsurgical instrument called a
microkeratome to create the flap in the cornea.
• Femto-LASIK uses a specific type of laser, called a femtosecond
laser, to create the corneal flap.
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How is FEMTO-LASIK or
BLADELESS LASIK different?
LASIK refractive
surgery procedure

15. Bladeless LASIK
• A preoperative eye exam includes measurements to give the
surgeon the necessary information to perform the procedure:
 Refractive error measurement
 Pupil evaluation and measurement
 Tonometry: measurement of your eye’s intraocular pressure
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How is Femto-LASIK performed?
Slit lamp exam

16. Bladeless LASIK
• Corneal topography: mapping the surface details of the cornea
• Corneal keratometry: measurement of the form and curvature
of the cornea
• Corneal pachymetry: measurement of corneal thickness
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How is Femto-LASIK performed?
Pachymetry
measures corneal
thickness.

17. Bladeless LASIK
• Prior to the LASIK procedure, your eye(s) are prepped for surgery
and treated with anesthetic drops.
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How is Femto-LASIK performed?

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How is Femto-LASIK performed?
Your ophthalmologist (Eye M.D.) uses a laser to create a thin, hinged
flap of corneal tissue.

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How is Femto-LASIK performed?
Once the flap is lifted to one side . . .
. . . a different laser is used to
apply laser energy for a few
seconds to a minute or so to
reshape the exposed surface of
your cornea.

20. Bladeless LASIK
• The tissue flap from your cornea is placed back into its original
position, where it adheres naturally, protecting the treated area
and restoring the smooth front surface of your eye.
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How is Femto-LASIK performed?

21. Bladeless LASIK
• After the procedure, the reshaped cornea focuses light more
accurately on the retina.
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How is LASIK performed?

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How is Femto-LASIK performed?

23. Bladeless LASIK
Considerations for Femto-LASIK surgery
• Femto-LASIK is a less invasive procedure than intraocular surgery.
• The procedure and visual recovery are quick, and discomfort is
typically minimal.
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24. Bladeless LASIK
Considerations against Femto-LASIK surgery
• Femto-LASIK is not recommended for patients with thin corneas.
• Femto-LASIK is not recommended for patients with keratoconus
(irregular protrusion of the cornea), or other corneal diseases.
• Femto-LASIK is not recommended if myopia, hyperopia or
astigmatism is beyond the approved parameters of the procedure.
• Femto-LASIK is not recommended for patients with significant
systemic medical illnesses that may severely affect healing.
• Femto-LASIK is not recommended for patients with severe dry eye.
• After Femto-LASIK, you may be restricted from certain occupations.
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25. Bladeless LASIK
Risks and possible side effects of Femto-LASIK surgery
• Overcorrection or undercorrection (with a possible need for retreatment)
• Reduced contrast vision (sharpness)
• Poor night vision
• Glare, halos, starburst, ghosting of images
• Corneal infection
• Light sensitivity
• Dry eyes
• Flap complication (either during or following surgery)
• Loss of vision
• Regression of initial surgical effect
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26. Bladeless LASIK
To be a candidate for Femto-LASIK, you should:
• be at least 18 years of age;
• not be pregnant or nursing;
• be free of any eye disease;
• have a stable eye prescription over the past year; and
• have a refractive error within the approved range of correction.
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27. Bladeless LASIK
Is refractive surgery right for you?
• Advanced surgical procedures, like Femto-LASIK, are creating more
opportunities for people who want to be less dependent on glasses
or contacts.
• Surgery may not entirely eliminate your need for corrective lenses.
Glasses or contacts may still be needed for activities such as fine or
detailed work, reading and perhaps night driving.
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28. Bladeless LASIK
Is refractive surgery right for you?
• A large part of the success of any
refractive surgery depends on your
understanding of the procedure and
your expectations.
• Since refractive surgery is an elective
procedure, you have the opportunity
and responsibility to become fully
informed about its risks and benefits.
• Your ophthalmologist will explain the
specific technique, its benefits, as
well as possible risks and side effects
associated with your case.
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29. Bladeless LASIK
• With the help of your ophthalmologist, it’s ultimately your responsibility to
weigh the risks and side effects of a procedure with the benefits it has to
offer.
• If you decide refractive surgery is right for you, you may join millions of
people who have reduced their dependence on glasses or contacts.
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Discuss options and questions with your ophthalmologist