Traditional LASIK: Microkeratome vs Bladeless Femtosecond Comparison

What Is Traditional LASIK?

Traditional LASIK refers to the original technique using a microkeratome — a precision oscillating blade device — to create the corneal flap before excimer laser reshaping. This method was the standard of care from LASIK's FDA approval in 1999 through the mid-2000s, when femtosecond laser technology became widely available. While bladeless LASIK has become more prevalent at modern centers, traditional microkeratome LASIK remains a clinically valid option with an extensive long-term safety record.

The LASIK procedure itself — the excimer laser treatment that reshapes the cornea — is identical regardless of how the flap is created. The distinction between traditional and bladeless LASIK lies entirely in the flap creation step, which takes only 15 to 30 seconds of the total procedure time.

How the Microkeratome Creates the Corneal Flap

A microkeratome is a precision surgical device that attaches to the eye via a suction ring, stabilizing the globe while a motorized oscillating blade passes across the corneal surface at a controlled depth. The blade creates a thin, hinged disc of corneal tissue (the flap) approximately 130 to 160 microns thick. The hinge is preserved at one edge (typically the superior or nasal side) so the flap can be folded back, the underlying stroma treated with the excimer laser, and the flap repositioned.

Modern microkeratomes have achieved extraordinary precision. The Moria M2, Bausch & Lomb Hansatome, and similar devices produce consistent flaps within a narrow range of thickness variation. The suction phase briefly raises intraocular pressure, which is why patients experience temporary visual darkening ("lights go out") for a few seconds during this step.

Traditional LASIK vs Bladeless LASIK: Head-to-Head

Feature	Traditional (Microkeratome)	Bladeless (Femtosecond)
Flap creation method	Oscillating blade	Infrared laser pulses
Flap thickness	130–160 microns (less consistent)	90–110 microns (highly consistent)
Flap edge geometry	Angled cut	More precise, can be customized
Suction ring IOP elevation	Moderate (~65 mmHg)	Higher (~45–60 mmHg, varies by platform)
Risk of incomplete flap	~0.5%	Very rare
Cost	Lower	Higher ($200–$500 more per eye)
Long-term safety record	25+ years	15+ years
Visual outcomes	Excellent	Equivalent or slightly better

Clinical Outcomes: Does the Flap Method Matter?

Large-scale studies comparing microkeratome and femtosecond flap creation find equivalent visual outcomes in terms of final uncorrected acuity, patient satisfaction, and long-term stability. Both methods achieve 20/20 or better in over 92% of appropriately selected patients. The femtosecond approach shows modest advantages in flap thickness consistency (which matters most in patients with thinner corneas) and a lower rate of flap-related mechanical complications. Dry eye incidence may be slightly lower with femtosecond flaps in some studies, though the evidence is not uniformly consistent.

Who Traditional LASIK Is Best Suited For

Traditional microkeratome LASIK may be the preferred choice for patients who: have thick corneas where flap thickness precision is less critical, are seeking the most cost-effective option, or are being treated at a center with extensive microkeratome experience but limited femtosecond availability. In parts of the world outside North America and Western Europe, microkeratome LASIK remains the predominant technique due to equipment cost considerations.

Most contemporary ophthalmologists in the United States and Canada now default to femtosecond flap creation, particularly for wavefront-guided or topography-guided treatments where the precision benefits are most valuable. Compare all procedure types in our LASIK procedure guide.

Cost Difference Between Traditional and Bladeless LASIK

Traditional LASIK is typically $200 to $500 less per eye than bladeless femtosecond LASIK, reflecting the lower equipment and per-use cost of microkeratome technology. For a full breakdown of pricing by procedure type, see LASIK cost and cost by procedure type. The choice between traditional and bladeless should ultimately be based on your surgeon's recommendation for your specific corneal anatomy, not solely on price.