Flapless LASIK refers to a group of LASIK treatments that does not involve flap creation.
Flapless LASIK methods include Epi-LASIK, ReLEx SMILE, Advanced Surface Ablation (ASA), PRK, and LASEK. On the other hand, methods with flap creation include LASIK and iLASIK.
During the standard LASIK procedure, a corneal flap is created by a laser. This flap allows the excimer laser to reshape the cornea and correct for refractive errors (myopia, astigmatism, hyperopia, and presbyopia).
Conversely, a corneal flap is not created during flapless LASIK. Instead, different methods are used to prepare the cornea for the excimer laser. The method used depends on the LASIK treatment:
In Epi-LASIK, part of the corneal epithelium is removed by a surgical blade or laser. That being said, corneal tissue is being removed. Consequently, this can cause pain and discomfort following surgery. Epi-LASIK is also known as Advanced Surface Ablation (ASA), PRK, and LASEK.
In ReLEx SMILE, small incision lenticule removal (2-4mm) is performed. This procedure is considered minimally invasive as it leaves the cornea structure untouched. In this way, ReLEx SMILE is said to produce accurate results with less dry eye side effects.
#1 Flapless LASIK Is Safer Due to Lack of Flap Complications
A common misconception is that flapless LASIK is safer due to the lack of corneal flap. As the train of thought goes, without a corneal flap, there will be no risk of flap-related complications. Therefore, flapless LASIK is safer than normal LASIK.
While it is true that there is no risk of flap-related complications, this alone is not sufficient to conclude that flapless LASIK is safer than its flapped counterparts. Conversely, flapless LASIK has its own share of possible complications and side effects. This side effects include pain, longer recovery times, and slower visual recovery.
#2 Flapless Lasik Does Not Remove Any Corneal Tissue
Another misconception is that flapless methods are safer as they do not remove tissue from the cornea. This is entirely untrue. In Epi-LASIK, the corneal epithelium (tissue that covers the front of the cornea) is scrapped off by a surgical blade or laser. Similarly, part of the cornea, a small lenticule, is removed during ReLEx SMILE. As such, there is no LASIK method that keeps the cornea a 100% untouched.
In contrast, standard LASIK involves flap creation and repositioning. After the LASIK procedure is done, the flap that was created is repositioned as it originally was in the eye. The flap recovers quickly, no stitches are needed. That being said, standard LASIK often has more predictable results, faster downtimes and swifter visual recovery.
It is possible that some LASIK centres only have the equipment for one type of LASIK treatment. Hence, they will promote whichever service they offer. Bear in mind that there is no one-fits-all treatment. Conversely, the best treatment for you will depend on your unique eye condition (degree, cornea thickness, cornea shape, and lifestyle).
However, flapless treatments are, in fact, a better option for certain patients. Epi-LASIK is good for thin corneas. These patients would otherwise be unsuitable for normal LASIK. During a LASIK assessment, your doctor will be able to advise you on a suitable LASIK treatment method.