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LASIK Variants: Bladeless LASIK, Epi-LASIK, LASEK

Most patients do not realize that there is more to LASIK eye surgery than the “One size fits all” , cookie-cutter Lasik surgery offered in most practices and Lasik surgery chain centers. Dr. Gulani has been involved in LASIK surgery, (Lasik meaning, Laser Assisted in-Situ Keratomileusis) for over 3 decades along with contributing with his Award -Winning innovative Lasik surgery instruments, surgical protocols and publications while sharing his knowledge with Lasik surgeons globally.

Lasik surgery being a combination concept of corneal flap making with laser ablation can be varied at many levels to individualize to each patient’s eye uniquely right from pharmacological modulations to technological applications like Laser algorithms, parameters and ablation patterns along with Laser energy and frequency modes. Corneal Lasik flap creation too can be approached individually in preparation with Laser, Blades, Microkeratotome and Chemical dissection besides size, thickness and hinge placements along with contour and circumferential modifications. Laser ablation profile itself can be changed in centration, zone sizes and topography, refraction or wavefront-guided patterns.

Though various practices use different names for these Lasik variants (usually limited to that surgeon’s limited abilities or technological access) that can mislead patients under the guise of marketing, Dr. Gulani encourages patients to disregard the names and speak to the surgeon “One – on – One” and understand the “why” and “how”  of any procedure insisting that it be tailored to their eyes.

With his international privileges, Dr. Gulani often performs and leads his worldwide colleagues by years in selecting what is best for his patients without wavering with any marketed hype or illusions.

So lets review variants of LASIK surgery and take advantage of Dr. Gulani’s personal innovations in raising this surgery to his NexGen LASIK concept that has helped patients from all over the world.

Dr. Gulani posing with his patients

After going through your detailed evaluation and personal consultation with Dr. Gulani he will decide which technique or combination of techniques would be best suited to correct your vision.

Bladeless Lasik:

In traditional LASIK, an instrument known as a microkeratome cuts a thin, hinged flap into the eye’s clear surface (cornea). In Bladeless Lasik this blade is replace by a high-energy laser (femtosecond laser). The flap then is lifted for application of laser energy that reshapes the eye for vision correction. The flap is then replaced on top of the cornea to heal.


In Laser Epithelial Keratomileusis (LASEK) a shallow cut is made in the outermost layer of tissue of the cornea (the epithelium). An alcohol solution is then applied to help loosen the tissue and the surgeon pushes this new ultra-thin “flap” of epithelium off to one side of the cornea, where it remains attached to the eye (like the thicker flap of corneal tissue created during LASIK surgery). The laser is then used on the cornea to reshape the eye and correct vision. After the laser treatment is finished, the epithelial tissue is repositioned on the surface of the eye to cover the lasered area, and a bandage contact lens is placed on the eye to help promote healing.


Sub Bowman’s Keratomileusis is a  variant with Sub-Bowman (Bowman’s membrane) application of Lasik-like surgery avoids excessive tissue depth with its inherent strength (tectonic) corneal implications.

Epi – Lasik:

Another laser eye surgery, called epi-LASIK or e-LASIK, is very similar to the aforementioned LASEK procedure. But, instead of using alcohol to loosen the epithelium like in LASEK, in epi-LASEK the surgeon typically uses a blunt, plastic blade to separate the outermost layer of tissue from the eye. This avoids the possibility of a reaction from the alcohol, which can kill epithelial cells.


SMILE (Small Incision Lenticule Extraction) also known as ReLExSMILE (refractive lenticule extraction) surgery performed using a femtosecond laser to create a small, lens-shaped bit of tissue (lenticule) within the cornea. Then, with the same laser, a small arc-shaped incision is made in the surface of the cornea, and the surgeon extracts the lenticule through this incision and discards it. With the tiny lenticule removed, the shape of the cornea is altered, correcting nearsightedness. The corneal incision heals within a few days without stitches.

ReLExSmile has been recently introduced in the United States especially directed to make LASIK surgery more minimalistic and hence safer with lesser side effects, such as dry eyes and corneal ectasia. With present FDA approval status, patients with SMILE surgery in most cases do not recover vision as quickly and in fact there have been reported cases of corneal ectasia and dry eyes too.

Topography Guided Laser:

Since the curvature or shape of your cornea (front clear window of your eye) decides, in most cases, whether you are nearsighted (steep curvature), farsighted (flat curvature) or have astigmatism (football shape as opposed to a basketball shape), corneal Topography is helpful in planning Laser Refractive Surgery of all kinds.

Dr. Gulani posing with 4 patients.

In certain eyes where this topography is irregular and uneven, the Laser itself can be programmed to follow that Topographical pattern to help normalize the corneal shape.

This procedure uses a customized excimer laser treatment guided by a topographic map. Preoperatively, multiple consecutive maps are obtained, and this information is transferred to an excimer laser. A sophisticated algorithm interprets the data and constructs a laser ablation pattern where a number of parameters that can be modified including optical zones, depth of treatment, and curvature modified refractive protocols centered over the line of sight.

Dr. Gulani has raised this concept to an ART since his experience has proved that refraction decides vision, not topography and has honed his skills over time to offer proprietary LaZrPlastique techniques to help patients with irregular astigmatism, Keratoconus, Pellucid Marginal Degeneration and Lasik & PRK complications

Wavefront Optimized Laser:

In wavefront-optimized laser procedures the curvature of the cornea is taken into account when applying the laser to the surface of the eye. This means that the peripheral of the eye has an increased number of laser pulses to reduce the induction of abnormalities.

Wavefront-guided laser procedures utilize a wavefront-sensing aberrometer (a technology that quantifies aberrations on the surface of the cornea) which directly transfers information to the laser program as opposed to using a refraction (glasses or contact lens prescription) as in other procedures.

After going through your detailed evaluation and personal consultation with Dr. Gulani he will decide which technique or combination of techniques would be best suited to correct your vision.

Among the first in the world to apply Wavefront technology to Laser Vision Surgery, Dr. Gulani has written a prominent book chapter in Clinics of North America along with his co-authors from Cleveland Clinic.

For over three decades as a pioneer of laser vision surgery Dr. Gulani has experienced every technique and technology often beyond other eye surgeons with his international privilege. His signature style of going beyond “cookie-cutter” underscores his art to best fit your unique eyes but also to develop the best vision he can no matter how simple or complex your case. Dedicatedly continuing to evolve his techniques given his passion to make people see, Dr. Gulani has raised LASIK surgery to a non-cutting, flapless technique called LaZrPlastiqueTM.

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