Every LASIK procedure starts with a corneal flap, made either with a mechanical microkeratome or with a femtosecond laser. Practices setting up refractive surgery, or replacing ageing equipment, often weigh the two. This guide compares them from the practice's point of view. Clinical choice between them is for the surgeon.
How each one works
A microkeratome is a precision mechanical device: a suction ring holds the eye, and an oscillating blade passes across the cornea to cut the flap. Examples include the Bausch + Lomb Hansatome and Zyoptix XP.
A femtosecond laser creates the flap with focused laser pulses instead of a blade. The flap dimensions are programmed in software, and many platforms can make other corneal cuts too.
Capital and running costs
A microkeratome costs far less to buy and takes almost no space. Its running costs are blades and any single-use parts, plus regular servicing of the motor head.
A femtosecond laser is a major capital purchase with room requirements, a service contract and a patient interface for every procedure. Some platforms have also used per-procedure fees. Compare total cost per case over the years you expect to use the equipment, not only the purchase price.
Workflow and space
A microkeratome fits in the same room as the excimer laser and adds little time to the procedure. A femtosecond laser needs its own footprint, sometimes its own room, and a step in the patient flow to move between devices. Mobile femtosecond lasers reduce this but still need planning.
Buying either one used
For a pre-owned femtosecond laser, check the licensed applications, the laser source service history and the supply of patient interfaces. Our femtosecond buying guide covers this in detail.
Before buying a pre-owned microkeratome, confirm:
- The motor head has been serviced, with the record.
- Which suction rings, heads and footswitch are included.
- Blades and single-use parts are still available to you.
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