Brusco Vision, a LASIK surgeon located in Falls Church, Virginia, has published a patient guide examining how surgeons create the corneal flap during LASIK. The guide, “All-Laser LASIK in Northern Virginia: A Falls Church Surgeon’s Guide,” was last medically reviewed on June 26, 2026. It addresses a question that arises when patients compare refractive surgery providers: whether a practice forms the corneal flap with a femtosecond laser or a mechanical blade.
All-laser LASIK, also called bladeless LASIK, iLASIK, or SBK LASIK (Sub-Bowman’s Keratomileusis), uses a femtosecond laser to create the thin corneal flap in place of a mechanical microkeratome blade. The procedure involves two distinct laser systems performing separate steps. The femtosecond laser creates the flap, and a second system, an excimer laser, then removes corneal tissue to correct nearsightedness, farsightedness, or astigmatism. The term all-laser refers to the use of lasers at both stages.
The guide notes that flap-creation method is one of several variables in a LASIK evaluation and does not by itself determine a given patient’s result. LASIK is not appropriate for every patient. Corneal thickness, prescription stability, pupil size, dry eye, and certain corneal and systemic conditions affect whether a patient is a candidate. The U.S. Food and Drug Administration lists dry eye, glare, halos, difficulty with night driving, and the possible need for additional treatment or corrective lenses among the risks and side effects associated with LASIK. In draft guidance issued in 2022, the agency recommended that patients considering the procedure receive a decision checklist describing it and its risks, following reports that some patients did not believe they had been fully informed before surgery. Outcomes vary between patients, and no laser platform or flap technique removes these considerations.
Femtosecond and excimer platforms used in refractive surgery include systems manufactured by ZEISS and Alcon. Brusco Vision performs SBK LASIK using the ZEISS VisuMax femtosecond laser for flap creation, paired with an excimer laser for corneal reshaping. Excimer systems in current use include the Alcon WaveLight EX500 and the ZEISS MEL 90. The practice also performs other refractive procedures, including SMILE, EVO ICL, and Custom Lens Replacement, and states that candidacy determines which procedure is recommended.
Patients who are not candidates for LASIK may be evaluated for other approaches. Surface ablation procedures such as PRK remove no flap and are sometimes considered when corneal thickness is limited, while lens-based options such as implantable collamer lenses address prescriptions outside the treatable range for corneal laser surgery. The guide states that a candidacy evaluation, rather than a preference for a particular technology, determines which of these paths applies to an individual patient.
For patients researching providers, the guide outlines how to confirm a surgeon’s method. Patients can ask directly whether flap creation is performed with a femtosecond laser or a microkeratome, review the laser platforms a practice lists publicly, and ask which procedure a surgeon recommends and on what clinical basis. Blade-based microkeratome LASIK continues to be performed in some settings.
“Flap creation method is a reasonable thing for a patient to ask about, but it is not the variable that decides candidacy,” said Dr. Michael Brusco, MD, FACS, board-certified ophthalmologist and founder of Brusco Vision. “Corneal measurements, prescription, and ocular surface health carry more weight in that evaluation. Patients are better served by understanding why a specific procedure is being recommended for their eyes than by assuming any single technology is right for everyone.”
Brusco Vision is located at 3120 Fairview Park Drive, Suite 100, Falls Church, Virginia 22042. Driving directions to the practice are available through Google Maps.
Brusco Vision is a refractive surgery practice in Falls Church, Virginia, providing LASIK and other vision correction procedures to patients in Northern Virginia and the Washington, D.C. area. Information about the practice and the procedures it performs is available at bruscovision.com and on its Google Business Profile. The full guide on laser and blade flap creation is available on the practice’s website.
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For more information about Brusco Vision, contact the company here:
Brusco Vision
Michael Brusco, MD
(571) 755-2020
info@bruscovision.com
Brusco Vision
3120 Fairview Park Dr Ste 100
Falls Church, VA 22042