Almost everyone knows someone who has undergone Lasik eye surgery. This is not surprising at all. To date, there are more than 30 million people worldwide underwent Lasik surgery. Today, LASIK is now a household term and common form of surgery, but the key developments in its history took over a century to unfold.
So, how did LASIK surgery go from the experimental stages to become one of the most effective and popular elective procedures today?
The early years of LASIK
Surgical solutions to refractive errors of the eye date back as far back as the 19th century. In 1898, the basic principles of Radial Kerototomy (RK) had been laid down by Lans, a Dutch Ophthalmologist.
In 1949, a Colombian ophthalmologist named Dr. José Barraquer described the principles of keratomileusis, a Greek term that literally means “sculpting” of the “cornea. He changed the cornea’s shape by removing a piece of corneal tissue which was frozen with an instrument called a microkeratome. It was only in the 1970s that Dr. Fyodorov invented Radial Keratotomy in the Soviet Union and later introduced in the United States in 1978. This technique involved making a number of tiny radial incisions in the cornea surface to change its shape and correct refractive errors such as near-sightedness.
As time went on, the procedure continued to develop, then in 1987, Luis Ruiz, a protégé of Dr. José Barraquer, modified the principles of microkeratome corneal resection and developed an automated form of the instrument to perform the operation directly on the eye. This procedure became known as Automated Lamellar Keratoplasty (ALK).
The Game Changer: The Excimer Laser
Even greater strides were made in the history of LASIK eye surgery with the introduction and application of the excimer laser in the 1970s. Srinivasan, an IBM engineer and Trokel, an ophthalmologist recognize the potential use of excimer laser on corneal surgery. The Excimer laser uses a cool ultraviolet beam of light to vaporize tissue with exact precision while causing no heat-related damage to the adjacent tissue. The excimer laser was first used on human eyes in the 1980s with a method called Photorefractive Keratectomy (PRK). This involved the ablation of the surface of the cornea to reshape by using Excimer laser. Since then, more than two million people have had their vision corrected through PRK procedure in over 40 countries. In the late 1990s, PRKs latest variants LASEK (laser assisted sub-epithelial keratectomy) and Epi-LASIK were introduced.
Finally, LASIK is Born!
In the 1990s, Dr. Pallikaris and Dr. Buratto introduced a procedure combining the microkeratome and the Excimer laser. This created what we now know as LASIK, an acronym for “Laser-Assisted In-Situ Keratomileusis”. Due to its popularity with patients, LASIK gained U.S. FDA approval in 1999 and thus began the era of LASIK.
The advent of the Femtosecond laser and Wave-front technology marked a significant advancement in laser refractive surgery. In 2001, the FDA approved “bladeless” LASIK or IntraLASE. Instead of the microkeratome blade, a Femtosecond laser was used to make the corneal flap incision. This allowed surgeon to come up with a very predictable, reproducible flap with fewer complications. Dr. J. Trevor Woodhams was the first eye surgeon in Georgia to perform this blade-free procedure.
In 2002, the FDA approved the use of Wavefront technology, also known as Custom LASIK. Wavefront technology gave LASIK surgeons a level of refinement that was previously unattainable with other techniques. A specialized corneal map or wave scan is obtained using an instrument called aberrometer. This creates a guide for the laser and provides a personalized treatment for correction with even higher prescriptions, thin corneas, large pupils or asymmetrical eye surfaces.
Still evolving, LASIK continues to offer exciting new options for patients. Advancement of laser eye surgery led to a new flap-less form of procedure based on lenticule creation and extraction. ReLEx (Refractive LEnticule Extraction) SMILE (SMall Incision Lenticule Extaction) is performed using the VisuMax Femtosecond system (Carl Zeiss Meditec Inc., Jena, Germany). Instead of vaporizing cornea tissue, ReLEx SMILE creates a precisely shaped lenticule inside the intact cornea by using the Femtosecond laser. The removal of the lenticule through a small access measuring less than 4mm changes the form of the cornea, creating the required change to the prescription.
While the technology has improved drastically over the last two decades, the success of any form of vision correction lies heavily on suitability of the patient, and continued education on the doctor’s part is vital to evaluating patient readiness. Individuals considering the procedure should be sure to consult with their eye care provider and stay informed on the benefits and caveats of laser-assisted vision correction.