History Of Lasik Surgery

Tracing the history of lasik surgery

Before lasik surgery enjoyed considerable success as one of the treatments for eye problems, it started as a lesser known procedure that is still trying to prove its worth. Lasik is actually an abbreviated form of a really long scientific name, in situ keratomileusis. The technique involves the introduction of a hinged lamellar flap in the cornea. An instrument called an excimer laser is then used to make refractive cuts on the stromal bed in the eye. Now, more than 5 million surgical procedures have already been performed in the United States alone since the procedure was approved sometime in 1995. In 2005, more than a million procedures were done.

Unknown to many, lasik is not exactly a new technology anymore but rather a marriage of the old and the new medical and scientific technology. It uses the principles of keratomileusis and automated lamellar keratectomy (ALK) or what is now commonly practiced as photorefractive keratectomy (PRK), which is performed under a flap.
Refractive surgery has actually started way way back during the World War II by the Japanese who seek to treat myopia. What they do is to make cuts in the cornea of patients to make it flat. The procedure however had so many complications that it was soon abolished.

The technique actually began as early as 1966 when Pureskin demonstrated the changes in refraction that can be achieved by the use of a corneal flap and in the removal of the central tissue in a lamellar fashion. In his studies, he discovered that the smaller the disc that one will insert, the greater will be the refractive change.

It was only through the work of Dr. Jose Barrager of Columbia that the science of refractive surgery was revived. The professor invented the a technique that makes use of an instrument called microkeratome to treat or correct vision deficiencies. The microkeratome was used to shave off the corneal tissue’s thin cap. This cap will then be reshaped and then returned back into the eye. He called this procedure the Keratomileusis. Because of his work and contribution, Barrager is considered to be the father of modern refractive surgery.

Barrager also came up with the idea of freezing the corneal disc and then reshaping it with cryolathe. The technique however did not gain popularity because of the damage that freezing can do to the corneal disc. In 1980s, Ruiz and Barraquer performed the keratomileusis in situ, a procedure that is based on the principles of Krumeich. It involves the removal of the corneal disc with a device called microkeratome. Then, refractive change is set by cutting it with the same device. The resulting refraction will depend upon the thickness and the diameter of the second disc. This procedure however has its set of problems including complexity and irregular astigmatism brought on by problems in the corneal disc.

It was until Burratto and Pallikaris developed a technique that used both the excimer laser and the microkeratome technology that the procedure began to really work with less complications. Burratto’s work centered on the use of a corrective excimer laser while Pallikaris developed the technique that allowed the use of the laser for the corrective ablation of the corneal bed under a flap. In 1989, he performed the procedure in blind human eyes and in 1991 with sighted eyes.

In 1993, the procedure was refined by the use of an automated microkeratome to create a flap. The technique was developed by Steve Slade, who is one of the first surgeons in the United States to perform what we now called the Lasik surgery.