The History and Evolution of LASIK Surgery

Modern Lasik

Timeline: Important Discoveries that Shaped the Future of Eye Surgery

1869

  • Herman Snellen, a Dutch ophthalmologist, speculated that using specific incisions to flatten the eye might improve vision in some patients. Snellen also developed the standard eye chart, now used by practitioners worldwide to test vision acuity.


    1870 - 1895

  • Several physicians in multiple countries, including Xavier Galezowski (France), Hjalmar August Schiøtz (Norway), William Horatio Bates (United States), Faber (Holland), and Lucciola (Itally), attempt corrective surgery using various techniques, with mixed results.


    1896

  • Leendert Jan Lans, a Dutch ophthalmologist, systematically studies refractive surgery at the University of Leiden. He conducted a series of experiments on rabbits to evaluate patterns of keratotomy, keratectomy, and thermokeratoplasty.


    1939 - 1943

  • Tsutomu Sato (Japan) observes patients with a particular corneal disease (keratoconus) and notes that when their cornea, some patients experience improved vision. He developed surgical techniques based on his observations, and performed surgery on hundreds of patients. While successful at first, many of these patients suffered serious complications years later, as the structure of the eye was not fully understood at the time.

    1950s

  • Jose Barraquer (Columbia) develops the first microkeratome. A microkeratome has an oscillating blade and is used to cut thin flaps in the cornea.


    1970s

  • Svyatoslav Nikolatevich Fyodorov (Russia) observed a patient with corneal lacerations (the result of an accident) and noted that the patient's vision was improved after the eye healed. Based on this, he developed a system of anterior radial keratotomy which made the procedure more predictable than ever before.

  • Dr. Leo Bores visited Fyodorov in the Soviet Union and brought his technique back to the United States. He was the first to perform the procedure in the U.S., and trained other doctors to perform it as well.

  • The first excimer laser was developed. This type of laser uses UV light to remove an extremely fine layer of organic material from the surface of an object. The material that is removed is disintegrated into the air, without heating or otherwise causing damage to the layers underneath. The device was originally used in manufacturing, but was later found to be extremely useful for delicate surgery, such as LASIK.


    1980s

  • Photorefractive Keratectomy (PRK) surgery is developed using the excimer laser, though it is not approved by the FDA until 1995. During PRK, the laser is used to reshape the surface of the eye by removing fine layers of tissue

  • In 1989, Lucio Buratto (Italy) and Ioannis G. Pallikaris (Greece) develop the LASIK procedure by combining two previously known techniques: keratomileusis (the creation of a hinged corneal flap) and PRK. LASIK stands for Laser Assisted In-situ Keratomileusis


    1990s

  • The first LASIK surgeries in the U.S.A. are performed by Dr. Stephen Brint and Dr. Stephen Slade.


    The Evolution of Surgical Vision Correction
    Since the 1990s there have been many innovations in the field of refractive surgery. New lasers and tools have been developed, making laser eye surgery safer, more effective, and able to treat a wider range of problems. While traditional PRK and LASIK are still performed today, there are many alternatives as well, including:

    • Wavefront-guided LASIK - Wavefront technology allows the surgeon to create a 3D map of the cornea prior to surgery. The procedure can then be customized to the patient's specific needs.

    • Intralase "Bladeless" LASIK - A laser is used to create the corneal flap instead of a microkeratome blade.

    • LASEK - The surgeon uses a trephine, which is a finer blade than a microkeratome, to cut a much thinner corneal flap. This procedure is ideal for patients with corneas too thin for traditional LASIK.

    • Epi-LASIK - An epikeratome is used to separate the epithelial layer from the rest of the cornea. This is not a blade, like a microkeratome, but rather a blunt plastic separator. This procedure does not involve the application of alcohol as in other surgeries. Like LASEK, Epi-LASIK creates a very thin flap.

    • Conductive Keratoplasty (CK) - A small probe is used to apply radio-frequency energy to the cornea in a circular pattern. This produces heat which shrinks tissue in that area, resulting in a steeper cornea. This procedure is only used to treat hyperopia (farsightedness) and presbyopia. It is not for myopic (nearsighted) patients.

    • Implantable Lenses - These work like contact lenses, but are permanently implanted in the eye between the iris and the natural lens. This option is ideal for patients who are not eligible for laser correction, such as those who are severely nearsighted.

    Each procedure comes with specific benefits and risks. If you are considering surgical vision correction, be sure to discuss all the options with your ophthalmologist. He or she can help you decide which procedure is best for you.

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