History of LASIK: Part 1

Jennifer Kimberley

For about 110 years there have been eye doctors experimenting and writing about possible methods for improving eyesight by changing the cornea’s curvature. Before the 20th century the steps of progress were few and far between, as you can see by reading our page on Early History of Vision Correction. But after the 1930s the pace picks up.

Jose Barraquer, Father of Refractive Surgery
Jose Barraquer was born in Spain in 1916 and in 1953 moved to Colombia, where he founded an institute and trained many eye surgeons from other countries. He designed surgical instruments and worked to improve materials and techniques for cataract and corneal surgeries. But his main focus was on reshaping the cornea to change the way it refracted (bent) light. He designed the microkeratome (still used in a modified form) and developed keratomileusis.

Precursor to LASIK
He pioneered what we now know as LASIK, but he had no laser. The term LASIK is an acronym for Laser Assisted In-Situ Keratomileusis. Use of the excimer laser in keratomileusis makes it far easier, quicker, less painful, and less risky. But how did we arrive at this happy condition?

Jose Barraquer invented an instrument called a cryolathe which he used to cut thin slices of corneal tissue and freeze them. In their frozen state, he made small changes to their shape. Then he thawed them and stitched them into the person’s eye beneath a thin flap of surface tissue. This is the same approach to vision correction that our LASIK procedures take, except that Barraquer had less sophisticated tools.

A retrospective study done in Saudi Arabia
In 1993, the results were made public of an ophthalmological study done at the El Maghraby Eye Hospital in Jeddah, Saudi Arabia. This study had used the Barraquer microkeratome and cryolathe to correct severe myopia (between four and eight diopters) in 61 eyes (44 patients). They followed up with their participants for an average of 28 months afterwards.

At the end of that time, 37 eyes were within +/- 1 diopter of normal vision, and 44 eyes had 20/40 vision or better, uncorrected. Only two eyes had any complications. The ophthalmologists felt that this showed cryolathe keratomileusis (non-laser LASIK) to be a “proven and feasible technique …”

Quick Strides Towards LASIK
In 1936 a Japanese ophthalmologist named Tsutomu Sato noticed that the cornea could be flattened when he examined one which had suffered a trauma. He experimented with incisions in the cornea, trying to improve his patients’ vision, but apparently made the incisions too deeply into the cornea, and was not effective.

In the 1960s, a Russian eye doctor, Svyatoslav Nikolayevich Fyodorov, developed Radial Keratotomy. He stumbled upon it while treating a boy who had fallen off his bicycle. The boy’s glasses had broken and several pieces of glass needed to be removed from his eye. Fyodorov did this by making radial cuts from the pupil to the edge of the cornea like bicycle wheel spokes. After the boy’s eye healed, his vision was vastly improved. Radial Keratotomy (RK) was performed for many years with good effect, but is less popular now that LASIK can be modified to accommodate so many people.

In the 1970s, excimer lasers were developed. This is the laser used for treatment in a LASIK procedure. It is a cool, ultraviolet beam made from a combination of reactive and inert gases. Its UV rays are biocompatible and neither burn the eye nor penetrate deeply into it. Instead, they apply just enough light energy to disrupt the bonds between molecules on the corneal surface. This releases each molecule, separating it from the eye, and it evaporates into the air. Removal of tissue is called ablation and LASIK is an ablative procedure.

Working up to FDA Approval
Dr. Steven Trokel, a N.Y. City ophthalmologist, patented the excimer laser for vision correction. Until then it had been used for etching silicone computer chips. Some of the workers in IBM’s research department were seeing that this laser could be used on living tissue, as it could remove a tiny piece without burning any nearby tissue.

In 1987 Dr. Trokel did the first laser surgery on a person’s eyes, using the excimer laser. For the next ten years or so, scientists worked on improving the equipment until in 1995, the FDA approved the excimer laser for treatment of myopia.

Of course that wasn’t the end of experimentation or improvements.

Millions of people worldwide have now had successful LASIK surgeries, and have delighted in the dramatic improvement in their vision. If you are wondering about joining their number, the first step would be to set up a consultation with a qualified LASIK surgeon. LASIK is not for everyone, but a good eye surgeon can examine your eyes and advise you as to which procedure would be most effective and appropriate for you.

Click to View the Interactive Cataracts and Glaucoma Vision Test.