LASIK Innovation: A History of Vision Correction Advances

1940s-1950s: The Foundation of Refractive Surgery

One of the early pioneers in refractive surgery was Jose Barraquer, M.D. In his clinic in Bogota, Columbia, in the late 1940s, he worked on his idea to reshape the cornea. His work on the concept of cornea-based surgery to decrease a patient’s reliance on glasses led to the development of the microkeratome, a tool instrumental in the LASIK procedure. Moving from a manual dissection of the cornea to a mechanized technique, he first used a prototype microkeratome in 1958 to remove a disc of corneal tissue. Next, he coupled the use of the microkeratome with a cryolathe. The cryolathe was an instrument used to carve the corneal disc removed by the microkeratome. Once the disc was reshaped to compensate for the patient’s refractive error, it was reattached to the patient’s cornea. Interestingly, the cryolathe was based on the same technique used to generate contact lenses.

Because the use of the cryolathe had certain drawbacks, Barraquer and others in the 1980s introduced a non-freeze technique that gained popularity among ophthalmologists. It involved using a microkeratome to make two separate cuts on the cornea and removing the tissue from the second cut to effect a change in the corneal shape. Automated lamellar keratoplasty (ALK) was a big advancement in corneal-based surgery, but its accuracy was not good as many had hoped.

1980s: The Introduction of Laser Technology

At approximately the same time, Stephen Trokel, M.D., began to explore the possibility of using the newly-invented excimer laser to perform surgical removal of corneal tissue. This laser removal of tissue was shown to be effective in flattening the central cornea, first in animal models and then later in humans. The first patients treated were blind, and when their recovery showed no damage to the clarity and structure of the human cornea, the first sighted patients were treated in the mid-1980s. This procedure was named photorefractive keratectomy (PRK). Because PRK removed tissue from the front part of the cornea after the creation of a well-controlled corneal abrasion, recovery was measured in weeks.

1990s: The Birth of Modern LASIK

In 1989, Lucio Buratto, M.D., of Italy introduced a procedure combining the microkeratome and the excimer laser. A corneal cap was created using the microkeratome, followed by tissue removal from the surface under the cap, or the exposed cornea under the cap, using the excimer laser, a technique called excimer laser intrastromal keratomileusis (ELISK). Further refinement led to a procedure where the corneal cap was not completely removed from the cornea, but rather left partially attached. This made for easier repositioning of the cap, and thus began the era of laser assisted in situ keratomileusis (LASIK).

2000s-2010s: Advancements in LASIK Technology

The evolution of LASIK has been marked by continuous technological improvements aimed at increasing precision, safety, and patient satisfaction. Key advancements include:

• Bladeless LASIK (2001): The introduction of femtosecond lasers enabled the creation of corneal flaps without blades, enhancing precision and reducing complications. This method, developed by researchers Tibor Juhasz and Ron Kurtz, led to the founding of IntraLase, a company specializing in bladeless LASIK technology.

• Wavefront-Guided LASIK (2002): FDA-approved technology that customizes laser treatment using detailed measurements of the eye’s aberrations, improving visual outcomes and reducing side effects.

• Topography-Guided LASIK (2015): This approach maps the corneal surface to guide laser treatment, addressing irregularities and enhancing visual quality. Nearly 100% of patients undergoing all-laser topography-guided LASIK achieve 20/20 vision or better.

2020s-Present: Refinements and Future Innovations

Today, LASIK continues to be one of the safest and most effective elective procedures, with a satisfaction rate exceeding 98%. While the procedure has been fine-tuned over decades, ongoing research aims to expand eligibility and further enhance outcomes. Innovations such as corneal cross-linking are being explored to strengthen the cornea, potentially allowing individuals with thinner corneas or mild keratoconus to become candidates for LASIK.