The Early Years
Among the earliest attempts at refractive surgery was conceived by Dr. Jose Barraquer, M.D. of Bogotá, Columbia. He first conceived of reshaping the cornea to reduce a patient’s reliance on glasses in his clinic in the late 1940’s Dr. Barraquer’s work on the concept of reshaping the cornea to correct vision led to the creation of a microkeratome, a blade used to dissect the cornea to remove tissue. A prototype of the mechanized microkeratome was first used in 1958 to remove a segment of corneal tissue, freeze it, reshape it and reattach it to the surface of the eye.
The Happy Accident
In 1974 a Russian Ophthalmologist, Svyatoslav Fyodorov had a young, nearsighted patient who had injured his eye after falling, breaking his glasses and getting some of the glass in his eye. To remove the glass, Dr Fyodorov performed an operation consisting of numerous radial incisions. As the eye healed, all were surprised to find that the boy’s vision was better in his injured eye than before his injury!
Refinement of his technique led to Radial Keratometry, or RK. This was a highly popular procedure in the 1980s and early 90s, though there were problems. While many people enjoyed great vision following RK, many others found the healing of the RK incisions was often slow and unpredictable. Even years following the surgery, some patients’ vision can be variable. The treatment range of RK was also problematic, in that it could only treat people with low levels of nearsightedness. It was not an option for those moderately or highly nearsighted, nor for any level of farsightedness, nor astigmatism. Attempts were made to push the envelope, including incisions (AK) meant to relax astigmatism, in order to treat more people but results were less than satisfactory.
The Laser Generation
In the 1987, Dr. Steven Trokel first used the excimer laser for eye surgery and performed the first PRK (Photorefractive Keratectomy). They spent the next ten years perfecting the excimer laser for the eye and in 1996 PRK was approved for vision correction by the FDA. PRK is a treatment where the laser is applied directly to the corneal surface. PRK is less often used because the procedure is slower to heal, and the discomfort experienced by the patient is greater, however, an excellent result can be expected with this procedure and it is often still used today to treat eyes that aren’t viable for LASIK.
In 1990, two European Doctors used a thin microkeratome blade to create a flap, applied the laser to the cornea and returned the flap to its original position and created the very first LASIK procedure. The use of the flap enabled the surgeons to minimize post op discomfort. Additionally, the flap acts as a natural bandage and encourages rapid healing. LASIK was approved by the FDA in 1996. Many refinements have come along including the use of a femtosecond laser to replace the microkeratome blade, thereby ensuring more accuracy. Wavefront technology allows patients with astigmatism to be treated as well as those suffering from near and farsightedness.
State of the Art
Pacific Laser Eye Center uses the Zeiss Visumax femtosecond laser in combination with the Alcon Allegretto Wavelight to create the best visual outcome for our patients! Both Drs. Barth and Rich have been doing the procedure since it’s approval in 1996 and have left quite a wake of happy patients, enjoying a freedom they had only dreamed!