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History
of Refractive Surgery
Physicians
have been performing refractive surgery since the 1970s. Refractive
procedures have dramatically improved in recent years with the introduction
of the excimer laser. The excimer laser is a computer controlled ultraviolet
beam of light that reshapes the eye's cornea so light can focus more
directly on the retina, thereby reducing refractive errors. The excimer
laser has been in use since the early 1980s and is now widely used
around the world for Laser Vision Correction procedures. The laser
is extremely accurate and can remove portions of tissue smaller than
the thickness of a human hair. LASIK has proven to be one of this
century's most amazing technological breakthroughs in eye care. In
its second decade of use, the excimer laser adds a tremendous amount
of precision, control and safety to the surgical correction of vision
errors.
From
RK…
In the early 1970’s a Russian physician, Dr. Svyatoslav Fyodorov,
treated a patient with glass fragments in his eyes. Dr. Fyodorov noted
that after the glass fragments were removed and the cornea had healed,
the patient was able to see better without glasses. After researching
past efforts at refractive surgery, he worked out a formula that made
this procedure more predictable then it had ever been before. In 1978
he then began working on methods with cuts being made to the outer
surface of the cornea to change the shape of the eye, which later
became known as radial keratotomy. In the late 1980’s as more
and more patients were having RK on their eyes, and the instruments
used during surgery were improved as well. Gem-quality, highly polished
diamond blades took the place of metal blades that were being used.
Improved techniques and advances in instrumentation made radial keratotomy
a predictable, precise, and safe alternative to eyeglasses and contact
lenses. Since it was introduced, radial keratotomy has been performed
on over 2 million patients in the United States alone. However, a
number of limitations of radial keratotomy prompted research into
alternate forms of refractive surgery.
To
PRK…
In the late 1980’s, excimer lasers were developed for use in
myopia correction. Doctors and researchers began looking at lasers
to improve the predictability and precision of refractive surgery
in altering the shape and thickness of the cornea. Using a beam of
cool ultraviolet light, the excimer laser creates a slight thinning
of the corneal surface in order to achieve the desired flattening
effect. This laser can remove 1/4 of 1/1000 of one millimeter at a
time. This procedure, known as Photorefractive Keratectomy, or PRK,
could more accurately correct much higher levels of nearsightedness,
astigmatism and even farsightedness. The first patient to have photorefractive
keratectomy was treated in Germany in 1988. As of November 1994, it
is estimated that over 1,000,000 PRK cases have been performed in
40 countries around the world.
To
LASIK
In 1991, Dr. Ionas Pallikaris was the first physician to use the microkeratome
to create a thin corneal cap and then apply the excimer laser to reshape
the internal cornea. The word "Keratomileusis" is derived
from two Greek words that literally mean "to shape the cornea".
"In-situ" means "within". The term LASIK literally
means "to reshape the
cornea from within using laser". LASIK has become increasingly
popular with leading surgeons throughout the world, replacing previous
forms of refractive procedures like RK. Now the challenge is improving
the lasers for precision, predictability of results, and cost effectiveness
for accessibility.
