History of LASIK Eye Surgery

When trying to understand LASIK eye surgery, it helps to know its history. This is an outline of the development of refractive surgeries, including Radial Keratotomy, PRK, and LASIK. By knowing this, you will be informed and better able to ask questions of your surgeon.Refractive surgery is done on the eye to diminish dependence on corrective lenses. These surgeries can correct refractive errors, such as
nearsightedness, farsightedness and astigmatism. LASIK was preceded by several other procedures. The concept of changing the shape of the cornea to improve vision was conceived in the mid-1800s when an experiment using a spring-mounted mallet attempted to flatten the cornea through the closed eye.

Incisional surgery (keratotomy) was tried in The Netherlands in 1898. In the 1940s and 1950s there were clinical trials in Japan. These surgeons placed incisions in the cornea, causing it to flatten, thereby correcting nearsightedness. They concluded that the amount of vision correction achieved was directly related to the number and size of the incisions. A USSR surgeon experimented in Radial Keratotomy (RK) in the 1960's, and made RK safer by placing incisions on the anterior surface of the eye, instead of the posterior. Predictable results were achieved by using steel surgical blades and a standard formula of correction.The National Eye Institute study in the US in the late 1970s demonstrated RK's effectiveness, but a high percentage of patients with fluctuating vision was noted. This caused decreased popularity of RK, but development of diamond micrometer cutting blades and microscopic guidance caused a surge in RK surgeries in the early 1990s.

Keratomileusis surgery was developed in the 1970s. Research into the use of the excimer laser began in 1973. Its first ophthalmological use was in 1981 and the race was on for LASIK. Automated Lamellar Keratectomy (ALK) was created in 1982, using an automated device called a microkeratome. The first PRK in the US was performed in 1987 on a blind eye and in 1988 the first United States PRK was done on a person with nearsightedness. LASIK, as it is known today, was originally described in 1989 when a Greek physician used the excimer laser to treat the stroma beneath a flap.The US Food and Drug Administration approved the use of the Summit laser for PRK correction of nearsightedness in 1995 and the VISX laser in 1996, after a series of clinical studies. The excimer laser was approved for PRK in 1995 for correcting nearsightedness. LASIK became more predictable and the word spread about the lack of pain and the rapid visual improvements. Demand grew. In 1997, the FDA listed the procedure as 'off label' and any licensed physician was permitted to perform LASIK. The FDA approved LASIK as a medical procedure in 1999. Some estimates say that LASIK accounts for 98% of all refractive surgeries worldwide.

Vision problems have plagued humanity since our beginning. We developed corrective lenses long before we attempted to surgically correct vision. It was a long road to the development of LASIK eye surgery. Even though LASIK is generally successful, new developments in surgery may vastly improve even this procedure in the near future.
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