Who invented LASIK surgery?

No single person invented LASIK. Rather, it was the child of a marriage of two different, early myopia (nearsightedness) correcting procedures: 1) Keratomileusis and 2) PRK (PhotoRefractive Keratoplasty).

Pioneered by Columbian ophthalmologist, José Barraquer, in Bogotà, Keratomilieusis reshaped the cornea mechanically. A micro-blade removed the front half of the cornea which was then frozen in liquid nitrogen. The frozen corneal tissue was shaped on a micro-lathe, then thawed and sutured back in place, giving the cornea a flatter surface than before. This made it focus better in a myopic eye. Keratomileusis was extremely difficult to do and lacked a high degree of accuracy. But in the 1960s, this was the only alternative to thick glasses, contact lenses not being available. His protégé, Dr. Luis Ruiz, developed a technique (ALK) that did away with the freezing and lathing. By shaving a very thin corneal flap off the front of the cornea, he would use the same microplane to thin the cornea underneath, making it flatter. By replacing the thin superficial flap, patients could see much more quickly and with less discomfort. Although this was safer and easier than keratomileusis, the accuracy was no better.

In about 1985, Steve Trokel, MD applied the idea of using a "cold" (excimer) laser to reshape the corneal surface. PRK precisely thinned and flattened the curve of the cornea's surface. But this was rather painful, needed 3-5 days for recovery, and was little more accurate than keratomileusis. Two laser companies began FDA clinical trials to determine its accuracy and safety. Some rather creative people realized quickly that the excimer laser could far more accurately and gently remove corneal tissue than in keratomileusis and also leave a super-thin flap intact above -as in ALK. The patient would have minimal discomfort and could see the very next day: the best of PRK, keratomileusis, and ALK! I was honored to have been one of the 4 American ophthalmologists to assist at what we thought was the very first LASIK. Somewhat flippantly, we called it "flap-and-zap." [We later learned several of my colleagues including Dr. George Waring were in Saudi Arabia at about the same time implementing the same idea!] A small group of us met to talk about this new technique and decided that LASIK was a more respectable name than "flap-and-zap."

What came to be called LASIK (Laser Assisted Stomal In-situ Keratomileusis) was already being performed by 1995 when the excimer laser was finally approved in the U.S., far surpassing the success of PRK!

Written by J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic

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