#2: LASIK Procedure

Keratomileusis is not a new procedure. It was, in fact, first conceptualized in the 1940s by José Ignacio Barraquer Moner as a way to correct refractive errors by sculpting corneal stromal tissue to change corneal curvature. The in situ keratomileusis procedure was initially described in the early 1980s by surgeons who removed tissue from the stromal bed rather than the free corneal cap. Still, because of the technical skill necessary to perform this manual surgery, procedures were rare and outcomes were often unpredictable.

In the early 1980s, scientists at the IBM Research Laboratory discovered that an ultraviolet excimer laser could etch living tissue with precision and no thermal damage to the surrounding area. This breakthrough spurred innovation in a variety of areas, perhaps most notably in refractive laser eye surgery.

The first LASIK procedure was performed in 1990. It took approximately a decade more for the procedure to be approved in the United States and Europe. LASIK peaked in popularity in the United States and through most of Europe between 2000 and 2009 and the procedure remains the most popular elective surgery in the world, with an estimated 35 million procedures performed by 2010.

LASIK flap as seen with the SPECTRALIS(R) OCT Anterior Segment Module

Since its initial approval, a variety of advances have been made to improve the precision and ease of use of the LASIK procedure. In 2002, wavefront analysis for LASIK was approved by the US Food and Drug Administration, allowing surgeons to develop a 3-dimensional corneal map prior to surgery and to better individualize each patient procedure.

Use of a femtosecond laser during LASIK surgery was popularized in the late 2000s, with the number of LASIK procedures performed with femtosecond laser increasing from 30% in 2006 to 55% in 2009. The use of femtosecond laser has reduced the incidence of flap complications and allowed surgeons to cut thinner flaps to accommodate a broader range of patients.

These advances have resulted in significantly improved patient outcomes. Approximately 90% to 95% of today’s LASIK patients achieve 20/20 vision or better following surgery compared to only about 65% in the early 1990s.