History of Laser Eye Surgery

Laser eye surgery is a type of refractive surgery used to treat a variety of vision problems. This treatment uses laser technology to change the shape or size of the eye's outer surface, known as the cornea. Various types of laser eye surgery are available to treat nearsightedness, farsightedness, and astigmatism, providing an alternative to glasses or contacts. Scientists have experimented with cornea modification for hundreds of years, but it took the development of modern lasers to make laser eye surgery a viable option for a large number of patients.

Earliest History

• The development of laser eye surgery began in 1823 when scientist Johannes E. Purkinje determined that visions are formed by the reflection of external light. His work was the basis for the modern science of keratometry, which involves measuring and understanding the shape and size of the cornea. By 1867, surgeons had begun using regular surgical tools to perform cataract surgery, with limited success. In 1869, ophthalmologist Hermann Snellen was the first to propose treating vision problems by cutting the cornea.

The First Vision Surgery

• The first successful use of surgery to treat a vision problem was performed in 1895 by Dutch surgeon E. Faber. After a corneal incision to treat astigmatism, Faber's patient was able to pass the eye tests needed for acceptance at the Royal Military Academy. Research and study in the field continued throughout the early 20th century, with few successes. In 1939, a Japanese doctor named Tsutomu Sato greatly expanded the modern practice of keratotomy. His work in the field began when a patient experienced a fall that broke the patient's eyeglasses. The broken glass cut his eye, and when the eye healed, the patient found his astigmatism cured. This led Sato to experiment with cornea surgery on a large number of patients in the 1940s and 50s. After his death, it was found that many of these cases led to a number of complications, though Sato is credited with making keratotomy surgery a viable option for the public.

Laser Eye Surgery

• Building on Sato's work, surgeons around the world worked to perfect corneal surgery throughout the 20th century. By the 1970s, scientists understood that simply changing the shape of the cornea's inner layers produced better results than other cuts or shaving. This was achieved by removing an inner cornea layer, freezing it, then replacing it in the eye. The changed shape could often heal most vision problems. In 1980, the first laser eye surgery was performed by a group of American scientists. Led by Dr. Gohlam E. Peyman, the team used a carbon dioxide labor to shrink a patient's cornea without removing it. At the same time, a European team used an excimer laser to flatten the cornea in a process called Photorefractive Keratectmoy (PRK).

The Last 20th Century

• Throughout the 1980s, PRK became the dominant type of laser eye surgery. While it was considered fairly accurate and reliable, PRK came with several complications. First, it involved a fair amount of pain for patients, along with a week long recovery period. Second, many patients were left with vision problems such as haze or blurriness. Because of these problems, PRK was eventually abandoned in favor of laser-guided cornea reshaping. With improved laser technology, surgeons were able to safely and effectively reshape the cornea with minimal complications. The process was eventually named LASIK, which stands for Laser (LAS) In situ (I) Keratomileusis (K), which refers to cornea reshaping.

Modern Laser Eye Surgery

• As lasers and surgery techniques become more advanced, laser eye surgery is available to a wider number of patients with more complicated vision problems. Those with thin corneas may be better suited LASEK, which combines PRK and LASIK technologies to treat the eye. While traditional LASIK uses a blade to create a small flap in the cornea to provide laser access, Bladeless LASIK instead uses two lasers, which may be safer for some higher risk patients. Custom Wavefront LASIK uses a computer to create a custom cornea reshaping based on an individual's unique eye shape and vision issues.