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Most people think of LASIK as a new procedure to treat bad vision.
But, the first LASIK procedure in the United States was actually done
over 13 years ago, and LASIK developed from surgeries that date back
over 55 years ago.
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In The Beginning
The modern day field of vision correction procedures
began in Bogota, Columbia in 1948. Dr. Jose Barraquer
would remove 60% of the cornea, freeze it, and then use
a lathe to reshape it. The cornea was then sewn back
into place. The procedure was called freeze myopic keratomileusis
(MKM for short) and seems barbaric compared to seamless modern day
LASIK surgery. MKM was an important first step in vision correction
surgery. It provided doctors with knowledge about how much of the
cornea had to be left unaltered to provide a stable long-term result.
MKM utilized a very rudimentary microkeratome, which is the instrument
that today is mainly used to create the flap in LASIK surgery.
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MKM surgery was difficult to perform well and sometimes gave unpredictable
results. Through trial and error doctors made modifications to MKM, and thus
Automated Lamellar Keratoplasty (ALK for short) was born in the 1960’s.
In ALK a microkeratome was used to create a corneal flap. The microkeratome
was then used to remove a wedge of corneal tissue from underneath the flap,
thereby correcting the patient’s nearsightedness. But, this technique still
provided inconsistent results and was abandoned pending the development of more
refined instruments and techniques.
The Development of RK
In the 1960’s Fyodorov, a Russian Ophthalmologist, ushered in a much
more reliable, albeit it manual, technique called RK. RK, also known
as radial keratotomy, made use of a scalpel to reshape the cornea. Cuts
were made through 90% of the cornea’s thickness to cause a reshaping of
it and correction of low to moderate levels of myopia and astigmatism. RK
was a reliable procedure, but could not treat a broad enough range of
myopia and astigmatism to gain the widespread acceptance that LASIK enjoys today.
Over the last thirty years several inventions set the stage for
laser vision correction. Ophthalmologists first adapted technology
that the U.S. government used to create topographic maps of the earth.
This technology made it possible to study the cornea in much greater detail
than ever before.
The Birth of Laser Vision Correction
The excimer laser was developed by the U.S. military and subsequently
altered by ophthalmologist Steven Trokel, who first described its use
in 1983 in removing corneal tissue. The excimer laser removes 39 millionths
of an inch of tissue in 12 billionths of a second. Dr. Trokel’s work lead
directly to the development of PRK, the immediate precursor to LASIK. PRK
has been performed in the U.S. for 16 years, and was a great improvement
over RK, mainly due to the accuracy of the excimer laser. With PRK only 10-20%
of the cornea needs to be altered instead of the 90% required with RK. Also,
a much larger range of prescriptions can be treated with PRK than RK. The modern
era of laser vision correction had begun.
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LASIK Takes Over
In 1991 the first LASIK procedure was performed in the U.S. LASIK
makes use of decades of research and refinements to provide an amazingly
accurate, comfortable procedure with a fast recovery time. This procedure
has been performed millions of times since its inception, making it one of
the most popular and successful surgical procedures in medical history.
Today about 99% of laser vision correction is some form of LASIK.
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As you can see, LASIK is far from new, and has given sight to millions
and millions of people. It promises to provide crystal clear vision to
many more millions of people each year. Dr. Barraquer would be proud of
where the last 55 years have taken us with vision correction surgery and
the bright future the field has that he created.
“The Art of LASIK” Second Edition, published by SLACK in 1999 was used as
a reference for this article.
Sort History about IN SHORT OF LASIK
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