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The laser eye surgery story


The laser eye surgery story

Today, most people take safe, accurate laser eye surgery for granted. However, the journey to get to where we are today has taken many decades. Here’s a brief history of laser eye surgery.

First steps – before the laser…

In the 1930s, long before the advent of laser eye surgery, Dr Sato in Japan was the first to introduce vision correction surgery. He used a scalpel to make incisions on the inside surface of the cornea that would radiate out, rather like slicing a pizza. His technique appeared successful at first, but ultimately failed, and all his patients had to have corneal grafts. During the 60s and 70s, Dr Barraquer in Colombia developed a novel technique for reshaping the cornea. This involved removing a piece of the cornea, reshaping it on a special lathe and replacing it back in the eye. His research was the basis for modern vision correction surgery techniques. The next vision correction development pre laser eye surgery came along in the 1970s. In Moscow, Dr Fyoderov used a similar technique, although this time on the front surface of the cornea. The technique, which he called ‘radial keratotomy’, allowed the steep myopic cornea to flatten and re-shape in the centre.

A story that began over 40 years ago

The laser eye surgery story actually began with microchips. In 1980, an IBM scientist was busy operating an excimer laser while producing circuits in microchips for information equipment when it occurred to him that the laser could also cut organic tissue without creating damage to the surrounding tissue.

The journey begins in earnest

In 1983, a highly influential article appeared in the American Journal of Ophthalmology that outlined the basic principles behind laser eye surgery. It explained the results of experiments on animal corneas and suggested the use of the excimer laser for refractive cornea surgery. The article, written by Dr Stephen Trokel, MD; Rangaswamy Srinvasan, PhD and Bodil Braren, was, effectively, the beginning of an exciting journey, one that was to create a paradigm shift in how vision correction would be perceived. Laser eye surgery was unknown in 1983, but such was its progress, it would go on to transform the lives of millions of people across the globe.

The unstoppable march of progress

During the 1980s, experiments into how to best utilise technology to perform laser eye surgery continued around the world at a hot pace. A book could be written on what was being discovered during this time, although some of the most notable events included:

  • 1983 – New York ophthalmologist, Dr Steven Trokel, discovered the ability to re-shape the cornea with an excimer laser
  • 1984 – Laser experiments on animals indicate that corneal tissue could be removed without leaving a scar
  • 1985 – London ophthalmologist, John Marshall, recognised that the tissue needed to be removed from the cornea in the shape of a disc, rather than the radiating lines the others were working on and PRK was born.
  • 1985 – Dr Theo Seiler performs the first excimer laser procedure (PRK) on a human patient in Dresden
  • 1986 – First excimer laser prototype shown at American Academy of Ophthalmology (AAO) meeting in New Orleans, Louisiana
  • 1986 – Seiler, Trokel and Marshall, leading pioneers of laser technology, host the first Corneal Laser Congress in Berlin, Germany
  • 1987 – First Summit Technologies excimer laser using broad-area ablation shown at AAO meeting in Dallas, Texas
  • 1988 – Dr Marguerite McDonald performed the first PRK laser eye surgery procedure on a healthy eye in New Orleans, Louisiana
  • 1989 – Greek ophthalmologist, Ionnis Pallikaris, conceived the technique now known as LASIK, where a flap is raised in the cornea prior to laser eye surgery
  • 1989 – In Italy, Dr Lucio Buratto independently came to a similar conclusion as Pallikaris, although his technique was somewhat different and not ultimately as successful

Popularity and further refinements

In the early 1990s, there was a general consensus that LASIK would allow a more rapid recovery compared to PRK, a procedure that could sometimes require a number of weeks for recovery. However, there was continued debate about whether laser eye surgery should be carried out on both eyes in one session, or sequentially, with a time gap of days, or even weeks before the second eye was subject to a procedure. Even so, despite these discussions, it was clear that laser eye surgery was here to stay.

As more lessons were learned, it became a matter of discovering how to refine the technology further. While laser eye surgery became ever more popular, during these early days it was noted that some patients were not totally satisfied with the results achieved even though they had 20/20 vision. Nevertheless, the many advantages of laser eye surgery over glasses and contact lenses, especially in demanding active service conditions, was sufficient to gain strong support from defence forces around the world (it is now highly recommended that their personnel who need glasses or wear contact lenses undergo laser eye surgery).

The late 1990s saw the introduction of topography-guided LASIK (such as Wavefront) to gauge astigmatism more accurately. Then came femtosecond lasers in 2003, which were able to enhance the reproducibility and uniformity of the flap.

Another step forward – SMILE laser eye surgery

Laser eye surgery has come a long way since the 1980s and the current state-of-the-art technology is called SMILE laser surgery. Rather than cutting a flap (as in LASIK), SMILE laser uses a computer-guided, highly-focussed laser to create a tiny disc of tissue within the cornea. This is removed through a keyhole incision, leaving the cornea with a new shape for clear vision without glasses. Remarkably, the whole process takes just 25 seconds. This latest laser eye surgery technology introduces a one-step process to the procedure for the first time. A single laser defines the disc of tissue to be removed and creates the micro-incision. The major difference is that, unlike in LASIK, the top layers of the cornea remain undisturbed by the procedure, resulting in fewer dry eye issues and better corneal integrity. So, after 40 years, laser eye surgery has come a very long way. Today, the procedure is easier, faster and more accurate than ever before, so for patients it’s all good news. Now, it’s a lifestyle decision that’s easier to make than ever before.

Find more information about laser eye surgery here.

All medical procedures have benefits, risks and possible complications. If you have any queries regarding vision correction procedures please contact us.

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