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The History of Laser Eye Surgery
Laser eye surgery is a modern procedure for vision correction. The procedures use lasers to reshape the eyes’ surface.
Here’s a timeline of how laser eye surgery developed over time:
1948. Columbian ophthalmologist Jose Barraquer developed the microkeratome and keratomileusis technique. This approach involves cutting thin flaps of the cornea to provide long-term vision improvement.
1970’s and 1980’s. Russian scientist Svyatoslav Fyodorv developed Radial Keratotomy (RK) and was responsible for the first posterior chamber implantable contact lens.
1980. Indian physical chemist Rangaswamy Srinivasan discovered that an ultraviolet excimer laser could etch a living tissue with precision. This is called ablative photo-decomposition (APD).
1985. American opthamologist Stephen L Trokel experimented with ultraviolet excimer laser with eye procedures. He experimented on animal and human cadavers, and eventually on living animals. He then published his findings in radial keratotomy.
1987. Marguerite McDonald, also an American opthamologist, performed the first successful photorefractive keratectomy (PRK) based on Trokel’s theory.
Who Invented LASIK Eye Surgery?
Dr. Gholam Peyman, an Iranian-American opthamologist, invented laser in-situ keratomileusis (LASIK) eye surgery.
In 1989, after various trials, he patented the invention of the laser designed to reshape the cornea. Dr. Peyman also holds 124 other patents in the U.S.
In 1998, the FDA approved the first laser to perform LASIK.
Lasersight Technologies Inc. was the first manufacturer to receive FDA approval. Although Dr. Peyman is responsible for developing LASIK, other scientific professionals also contributed to its improvement.
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How it Started: The First LASIK Technique
As mentioned, LASIK started with the invention of the excimer laser.
The first technique of keratomileusis was developed in 1948 to correct refractive errors. The initial procedure involved freezing a disc of anterior corneal tissue. Then, a lathe helped remove stromal tissue.
Over the years, the laser eye surgery technique was developed. It eventually led to the creation of laser in-situ keratomileusis (LASIK).
How Has LASIK Progressed Over Time?
In 1990, microkeratome was used to create a thin flap in the cornea. Once the flap was lifted, the excimer laser was applied to the stromal bed. This technique differs from PRK, which applies the excimer laser directly to the surface layer of the cornea.
LASIK techniques include both microkeratome and excimer lasers.
However, because of LASIK’s continuous improvement, it now uses wavefront technology and a femtosecond laser. Modern LASIK surgeries include both technologies in their standard practices.
Surgeons use a femtosecond laser instead of a microkeratome laser to perform bladeless LASIK surgery. The femtosecond laser is popular because of its precision in cutting the corneal flap needed for the procedure.
On the other hand, Wavefront LASIK is popular because of its personalization. First, the doctor evaluates the person’s eye characteristics and creates a 3D map of the cornea. Then, they program the excimer laser based on the information gathered.
Success Rates of Modern LASIK Surgery
Studies revealed that 96 percent of LASIK patients are satisfied with the surgery’s outcomes. This is considered to be the highest satisfaction rate for any elective procedure.
According to the US Food and Drug Administration (FDA), PRK's overall success rate is approximately 95%.
LASIK and PRK are similar in terms of success rate. This shows that PRK is an excellent alternative for patients who aren't eligible for LASIK.
The success rate of LASIK and PRK surgeries depends on multiple factors, including:
- Visual acuity (vision sharpness)
- Overall patient satisfaction
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Types of Laser Eye Surgeries Available Today
There are three main types of modern laser eye surgery. These include:
LASIK is the most commonly performed modern surgery for correcting vision problems. It stands for laser-assisted in situ keratomileusis.
The surgery involves two lasers: one for cutting the thin flap and the other for shaping the cornea underneath. LASIK can correct:
SMILE is a laser eye surgery that corrects nearsightedness. It stands for small incision lenticule extraction.
The SMILE procedure uses a femtosecond laser to create a small opening. This allows for removal of the lenticule (lens-shaped tissue) within the cornea. Once removed, nearsightedness is corrected.
3. Surface Laser Treatments (PRK and LASEK)
These treatments are considered LASIK alternatives:
Photorefractive Keratectomy (PRK)
In PRK, the surgeon does not create the corneal flap. Instead, they remove the epithelium to expose the underlying stromal tissue. The epithelium is like skin for the cornea that protects its deeper layers and maintains clear vision.
LASEK or Advanced Surface Ablation (ASA)
LASEK stands for laser epithelial keratomileusis. This surgery can correct vision problems such as:
Compared to PRK, LASEK surgery creates a very thin flap in the epithelium which is replaced after surgery. Unlike in PRK, it removes the epithelium completely. Eye surgeons usually opt for advanced surface ablation (ASA) when the cornea is too thin to support LASIK.
With all three types, it’s important to consult a doctor to determine which procedure is best for you. Your surgeon can explain all risks and options to make it easier for you to decide.
With continuous technological advancements, we can expect improvements in the following LASIK strategies:
- Microkeratome technology
- More detailed screenings of patients’ eligibility for LASIK
- New technologies for identifying corneal curvature surface irregularities
- More customized LASIK treatments
- Other refinements to make the surgery more efficient
LASIK is a popular refractive surgery because of its effectiveness. It is not foreseen to end soon; rather, it will continue to evolve and improve over time.
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