LASIK

In the 1940's, Dr. Jose Barraquer originally from Spain who had moved to Bogota, Colombia developed a procedure called keratomileusis where a disc of corneal tissue was removed, frozen and reshaped using a device called a cryolathe. The procedure met with reasonable success but required a high degree of technical expertise to master the intricacies of the equipment and the surgical technique. Over the ensuing decades refractive surgeons refined the technique, but it failed to get widespread acceptance due to its complexity and long recovery time. Dr. Barraquer's creative approach had potential, and in retrospect it appears to have been truly a great idea simply waiting for technology to catch up.

In the 1980's as more and more surgeons focused on RK and the excimer laser for correcting refractive errors. Dr. Luis A. Ruiz, a past student of Dr. Barraquer, continued research in the field. This research led to the invention of a new microsurgical instrument that would be used for a technique he called automated lamellar keratoplasty, or ALK. Dr. Ruiz had created two major breakthroughs with this technique. The first was that Dr. Ruiz showed that a microsurgical instrument could remove the corneal cap simply for the purpose of gaining access to the underlying cornea who's shape could then be altered (previous keratomileusis techniques worked at changing the shape of the cap itself). The second breakthrough was having a machine that was actually automated, i.e. it quickly and gently passed across the cornea with the same speed and pressure every time (unlike previous keratomileusis instruments that were manually and therefore variably passed across the cornea). With this automated microkeratome ALK was easier for surgeons to perform and obtain reproducible results.

In 1990, Dr. Iannis Pallikaris of Greece, demonstrated the idea of combining keratomileusis with the excimer laser. Dr. Ruiz quickly saw the advantage to this approach. With his microkeratome first creating the cap of the corneal tissue to provide access to the underlying cornea, the shape of this underlying cornea was then altered not with the same microkeratome as was done with ALK but with the excimer laser. The laser performed this part of the procedure with greater accuracy and with more versatility enabling the correction of not only myopia but also of astigmatism and hyperopia. This procedure came to be known as LASIK (Laser Assisted In Situ Keratomileusis). With LASIK we were able to obtain excellent results first for both myopia, and astigmatism and then also for hyperopia .

LASIK has quickly become the refractive surgery technique of choice by most of the leading refractive surgeons throughout the world.

Radial Keratotomy

Radial Keratotomy (RK) for the treatment of nearsightedness and Astigmatic Keratotomy (AK) for the treatment of astigmatism had it's earliest beginnings in the 1800's in Europe, and then it was more fully developed in the 1940's in Japan. But it was not until its refinement in Moscow by Dr. S. Fyodorov in the 1970's that the technique was successful enough to be adopted by surgeons throughout the world. During the 1980's RK and AK were further developed with increasing experience and technological advances to the point where a conservative approach to RK gave very good results for mild amounts of nearsightedness and astigmatism.

PRK

The excimer laser was developed in the 1970's for industrial purposes, and in the early 1980's Dr. Stephen Trokel at Columbia University in New York recognized its theoretical potential for refractive surgery. Since it was a "cold laser" he thought it should be able to remove microscopic amounts of corneal tissue without damaging the adjacent corneal cells. Dr. Trokel and other researchers then began intensive work on this enabling the start of FDA clinical studies in the U.S. in the late 1980's. An excimer laser machine was fully approved for use in the US for the treatment of mild to moderate nearsightedness in October 1995 utilizing the technique that came to be called photorefractive keratectomy, or PRK. In early 1997 an excimer laser was approved in the US for the treatment of astigmatism. In 1998 an excimer laser was approved in the US for the treatment of hyperopia.