The Story of Lasik
It has now been approximately 15 years since LASIK was first performed and it has become the most popular, successful, safest, refractive procedure of all time.
In 1949, Professor Dr Jose I Barraquer of Bogata, Colombia, perfected the operation known as lamellar keratoplasty. He learned how to separate the superficial corneal surface with an innovative and delicate instrument called the microkeratome, by removing a small piece of cornea, refining it with a lathe and then suturing it back into place. This led to the beginning of the corneal refractive surgery era. By the 1960s, this line of surgery was known as 'lamellar' surgery and the operation, in which the cornea was reshaped by mechanical means, was called myopic keratomileusis (MKM). The creation of the flap was essentially the same as current mechanical methods. Why the procedure was not so popular was that the mechanical means of reshaping the cornea after the flap was made were always going to be inexact. We now have 30-year-follow-up results on MKM demonstrating stability. It was not until the advent of the laser that extreme accuracy, greater than that really required was made available in the shape of the excimer laser.
Forty years after the first trial of Dr Barraquer's procedure, Dr Trokel in New York and Dr Marshall in London used the excimer laser directly on the outermost layers of cornea to treat short-sightedness, long-sightedness and astigmatism, which is now called PRK (Photo Refractive Keratectomy). The first case was performed 20 years ago. Although this procedure was widely used, its limitation is the unpredictability in higher ranges of refractive error and higher risk of corneal haze after surgery. In 1990 Dr Buratto and Dr Ionnis Pallikaris of Greece adapted and combined these two techniques, lamellar surgery, with its rapid healing and lack of haze, and the submicron accuracy of the excimer laser. This was the development of the basic concept of LASIK which is highly precise and has few, if any, complications. Long term results on patients have recently been made available, underlining our confidence in lamellar surgery, of which LASIK is an important example.
This accuracy could never be achieved by mechanical means. Since then many millions of procedures have been performed around the world. Dr Wolfe was one of the pioneering surgeons to perform the first LASIK procedure in Australia in 1996.