The History of Laser Eye Surgery in America

When people first learn about the history of laser eye surgery in this country, they are surprised to discover that the first LASIK procedure was performed in America only over 15 years ago. However, the history of laser eye surgery really began in what may nowadays seem like a barbaric procedure.

MKM – 1948
Back in late 1940s Bogota, Colombia, Dr. Jose Barraquer would take out more than half of a patient’s cornea, freeze it, reshape it with a lathe, and then sew it back into the eye. No matter how gruesome it may seem compared to laser surgery, the procedure called MKM (freeze myopic keratomileusis) was where modern vision correction surgery originated.

Through MKM, doctors gained knowledge on just how much of the cornea should be left untouched to achieve vision stability for the long term. Furthermore, MKM made use of a basic blade, a more refined version of which is used today to create the flap in LASIK eye surgery.

ALK – ca. 1960
The main problem with MKM is that it was very hard to do accurately and results were, at times, unpredictable. Doctors eventually modified MKM in the 1960s and came up with ALK (automated lamellar keratoplasty)—embarking on the next, if short-lived, stage in the history of laser eye surgery.

The newer procedure made use of a more refined blade to create a corneal flap; and then, the blade was also used to take away a piece of tissue out from under the flap. ALK corrected nearsightedness, but results were inconsistent. The procedure was eventually abandoned until more refinements could make it more accurate.

RK – ca. 1970
The history of laser eye surgery will not be complete without mentioning the procedure that predated it, RK (radial keratotomy).

A Russian ophthalmologist, named Dr. Fyodorov, is credited with pioneering the more reliable RK. A remarkable story attaches itself to the discovery because Fyodorov made his discovery in the 1960s while treating a case of eye trauma in a boy who suffered cuts in the cornea when his glasses were smashed on his face.

After finding the boy’s vision improved after he was treated for the injury, Fyodorov retraced the procedure and researched past efforts in the field. In RK, a scalpel is used to restructure the cornea by making radial cuts through 90% of the cornea’s thickness.

By 1978, the procedure had already caught the attention of American ophthalmologists.

RK corrected low to moderate myopia and astigmatism. But while RK was a dependable medical option, it was not applicable to all cases of myopia and astigmatism.

Excimer Laser – 1983
Medical history has, many times before, progressed by leaps and bounds due to technology created by the US military. The history of laser eye surgery is no exception.

Developed by the US military, the excimer laser was first described by ophthalmologist Steven Trokel in 1983 as being a great tool for getting rid of corneal tissue (39-millionths-of-an-inch of tissue is removed in 12-billionths-of-a-second).

PRK and LASIK
Dr. Trokel’s discovery led to PRK (photorefractive keratectomy). With PRK, only 10%-20% of the cornea need be modified instead of the 90% in RK. Moreover, a broader range of eye conditions can be remedied with PRK. Although a precursor to LASIK, RK is still performed today on patients for whom the procedure specifically suited.

The first LASIK procedure was conducted in America in 1991. LASIK stands for Laser Assisted In Situ Keratomileusis. The procedure involves a blade used to cut a corneal flap, after which the laser is used to remove tissue from under the flap.

Although PRK does not entail the creation of a corneal flap, LASIK, on the other hand, allows the cornea to remain mostly intact, unlike PRK. Therefore, patients who undergo LASIK surgery are more comfortable and recover faster after the procedure.

Around 99% of all laser eye procedures performed in the US uses some form of LASIK eye surgery.