| A brief history of refractive eye surgery |
| Written by Michael Asu | |
|
Refractive eye surgery has recently become a leading method of improving the function of the eye, eliminating the need for corrective glasses or contact lenses. More than a million people underwent refractive surgery last year, and the number is expected to grow as the procedure becomes more common.
Most refractive surgery today is done by means of excimer lasers which are used to reshape the corneal curvature. However, the theory of refractive surgery has been around since the late 19th century, and the first surgical attempts at refractive surgery were made in the 1930s. The very first theoretical studies concerning the possibility of refractive surgery were done by Dutch ophthalmologist Lendeer Jans Lans in Holland in the late 1890s. Lans published a theoretical treatise on the possibility of using cuts to the cornea to fix astigmatism, a disorder of the cornea where the cornea is improperly curved, causing vision to be out of focus. Lans theories saw no real practical applications until the 1930s, when Japanese ophthalmologist Tsutomu Sato endeavoured to correct the sight of military pilots with corneal cuts. Sato managed to use corneal cuts to make corrections up to six diopters (a diopter is a unit of ophthalmological measurement). Because of the high rate of corneal degeneration, however, medical authorities rejected Sato's method as unsatisfactory. By the early 1960s, the Colombian ophthalmologist Ignacio Barraquer pioneered the first successful refractive surgery technique, which was dubbed keratomileusis, or corneal reshaping. In Barraquer's method, a layer of the cornea was removed and frozen. The frozen layer was sculpted in the required shape and then reimplanted. Barraquer's new method allowed the correction of both myopia, or nearsightedness, and hyperopia, or far-sightedness. At about the same time, researcher Arthur Schawlow and Charles Townes of Bell Laboratories began their pioneering work on the laser. The laser, of course, is a device that emits light through a process known as stimulated emission. The laser has come to have many applications in industry, science, medicine and other fields. In medicine, the laser is primarily used in applications involving imaging, surgery and other therapeutic uses. The laser's relevance for refractive surgery was not immediately obvious when it was created, and did not come into the picture until much later in our story. In 1986 Casmir Swinger refined keratomileusis, by finding away to achieve the same result without freezing the corneal layer. A few years earlier a scientist at IBM who was using an Excimer laser to create microscopic circuits in mirco chips noticed that the Excimer could be used to make very fine cuts in organic tissue without substantially damaging that tissue with heat. In 1983, a Columbia University researcher named Stephen Trokel and the same IBM researcher who discovered the organic cutting applications of the Excimer laser performed the very first photorefractive keratectomy in Germany. IN 1989, the U.S. Patent Office approved the first patent for what is now known as LASIK, a surgical procedure in which the surgeon cuts a flap into the cornea with a blade and then pulls the flap back to reveal the corneal bed. After this is done, the corneal bed is then cut into the appropriate shape with an Excimer laser. Following this, the flap is replaced. LASIK proved immediately popular because it offered less pain than the traditional refractive surgery technique and improvements to vision after surgery were noticable almost right way. The LASIK procedure has been refined over the years -- the lasers are now faster, recover techniques have been improved and other innovations have been made -- and today is the surgery of choice in a vast majority of all refractive surgeries. New techniques that may eventually replace LASIK are on the horizon, however, such as FEMTEC, which is used for incision-less ablation. The basic concept of refractive surgery remains the same as that proposed by Lans back in the 1890s. Today, based on the work of Lans, Suto, Trokel, Townes and many other intellectual giants, refractive eye surgery is providing hundreds of thousands of patients with the opportunity to improve their vision without the use of glasses or contact lenses. The increase in the quality of life for the people effected by this surgery is immeasurable. |
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