Doctors began investigating corneal reshaping to correct vision in the 1800s. Understandably, the initial methods used during that time were less than sophisticated. A major breakthrough came in the early 1940s, when Colombian eye surgeon Jose Barraquer began experimenting with a microkeratome to create flaps in the corneal surface.
Refractive surgeries were performed more frequently beginning in the 1950s and 1960s, though the corrective rate was typically very poor. During the 1970s, radial keratotomy (RK) was invented in the Soviet Union and later introduced in the United States in 1978, where it was a popular procedure throughout the 1980s. RK was performed using a precisely calibrated diamond microkeratome to make the incisions necessary to reshape the cornea. While many patients who underwent this procedure experienced positive long-term outcomes, RK's major drawback was the inconsistency in vision correction from patient to patient.
The introduction of the ultraviolet excimer laser was an exciting event in the refractive surgery field. This laser allowed surgeons to precisely correct the shape of the cornea while causing no heat-related damage to the surrounding eye tissue. Improvements in technology and education eventually allowed surgeons to develop the photorefractive keratectomy (PRK) procedure in the 1980s.
In the 1990s doctors used the excimer laser to create the LASIK procedure. The LASIK name was derived from Greek ophthalmologist Ioannis Pallikaris' suggested name for the procedure. He offered the name laser in-situ keratomileusis. Keratomileusis is derived from two Greek words that together literally mean 'to shape the cornea.' In-situ means 'in place.' Therefore LASIK means to 'reshape the cornea in place using laser.'
There are two major components of the LASIK procedure - the creation of a corneal flap and the ablation of the cornea. The corneal flap allows access to the cornea so that it can be ablated by the excimer laser. The corneal flap can be created two different ways. Many LASIK, surgeons use a small oscillating blade, or microkeratome. The newest and most advanced method to create the corneal flap is the IntraLase method, which includes the use of a special femtosecond laser. The IntraLase method is also referred to as 'bladeless LASIK.'
Once the flap is created, the ablation often takes less than five minutes, after which the flap is repositioned. Most patients are able to leave relatively soon after their procedure and typically only require regular eye drops for the next five days.
The Bochner Eye Institute takes pride in providing excellent patient care. Each patient undergoes an extensive eye examination, which helps the doctor to fully assess the patient's eye health and visual acuity.
After this initial examination, the doctor meets with the patient to discuss his findings and offer an expert recommendation. In this meeting he explains each of the procedures available, the possible results and the associated risks. To help provide each patient with rewarding vision results, the Toronto LASIK specialists at Bochner Eye Institute offer the VISX STAR S4 and Allegretto Wave excimer laser platforms. Having two state-of-the-art LASIK technologies in house allows the surgeon to provide each patient with the treatment that best suits his or her needs.
Like any surgical procedure, LASIK comes with certain risks. The most common risk is under-correction, which occurs when the cornea is not sufficiently ablated, or reshaped. Under-correction often can be resolved by an enhancement procedure that is very similar to the initial LASIK procedure. An overcorrection can result in reversal of pre-treatment vision. A patient who originally was farsighted can become nearsighted, and vice versa. Most overcorrections are temporary and usually correct themselves. Other LASIK risks include postoperative effects such as halos, phantom images, poor night vision and dry eyes.
PRK used to be the most common refractive surgery before LASIK's surge in popularity. The primary difference between PRK and LASIK is that PRK does not require a corneal flap. The surgeon exposes the inner cornea prior to treatment by removing the thin outer layer of the cornea, called the epithelium. The excimer laser then ablates this inner corneal layer. The epithelium is a fast-healing tissue that quickly regenerates after surgery. Most patients wear a special contact lens to protect the eye during the recovery period. Although the final visual results between PRK and LASIK are the same, the recovery period for PRK is longer. This includes light sensitivity and discomfort during the first few days after the surgery. Although the vision is much improved following the procedure, it continues to sharpen over the first several weeks.
To learn more about photorefractive keratectomy, please visit our PRK page.
LASIK and PRK are vision correction procedures that are performed at the surface of the eye, i.e. the cornea. Many patients have also had success with intraocular techniques, which correct vision by making changes inside the eye, instead of the cornea. The Bochner Eye Institute offers two different intraocular treatments - Implantable Contact Lenses (ICLs) and Refractive Lens Exchange (RLE). To learn more about these treatments, please visit our Intraocular Techniques page.