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Nearsightedness has plagued humanity for centuries, probably since Cave Man days. Attempts to correct it have mostly been the engine driving refractive surgery experiments and leading to our modern LASIK procedures. Ancient Chinese people are said to have slept with sandbags on their eyes, to flatten the corneas and correct for nearsightedness. Leonardo da Vinci in fifteenth century Italy doodled diagrams of the eye and ways vision might be impaired. Nineteenth century Europe came up with a procedure using a spring-mounted mallet to flatten the cornea. Another procedure used a strong rubber band. Luckily for us, eye surgery has become more subtle in recent years. In the U.S., eye drop anesthetics appeared in the mid 19th century, and after the Civil War, some surgeries were done to treat cataracts. They developed a device to measure the cornea’s curvature after cataract surgery (called a keratometer). Also in the 19th century, Dr. Snellen in Holland came up with the vision chart which eye doctors still use today, with the large E at the top. The idea that the shape of the cornea is central in good eyesight has been around for a long time, but no effective action was taken until after a late 19th century Dutch doctor, Leendert Jan Lans, wrote a treatise on how astigmatism could be corrected with certain cuts in the cornea. He did some experiments on rabbits and before long, people in Italy and Germany were doing similar work. Experiments were done in many countries for about fifty years. 20th century progress
• In 1936, Tsutomu Sato in Japan noticed that some people with eye injuries had flatter corneas. Having read Lans’ treatise, he followed it up with surgeries that placed tiny incisions in the cornea to flatten it, and thus laid the foundation for the procedure we know as Radial Keratotomy (RK).
• In 1948, an American Air Force physician noticed that when cockpit windscreens shattered and sent slivers of Perspex into the pilot’s eyes, it was not a great problem. In other words, the pilots’ eyes were able to tolerate the presence of Perspex. So he began designing plastic lenses that could be implanted in the eye. Thus we have the basis of cataract surgery and Intraocular Lenses (IOLs)
• In 1949, a Columbian doctor, Jose Barraquer, used a microkeratome (still used today) to create a corneal flap. He removed it entirely, rather than folding it back as eye surgeons do today. He froze it and then changed its shape with a device called a cryolathe, which precisely shaved a tiny portion of it off. Presumably that thawed-out flap was replaced on the eye and healed up, much as LASIK flaps heal up today.
• During the mid-twentieth century, several Russian eye doctors experimented with RK and determined that 16 incisions or less was enough to correct nearsightedness, and one of them, named Fyodorov, presented convincing evidence that this could be done with great precision to control the exact amount of correction. RK was begun in the U.S. in 1978.
• In 1980, still trying to correct nearsightedness, two American doctors tried using the heat of a carbon dioxide laser to shrink parts of the cornea and thus change its curvature. Now the progress speeded up. Throughout the 1980s and into the 1990s, various lasers were used in Germany and the U.S. and combined with use of a microkeratome to make the corneal flap. The name laser in-situ keratomileusis was coined for this procedure, abbreviated as LASIK. PRK was also developed during these years. U.S. clinical LASIK trials in the 1990s led to FDA approvals of the excimer laser in LASIK procedures for nearsightedness, farsightedness and astigmatism between 1995 and 1999. Following the FDA approvals, LASIK surgeons hung their shingles out all over the country, and many people had LASIK who shouldn’t have had it. Patient screening has improved greatly, reducing side effects and giving better results for the good candidates. When choosing your LASIK surgeon, check each doctor’s qualifications and background, and schedule a consultation. Ask how long he or she has been performing LASIK, and how many procedures have been done. With only one pair of eyes, it’s important to trust them only to responsible and qualified eye doctors. Contact Hummel Eye Associates for more information about LASIK and if the treatment is right for you.
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