A Journey Through the History of Corneal Refractive Surgery

Corneal refractive surgery such as LASIK is a widely recognized procedure, but how has it evolved into the advanced technique it is today?

Let’s explore the history of corneal refractive surgeries like LASIK and PRK while highlighting Dr. Dishler’s contributions to this groundbreaking technology.

Non-invasive refractive surgery has revolutionized vision correction, offering life changing solutions by reducing dependence on glasses and contact lenses. The journey to today’s advanced techniques is a tale of innovation, persistence, and medical ingenuity. Here’s a look back at how this fascinating field evolved.

The Origins of Vision Correction

Before surgical intervention, vision correction relied solely on glasses, which date back to the 13th century. Contact lenses came much later starting with hard lenses, in the late 19th century, offering a more portable solution and later transitioning into soft lenses that you know today. Although the invention of glasses and contact lenses are great, the dream of permanently correcting vision still was at the forefront in research.

The Early Days: Incisional Techniques of Corneal Refractive Surgery

In the 1930s, Dr. Tsutomu Sato in Japan pioneered radial keratotomy (RK), a procedure involving radial cuts into the cornea to reshape it and correct myopia. While groundbreaking, RK had its limitations: results were unpredictable, and over time, some patients experienced deteriorating vision. Despite this, RK laid the foundation for modern corneal refractive surgery. Still rarely performed today, there are a lot of complications that led to less invasive corneal manipulation.

The Advent of Laser Technology

The 1970s and 1980s witnessed a paradigm shift with the introduction of lasers into refractive surgery.

Photorefractive Keratectomy (PRK)

Developed in the 1980s, PRK was the first FDA-approved laser eye surgery. Using an excimer laser (a laser that utilizes UV light) instead of a scalpel, surgeons precisely removed corneal tissue to reshape the surface and correct vision errors. Though effective, PRK required a longer recovery period and was associated with post-surgical discomfort. This long recovery period led to the advent of LASIK and keeping the corneal epithelium mostly intact.

Laser-Assisted In Situ Keratomileusis (LASIK)

In the 1990s, LASIK emerged as a game-changer. Combining the precision of excimer lasers with the creation of a corneal flap, LASIK allowed for faster recovery, less discomfort, and more predictable outcomes, all while keeping most of the cornea’s integrity.  Its popularity surged, making it one of the most widely performed elective surgeries in the world.

Refinements and Innovations

The 2000s brought a wave of refinements and new techniques:

Wavefront-Guided, Topography-Guided, and Wavefront-Optimized LASIK:

These advances offered customized treatments based on the unique imperfections of each eye, improving visual outcomes and reducing side effects like glare and halos. We utilize Wavefront-Optimized technology in our clinic which studies have shown provide the highest amount of clarity for those with regular corneal topography.

Small Incision Lenticule Extraction (SMILE):

Introduced in the 2010s, SMILE eliminated the need for a corneal flap, offering a minimally invasive option for myopia correction. Although this is the newest procedure, it may not suit everyone because it still requires refinements.

Dr. Dishler’s Contributions to the Corneal Refractive World

• Dr. Dishler was a pioneer in the corneal refractive world as he began perfecting LASIK in Colorado in 1985.  
• He developed and built his own Dishler Excimer Laser for LASIK in 1996 and was FDA approved.
• Dr. Dishler was the first surgeon to perform SMILE in the United States and here in Colorado in 2017.
• In January 2023, he successfully developed a patent for SMILE to assist in extracting the lenticule (lasered material within the cornea).

The Present and Future

Safety, precision, and personalization define modern corneal refractive surgery. Techniques like Contoura Vision (a type of topography guided LASIK for those with irregular corneas), which uses detailed corneal mapping, and advancements in femtosecond laser technology continue to push the boundaries of what’s possible.

Researchers are exploring bioengineered corneal tissue, nanotechnology, and AI-guided surgeries, promising advancements in vision correction, efficacy, and safety.

Conclusion

The history of corneal refractive surgery is a testament to human innovation. From the rudimentary cuts of RK to the precision of lasers, each milestone has brought us closer to the goal of perfect, unaided vision. We’re grateful to have Dr. Dishler on our team, advancing refractive surgery to its current state. As technology and research (some studies of which are done at Dishler Laser Institute) continues to evolve, the future of corneal refractive surgery looks brighter than ever. Schedule your free consultation with us today to see better tomorrow!