LASIK, or Laser-Assisted In Situ Keratomileusis, is a widely performed surgical procedure designed to correct common refractive errors such as nearsightedness, farsightedness, and astigmatism. This procedure permanently changes the shape of the cornea, the clear front surface of the eye, to adjust how light is focused onto the retina. The history of LASIK involves exploring distinct scientific and technological milestones, representing a convergence of ideas in ophthalmology and laser physics.
Foundational Discoveries Leading to LASIK
The concept of surgically altering the cornea began decades before the laser was introduced. Spanish ophthalmologist Dr. José Barraquer pioneered keratomileusis, meaning “cornea sculpting,” in the late 1940s and early 1950s. This intricate procedure involved using a specialized precision instrument, a microkeratome, to cut a thin layer of corneal tissue. The tissue was then reshaped using a cryolathe before being reattached. Barraquer’s work established the fundamental principle that the cornea’s shape could be modified to correct refractive errors.
A separate breakthrough occurred in laser physics with the development of the excimer laser in the 1970s. This gas laser produces ultraviolet light, which can remove microscopic layers of tissue, a process called photoablation. Researchers at IBM discovered this high-energy UV light could ablate tissue without generating significant heat or causing thermal damage to surrounding cells. This precise, “cold” ablation offered an unparalleled tool for reshaping the delicate corneal surface with unmatched accuracy. The excimer laser provided the mechanism for exact tissue removal, complementing Barraquer’s surgical plan for accessing the inner cornea.
The Defining Moment: Developing the LASIK Procedure
The genesis of LASIK was the realization that combining Barraquer’s flap technique with the excimer laser’s precision would dramatically improve outcomes and recovery. The specific procedural combination—creating a protective corneal flap, reshaping the underlying tissue with a laser, and then repositioning the flap—was patented in the United States by Dr. Gholam Peyman in June 1989. This patent solidified the concept of using the laser underneath a corneal layer.
Following the patent, the first human procedures were performed outside the United States. Greek ophthalmologist Dr. Ioannis Pallikaris is credited with performing the first LASIK procedure on a patient in 1990, using a microkeratome for the hinged flap and an excimer laser for the stromal ablation. Italian surgeon Dr. Lucio Buratto also contributed to early excimer laser-assisted procedures around 1989. The advantage of this combined approach was significantly faster visual recovery and reduced post-operative discomfort compared to earlier surface ablation methods like Photorefractive Keratectomy (PRK).
Regulatory Approval and Public Availability
Following its initial experimental use, LASIK quickly gained traction outside the US. The procedure was performed routinely in regions like Europe, Canada, and South America years before achieving formal regulatory clearance in the US. American public availability began with the US Food and Drug Administration (FDA) focusing on the laser technology itself. The FDA first approved the excimer laser for the surface-based PRK procedure in 1995.
Although the excimer laser was approved, performing the full LASIK procedure (which involved a flap) initially occurred as an “off-label” use. By the late 1990s, clinical trials provided sufficient data to demonstrate the procedure’s safety and effectiveness. Formal FDA approval for the use of the excimer laser specifically for the LASIK procedure for treating various refractive errors was granted in 1999. This regulatory milestone marked the point when LASIK officially became a mainstream, commercially available vision correction option, leading to its widespread adoption across the United States.