SEEING PROGRESS
THE NEWEST UPDATE TO REFRACTIVE SURGERY:
TOPOGRAPHY GUIDED LASIK
AUTHOR Guruprasad R. Pattar MD, PhD
A
t this point in LASIK’s lifetime, ev-
eryone has at least heard of the term
LASIK. This is not to be confused
with furosemide’s trade name,
LASIX. Believe it or not, I have had
patients in my exam chair (who are
of the cataract age) ask me if LASIX
will be able to fix their cataracts. Fortunately
for my family, a pill won’t be able to correct someone’s refractive
error at this point.
Laser-Assisted In Situ Keratomileusis (LASIK) is a refractive
procedure that originated the day after Thanksgiving in 1981. Three
IBM researchers had been exploring new ways in which the excimer
laser, which their chemistry and laser physics group had recently
acquired, could be used today. This is the same laser that forms
the basis of what we use for LASIK today. In 1983, an American
ophthalmologist by the name of Dr. Stephen Trokel traveled to the
Watson Research Center to work with these researchers in its use
on the eye. Trokel was the first person to use the laser on corneal
tissue at Columbia University in New York. It was not until 1995
that the Food and Drug Administration (FDA) finally granted the
approval for the first excimer laser-based refractive surgery system
to treat spherical myopia (patients who were near-sighted with little
to no astigmatism). This resulted in the advent of photorefractive
keratotomy (PRK). Around this time, a manual keratome was being
used to create a LASIK flap. It was 2001 when the femtosecond la-
ser gained approval from the FDA to create LASIK flap leading to
“bladeless” LASIK. Since then, LASIK has become the most popular
vision correction surgery in the world.
Since the FDA granted approval in 1995, there have been nu-
merous technological advances in the world of laser vision correc-
tion. Initially, myopic patients were the only ones who benefited
from laser vision correction. However, patients that have hyperopia
(farsightedness), regular astigmatism, and higher order optical
aberrations can now be treated.
Laser vision correction for refractive error involves “reshaping”
of the cornea. In myopic LASIK treatments, an ablation profile is
created whereby the central cornea is essentially flattened through
the removal of tissue. Prior to 2013 when topography guided LASIK
was FDA approved, standard treatments, wavefront guided treat-
ments or wavefront optimized treatments were performed. Stan-
dard treatments essentially only treated the refractive error; it did
not take into account the shape of the cornea. Wavefront guided
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