By Dr Lee Mun Toong

The first refractive surgeries are thought to have been performed in ancient Greece. These crude surgeries involved removal of cataracts — the clouding of the lens in the eyes. In the 1850s, the first refractive lensectomy was performed. During this procedure, the lens of the eye was removed to correct myopia, commonly known as nearsightedness.

In the 1970s, Dr Fyodorov saw a young myopic boy with corneal injuries caused by glass fragments. After the injury healed, Fyodorov found the boy's vision was actually better than before the injury. He theorized the radial cuts flattened the cornea. Although a Japanese surgeon had already attempted refractive surgery (RK)  by making incisions from within the eye, Fyodorov developed radial keratotomy by calculating how to make radial incisions on the anterior surface of the cornea to change its shape.

 In the 1980s, a new type of laser, called the excimer laser, was developed. Though originally used to etch computer chips, ophthalmologists began using the excimer laser successfully in refractive surgery techniques to remove very precise amounts of tissue from the eye’s surface. Excimer lasers revolutionized refractive surgery by providing a degree of safety and precision that was previously unattainable with other techniques. Nearly all lasers used today are excimer lasers.

In 1987, Dr Stephen Trokel, was the first user for The Excimer Laser on the Cornea, then he introduced Photorefractive Keratectomy (PRK). He also patented the Excimer laser for vision correction and performed the first laser surgery on a patient's eyes in 1987.

PRK, was the first kind of corrective eye surgery to use a laser rather than a blade to remove corneal tissue like Dr Fyodorov. Though the excimer laser was developed in the early 1970s and modified for ophthalmic use in the early 1980s, the Food and Drug Administration did not approve its use for PRK corrective eye surgery until 1995. However LASIK was approved by FDA in 1996.

The idea of combining previously proven flap technology and reshaping the cornea with the excimer laser occurred in the early 1990s and the dawn of LASIK surgery began. LASIK surgery was initially performed throughout the 1990s in the US as an "off-label" use of the excimer laser. The initial clinical trials for LASIK began in 1996.

2001 - Evolution of Femtosecond Laser in Refractive Surgery

In 1997, Dr Tibor Juhasz, a biomedical engineer familiar with earlier femtosecond research, began pondering over medical applications. The first femtosecond laser approved for bladeless LASIK in the United States was the IntraLase laser, which gained FDA approval in 2001. IntraLase Inc. later introduced several new models of this laser with advanced features.