A Review of the History of Customized Corneal Ablation Custom LASIK

With the recent announcement by Technolas Perfect Vision of the FDA approval of its iris-tracking laser to improve LASIK outcomes, it reminded me that I was among the first to report on customized ablation (or Wavefront Driven LASIK), from its birth at the 1998 AAO Meeting, and subsequent blossoming at the 1999 ASCRS Meeting.

I was also the first to write about LASEK, the technique of pushing aside the epithelium and performing PRK on the surface of the cornea – as opposed to first making a flap with a microkeratome or laser, and then zapping the cornea to reshape it.

Here, in chronological order, is a series of writeups on these techniques that were first published in Ocular Surgery News, under my “Technology Update” byline:

1. I’ve Seen the Future....and its Custom Cornea, OSN, June 15, 1999.

I first learned about custom ablation at the 1998 AAO meeting, but it was at the 1999 ASCRS meeting that I came to realize that it was the future of refractive surgery.

2. Customized Ablation: the Future is Close, OSN, February 15, 2000.

Here is my report on my first encounter with wavefront and ray tracing diagnostics as a pre-cursor to customized ablation.

3. Customized Ablation: Getting Closer Yet, OSN, August 1, 2000.

At the 2000 ASCRS meeting I learned first-hand of the early results on the initial human clinical trials using wavefront combined with LASIK.

4. Customized Ablation: The Wave Moves Forward.....but Keep an Eye on a Newly Developed Technique....LASEK!, OSN, January 1, 2001.

My first exposure to LASEK – laser epithelial keratoplasty, as I explained it in detail.

5. AAO Report: LASEK, Customized Ablation Draws Interest, OSN, January 1, 2002.

More results from the ongoing custom LASIK trials and a new technique for performing LASEK.

6. AAO Refractive Pre-Meeting Focuses on LASIK, LASEK, OSN, January 15, 2002.

An overview of what was reported at the 2001 Refractive Surgery pre-AAO meeting.

7. ASCRS Report: Customized Ablation, Hyperopia & More, OSN, August 1, 2002.

An overview from the 2002 ASCRS meeting.

8. An AAO 2002 Update: Classic vs. Custom LASIK -- The Battle Continues, OSN, January 1, 2003.

And finally, my last report for OSN, reviewing the latest developments occurring at the 2002 AAO meeting.

9. Custom Ablation #9: Questions......and Answers

An update and answers to the question – Custom vs Classic Lasik.

Along with its April 2006 issue, CRS Today published a supplement (sponsored by an unrestricted grant from Advanced Medical Optics) that answered the questions I had raised in previous columns on customized ablation concerning whether wavefront-optimized LASIK was as good as wavefront-guided ablation. (And, were either better than conventional LASIK?)

Addendum to White Paper on Corneal Sculpting

In the November 2005 issue of Cataract & Refractive Surgery Today, I wrote a letter about a previously published article on the 193nm wavelength lasers, in which I told how I became involved in ophthalmic lasers and refractive surgery. The letter references both the White Paper and also another report that I wrote some years earlier that is probably the first marketing report on refractive surgery. Here’s a part of that letter (and links to the two reports):

...I began writing (and consulting) about ophthalmic lasers in 1983, following the first approvals of the YAG laser for capsulotomies. I became intrigued with the laser’s capabilities in medicine and decided to become an “expert” in the field. Part of my learning experience was attending a Gordon Research Conference on Biomedicine in the summer of either 1984 or 1985; I can’t remember the year. At that conference, I met several of the pioneers working on the excimer laser, including Carmen Puliafito, Fran L’Esperance, Steve Trokel, Charles Munnerlyn, David Muller, and I am sure others. It was there that Munnerlyn first showed his infamous chart showing the ablation depth versus dioptric correction for various optical zone sizes.

After meeting the experts at the Gordon Conference, in December 1985, I was hired by Fran L’Esperance and Anthony Pilaro (Fran L’Esperance’s financial backer and the founder of the Duty-Free shops found at every international airport) to prepare a marketing report forecasting the potential of what I then called laser refractive keratoplasty. That report was finished in March 1986 and was used to raise the initial monies from Alcon Laboratories, Inc., to fund Taunton Technologies (which later became Visx Incorporated). The report is also the basis for the per-procedure fee that became the moneymaker for the companies involved. It was Tony Pilaro’s idea, and he asked me to incorporate it into my report.

In September 1989, I published a white paper titled, “The Evolution and Prospects for Laser Refractive Keratoplasty.” In it, I believe I coined the term corneal sculpting. I updated the report for publication in the March 1992 issue of Laser Focus World.