For millennia, humans have dreamed of correcting vision problems without the aid of external devices. Ancient Egyptian manuscripts describe eye salves meant to improve sight, while medieval scholars experimented with rudimentary magnifying lenses. Yet the true revolution in vision correction would have to wait for our understanding of the eye’s anatomy and the invention of technologies that seemed impossible just decades ago.
The story of LASIK begins not in an ophthalmologist’s office, but in the realm of theoretical physics. In 1960, Theodore Maiman created the first functioning laser at Hughes Research Laboratories in California. This concentrated beam of light would prove to be one of the most transformative inventions of the twentieth century, with applications ranging from telecommunications to surgery. Within years, researchers began exploring whether lasers could be used to reshape the human cornea, the clear front surface of the eye responsible for focusing light.
The first major breakthrough came in 1963 when Spanish ophthalmologist José Ignacio Barraquer Moner developed a technique called keratomileusis. Working in Bogotá, Colombia, Barraquer removed a thin layer of the cornea, froze it, reshaped it with a specialized cutting tool called a microkeratome, and then sutured it back onto the eye. Though primitive by modern standards, this procedure established the fundamental principle that reshaping the cornea could correct refractive errors like nearsightedness and farsightedness. Barraquer is often called the father of refractive surgery for this pioneering work.
The next critical development occurred in 1970 when Russian ophthalmologist Svyatoslav Fyodorov pioneered radial keratotomy, a procedure that involved making small incisions in the cornea to flatten it and correct myopia. While this technique became popular in the Soviet Union and eventually spread to the West in the 1980s, it had significant limitations, including unpredictable results and a lengthy recovery period.
The true precursor to modern LASIK emerged in 1983 when Columbia University researcher Stephen Trokel, working with IBM scientist Rangaswamy Srinivasan, published a paper proposing the use of an excimer laser to reshape corneal tissue. The excimer laser, which had been developed in the 1970s for etching computer chips, emitted ultraviolet light that could remove microscopic amounts of tissue with extraordinary precision. Unlike earlier lasers, which essentially burned tissue, the excimer laser broke molecular bonds in a process called photoablative decomposition, leaving surrounding tissue largely unaffected.
In 1988, German ophthalmologist Theo Seiler performed the first excimer laser procedure on a human eye, a technique that became known as photorefractive keratectomy or PRK. This procedure involved removing the outer layer of the cornea and then using the excimer laser to reshape the underlying tissue. While PRK successfully corrected vision, patients experienced significant discomfort during healing, and recovery took several weeks.The breakthrough that would lead directly to LASIK came from Greek ophthalmologist Ioannis Pallikaris, who in 1990 combined Barraquer’s keratomileusis technique with the excimer laser technology. Instead of removing the cornea’s outer layers entirely, Pallikaris created a thin flap in the cornea using a microkeratome, lifted the flap, used the excimer laser to reshape the underlying tissue, and then replaced the flap. This technique, which he called Laser in Situ Keratomileusis, or LASIK, dramatically reduced recovery time and patient discomfort compared to PRK.
Throughout the 1990s, LASIK rapidly gained popularity in Europe and then spread to the United States. In 1995, the FDA approved the first excimer laser for vision correction, though the specific LASIK procedure wouldn’t receive full FDA approval until later. Early adopters of the technology refined the technique, developing better ways to create the corneal flap and improving the precision of the laser ablation patterns.One significant advancement came with the development of wavefront technology in the late 1990s and early 2000s. Traditional LASIK corrected basic refractive errors like nearsightedness, farsightedness, and astigmatism, but wavefront-guided LASIK could address higher-order aberrations, the subtle imperfections in the eye’s optical system that affect vision quality. This technology, adapted from astronomy where it had been used to compensate for atmospheric distortion in telescopes, allowed for truly customized vision correction tailored to each individual eye’s unique characteristics.
Another major innovation arrived in the early 2000s with the introduction of femtosecond laser technology for creating the corneal flap. Traditional LASIK used a mechanical microkeratome blade to create the flap, but the femtosecond laser, which fires pulses measured in quadrillionths of a second, could create the flap with even greater precision and consistency. This bladeless or all-laser LASIK approach reduced certain complications and allowed surgeons to create thinner, more uniform flaps.
The evolution of LASIK also involved improvements in patient selection and screening. Early in the procedure’s history, some patients experienced complications or unsatisfactory results because they weren’t ideal candidates. Over time, ophthalmologists developed better diagnostic tools and criteria for determining who would benefit most from the surgery, reducing the incidence of side effects like dry eyes, glare, and halos around lights.
By the 2010s, LASIK had become one of the most commonly performed elective procedures in the world, with millions of people undergoing the surgery each year. Studies showed high satisfaction rates, with the vast majority of patients achieving 20/20 vision or better. The procedure that once required overnight hospital stays could now be performed in less than 15 minutes per eye in an outpatient setting, with most patients returning to normal activities within a day or two.
Today’s LASIK technology continues to evolve. Modern systems incorporate advanced eye-tracking technology that follows the eye’s movements during surgery, ensuring precise laser delivery even if the patient’s eye shifts slightly. Topography-guided LASIK uses detailed mapping of the corneal surface to guide treatment, and some surgeons are experimenting with artificial intelligence to optimize treatment patterns.
The history of LASIK represents a remarkable convergence of multiple scientific disciplines: physics, engineering, computer science, and medicine. From Barraquer’s pioneering work with manual reshaping of the cornea to today’s computer-controlled laser systems, each generation of researchers and clinicians built upon the work of their predecessors. What once seemed like science fiction has become routine, transforming millions of lives by freeing people from dependence on glasses and contact lenses. The journey from ancient eye remedies to modern laser surgery spans thousands of years, but the most dramatic changes have occurred within a single human lifetime, a testament to the accelerating pace of medical innovation.
