Dr. Joseph Dello Russo and his happy clients minutes after LASIK surgery
While LASIK is a familiar term today, just 20 years ago it was an intriguing new procedure for people around the world. It took many efforts, years of testing and difficult decisions to make it successful and affordable for masses. I am proud to say that I played an important role in LASIK development and helped thousands of people get rid of glasses and contacts. And I am very excited to share this amazing story of LASIK birth and growth with you.
Part One: How It All Started…
In the 70s a Russian doctor discovered that if he made cuts into the cornea with a razor blade in a spoke-like pattern, the corneal shape would be flattened, making that eye less nearsighted. The surgery was called Radial Keratotomy, or RK. It enjoyed some success in the US, but was imprecise.
As surgeons we wanted something more precise than simply using the edge of as Schick Blue Blade. In about 1983 I heard that Dr. Steven TROKEL was working on a new kind of laser to reshape the cornea in a more precise and safer manner.
In 1987 he held a conference in New Orleans where he presented his findings for his new laser, called the Visx laser. I liked Dr. TROKEL as well as his laser. I was the first doctor to order a laser from the company. The FIRST in the world!
After this 7 surgeons, including me, embarked on a six-year research to determine if the FDA would rule the laser safe and effective, which it did in 1996. That approval allowed the Visx laser to be sold to any surgeon.
Over the next couple of years 4,000 surgeons became laser surgeons. And the laser procedure was called PRK, where the laser reshaped the surface of the cornea. The public demand for PRK was greater than anyone could imagine. Who could imagine something better? But that was just the beginning of the LASIK history…
Part Two: 1998 – The Year Of a More Advanced Laser
In 1998 I was performing more PRK surgeries than any surgeon in the country. One day I became intrigued by a new laser company that used a new delivery system called the ATC laser, also nicknamed the “flying spot” laser. And again I was the first surgeon who bought this laser and started using in my daily practice along with the Visx one.
One problem with both lasers was that as much as twenty percent of the patients needed a second treatment right after the initial PRK. Patience did not mind as they could still get rid of glasses, but surgeons faced the fact: PRK was not precise.
The other issue was the fact that PRK was performed on the surface of the cornea. At the end of the surgery the patient’s prescription was gone, but so was the smoothness of the cornea, leaving in essence a large scratch. This rawness caused pain for twenty-four hours or so and the vision took a few days to come back. These issues seemed not to be very important since there were no other options. Or we were wrong.
Part Three: Introduction of LASIK in 1998 and Beyond…
In 1992 Dr. Palliakariis presented his idea of using a blade to cut off the top of the cornea, perform PRK on the underside of the flap and then put it back on the cornea. All of the researchers for the Visx laser, including myself, were very skeptical of cutting off the top of the cornea. Why would we do that? To avoid the rough surface left by PRK.
Since the top of the cornea is smooth, the corneal surface would be sooth again, when the top of the cornea was re-applied. Right? Yes, but do we have to cut the top of the cornea off completely? The answer is NO. Dr. Palliakariis presented the concept of simply cutting into (not completely) and pealing this flap back as the first step of what was to be called LASIK. The second step is to reshape the bed of cornea below the flap (not the underside of the flap), and then put the flap down to complete the LASIK procedure.
It took several years for Dr. Palliakariis and other surgeons to devise the proper bladed instrument to create the flap. And by 1998 LASIK became my preferred surgery. I started to use PRK ONLY for those people who did not qualify for LASIK. It was fascinating to observe the reaction of patients after LASIK and PRK. After PRK a patient’s immediate response is: “I can see but it’s blurry”. Whereas the patient’s response after LASIK patient is: “Wow! I can see!” This last response became known as the “WOW factor” of LASIK. And did I mention LASIK procedure involves no pain. See this video where I explain the difference between PRK and LASIK. Or read my response here.
So could LASIK get better? How was it even possible to get better? You guessed it right. It was just about to get better!
Bladeless LASIK procedure in pictures
Part four: 2000 – The Year of Bladeless LASIK
Though LASIK became my preferred procedure, using a blade was not problem-free and precise. The cut into the cornea was not controllable, or was not precise. LASIK surgeons did not really know how deep a blade cut. Some corneas are thin and some are thick. And with thin corneas it would be useful to know how deep the blade would cut before LASIK is performed.
While attending a laser meeting in 2000, I met a well-respected corneal surgeon Lee Nordan, who expressed his desire to make LASIK more safe and precise buy using a new laser, which made the cut instead of a blade (no blade laser). My visit to Dr. Nordan’s office/lab and introduction to his INTRALASE company resulted in me ordering their first two lasers. On February 14, 2002 I officially introduced the first of what I liked to call all-laser LASIK. You might know it by some other popular names: Bladeless LASIK or no-blade LASIK.
No-blade was an immense change in LASIK. LASIK became safer and more precise. Just what LASIK needed. It took a few years for the surgical community to acknowledge the benefits of the INTRALASE. Could LASIK get even better? You guessed it right again.
Part Five: Three Types of Laser Surgeries
By 2002 three types of laser surgeries had been developed: PRK, blade LASIK and no-blade LASIK. But even today some surgeons offer ONLY PRK and obscure what they offer by giving it a new name – LASEK. Unfortunately, the name can’t change the procedure. LASEK is the original PRK. Other doctors offer PRK and blade LASIK. I personally have not used a blade since February 14, 2002. I am not critical of blade LASIK, but it’s no longer for me. As I have already mentioned, my preferred surgery is bladeless. The INTRALASE allows me to even operate on what we all agreed was too thin a cornea with a blade. If a cornea is too thin I can program the INTRALASE to make a safely thin flap.
Part Six: What Is The Future of LASIK?
The very last innovation in LASIK beside upgrades and the INTRALASE was a chair. What is a chair? Since there are two steps to LASIK performed by two lasers, the laser suite used to consist of two surgical rooms side by side. The INTRALASE was used in one room to market the flap, and the excimer laser was used in the adjoining room. In 2012 Alcon laser company developed a chair that would fit between the two lasers in one room and swing between lasers to shorten the full time of LASIK to about eight minutes, instead of an hour between two rooms. That chair was the last great innovation in LASIK history.
So what is the future of LASIK? Over the past twenty-four years of progressive improvements I honestly think that there cannot be any further improvements. I say this with some hesitancy since I always feel there can and will be improvements in any field. But I just can’t see how it can be improved.
Please remember that not all surgeons perform the most advanced LASIK as me and my son at our four Dello Russo LaserVision centers in New York and New Jersey. Some centers offer patients only the very first introductory PRK (also known as LASEK), some centers offer PRK and/or blade LASIK. Only a small percentage of centers offer no-blade, bladeless, or all-laser LASIK.
View this video, where Drs. Joseph and Jeffrey Dello Russo discusses the future of LASIK.