Laser Vision Correction over 30+ Years: How has Laser Surgery changed over time and why we’re living in great times for Eye Surgery

Embark on an enlightening journey through the remarkable evolution of Laser Vision Correction over the past 30+ years. In this article, written by renowned ophthalmic surgeon Sheraz Daya, we delve into the transformative changes that have taken place in the field of eye surgery.

From the early days of Radial Keratotomy to the cutting-edge advancements of today’s laser technologies, Daya’s expertise and experience provide a unique perspective on why we find ourselves living in an era of unprecedented possibilities for vision correction. Join us as we explore the fascinating history and promising future of laser eye surgery.

“Doctor, I hate wearing glasses and can no longer wear contact lenses anymore.”
“I really want to be able to see my young children when we go swimming – I just do not want to take the risk of anything happening to them.”
“I got lost on the beach and never want that to happen to me again.”
“I am a triathlete, and these prescription goggles are a nuisance.”
“I just want to be normal and see well without glasses or contact lenses.”

These are just a few of the many comments I’ve heard from patients when I ask them, “Why do you want to have laser eye surgery?” Everyone has their own personal reasons for undergoing a procedure to correct their vision.

Thinking about this and how it all began, I trained in the United States in the late ’80s and early ’90s and learned how to perform the Russian technique of Radial Keratotomy (RK). This involved using a precision diamond knife to make incisions in the cornea from just outside the center outward. As the cornea is like an elastic dome, these incisions caused the cornea to lift up on the outside, flattening the central cornea. This flattening effect effectively treated short-sightedness. Understandably, it was very popular early on, and many underwent this procedure. Over time, however, we realised that this was not entirely stable, and at least 30% of patients would continue to flatten and eventually become farsighted.

Fortunately, just as I was completing my training, the excimer laser was being investigated, and I performed my first laser case in 1991. The result of my first case was outstanding and remarkably accurate, even though the laser at that time was a simple black box compared to what we have today. Over the next 30 years, we have seen significant developments in laser technology. As a consultant for Bausch and Lomb and the medical director for lasers for many years, I have been fortunate to be involved in and have influenced many of the developments in this field. Laser eye surgery has become even more accurate, and with an improved understanding of corneal shape and how it can be influenced, we are able to address a wider range of prescriptions. With older lasers, about 10% of patients required a touch-up either due to overcorrection or undercorrection, or sometimes a regression over a 6 to 12 week period following the procedure. Today, we hardly ever need to bring patients back for further correction, and our “enhancement” rate in 2023 is less than 1%.

What has been particularly interesting is the evolution of different procedures. With improved technology, we can revisit older methods of providing laser treatments. For instance, photorefractive keratectomy (PRK) was the first laser procedure available and was later replaced by LASIK (Laser in situ keratomileusis), which involved creating a micro-thin corneal flap and treating the cornea under the flap. This was highly advantageous as it led to rapid recovery – just a few hours – and allowed treatment for those with high prescriptions without the wound healing problems like haze. With improvements in lasers and a better understanding of optimising laser beam size and energy, we realised that some of the issues with the older PRK procedure were no longer valid. We are proud to have influenced and developed the Transepithelial PRK option for Bausch and Lomb lasers. This treatment is essentially a no-touch technique, requiring no instruments. The laser recognizes the iris, and the treatment is provided by the surgeon. All that is required is a contact lens at the end. It is also “out of the box,” with no adjustments needed to achieve highly accurate outcomes. It’s gratifying to hear enthusiastic and congratulatory comments from many fellow eye surgeons who are using this option on the laser platform.

Laser eye surgery is now safer than ever in terms of technology. However, careful patient selection and customisation of treatment remain critical. Both factors cannot be understated and are best provided by well-long standing organisations with clear protocols and ongoing audit monitoring of outcomes. So, for patients seeking safety and reliable results, it might cost a little more, but it’s best to seek care from experienced organisations that are focused (pun intended) on customising treatments for the benefit of their patients.

As a testament to the phenomenal benefits of laser eye surgery, we often hear these comments from our patients:

“No one would touch my prescription – I’m so glad I found you.”
“I wish I had this treatment years ago.”
“The best money I’ve ever spent.”

In closing, the journey of Laser Vision Correction over the past few decades has been nothing short of remarkable. Technological advancements, expert precision, and unwavering dedication have made it possible for countless individuals to experience the world with newfound clarity. If you’ve been contemplating the idea of shedding your reliance on glasses or contact lenses and embracing the freedom of clear vision, the time is ripe. Take the first step towards a brighter future by booking a consultation with a trusted eye care professional. Discover if you’re a suitable candidate for laser eye surgery and embark on your own journey to visual freedom.

Author Information

Authored by Sheraz Daya MD FACP FACS FRCS(Ed) FRCOphth, Consultant Ophthalmic Surgeon & Medical Director, January 2019.

As an authority and leader in refractive surgery he has served on the Royal College of Ophthalmologists Refractive Surgery Working Group which developed the Standards for Refractive surgery including Implantable Contact Lenses /Phakic IOL. He has also served on numerous boards including the refractive committees of the European Society of Cataract Surgeons and Royal College of Ophthalmologists.