In Search of Excellence: From Radial Keratotomy to Laser-Assisted In Situ Keratomileusis

Summary

Since refractive surgery was started in Japan during the 1930s, there have been many developments and advances. We are still working, however, toward a more “perfect” procedure. The major difference between refractive surgery and other eye operations is that we are operating on eyes with normal vision. The demand for outcome predictability, stability of postoperative refraction, and operative safety is naturally high. Although radial keratotomy (RK) does not involve the central visual area of the cornea, the tissue damage incurred is substantial. Unpredictability about surface wound healing is the major problem associated with photorefractive keratoplasty (PRK). Neither PRK nor RK is a good choice for the high myopes. Although clear lens extraction with intraocular lens implantation can treat the severe high myopes, the risk of postoperative retinal detachment is not low. The intrastromal corneal ring is still in the investigational stage. The new procedure, laser-assisted in situ keratomileusis (LASIK) produces excellent results for the moderate and high myopia groups. Although there are problems at the interface, LASIK is undergoing active, rapid development. It is likely that LASIK will become state of the art and the gold standard for refractive surgery in future.