Few years were as momentous for refractive surgery as 1995. That year’s FDA clearance of the excimer laser for photorefractive keratectomy (PRK) marks an inflection point for surgical remediation of refractive error. While 1978 brought US surgeons the Russian technique of radial keratotomy (RK) to flatten the cornea, the addition of a laser in 1995 eclipsed the rather crude incisional RK approach with a new level of predictability. It also turbo-charged interest in the very concept of refractive surgery. Suddenly, there was a high-tech gadget that was going to allow myopes to “throw away their glasses.”
And Review of Optometry was there from the jump, debuting our annual surgery issue in January 1995 by kicking off a refractive surgery series that ran the first half of that year. While much of it was prescient and ground-breaking—we taught readers about surgical techniques, complications, the importance of understanding patient psychology and more—some of our coverage from 1995 has aged about as well as a Hootie and the Blowfish CD. Amazingly, we championed RK more than once as a viable option for low myopes. Imagine trying to offer eight-incision RK in today’s era of ultra-precise, custom laser ablations. We also were excited about a flash-in-the-pan procedure for hyperopia correction called holmium laser thermokeratoplasty that didn’t amount to much. A similar idea, conductive keratoplasty, didn’t either. Such was life in the Wild West atmosphere of the time.
PRK hadn’t even been approved yet in January 1995, but LASIK was already looming. Fred Kremer, MD, the prime mover behind LASIK in the early days, wrote about it for our first surgery issue before it even had its proper name. Terms used at the time: laser automated lamellar keratoplasty, laser intrastromal keratomileusis or its then-popular nickname “flap and zap.”
Refractive surgery fever ran so high in 1995 that we actually billed our annual contact lens issue as “Alternatives to Refractive Surgery.” Belated apologies to all the contact lens specialists who must’ve rolled their eyes at that one! An unrelated gem also found in the 1995 archives: a feature that used the phrase “information superhighway” without irony. Wow, just wow.
After the wild and wooly boom years of the 1990s and the inevitable backlash, a steady stream of iterative improvements honed refractive surgery to near perfection. Wavefront- and topo-guided LASIK leave few elements to chance these days. So it’s harder to find good topics to dig into now, but we are honored to have two world-renowned Danish surgeons writing this month on the SMILE procedure, the first genuinely new technique since the early days. Perhaps it can build on LASIK’s success and find new clinical gaps to close.
Mostly, though, our 23rd surgery issue centers on cataract surgery, which barely got a mention in 1995 but is currently where most of the action is—probably from those early RK patients reaching cataract status and needing extra attention.