The Dawn of a New Era

Colorado Custom LASIK Vision Correction Laser Eye Surgery with CustomVue Wavefront LASIK Technology in the Denver & Boulder Metro Area

In the late 1970's, a Russian Ophthalmologist, Sergiev Fyodorov introduced Radial Keratotomy (RK) as a procedure for reducing nearsightedness and Astigmatism. In Radial Keratotomy, the surgeon used a hand-held diamond knife to make deep radial incisions in the cornea. (When you cut a pizza you are making radial cuts. Unlike cutting a pizza, the cuts in Radial Keratotomy did not go all the way to the center of the cornea.) The surgeon would make four to sixteen radial cuts, depending on the amount of the patient's nearsightedness. The goal of Radial Keratotomy was to flatten the cornea and decrease the patient's nearsightedness. Radial Keratotomy flattened the cornea by structurally weakening and slightly collapsing the cornea. This is similar to cutting some of the support wires in a tent and then having the tent partially collapse.

Radial Keratotomy had two major drawbacks. First, the radial incisions would often cause visually-significant glare. The second problem with Radial Keratotomy was that the cornea was structurally weakened by the radial incisions. Short term, this weakness caused fluctuating unpredictable vision, often to the extreme that patients would see well without correction part of day and would require glasses to see clearly at other times of the day. Long term, the weakened cornea also continued to flatten, and patients were actually becoming farsighted. Even with these two major drawbacks, millions of patients underwent Radial Keratotomy and the vast majority were satisfied to be significantly less nearsighted. Also, after twenty years of experience with Radial Keratotomy, no visually threatening long term complications have been identified. Radial Keratotomy is rarely being performed today. However, I feel some reassurance that although Radial Keratotomy was an imprecise procedure performed by making deep corneal cuts with a hand-held knife, Radial Keratotomy was well accepted by patients and has been shown to be reasonably safe long term. If we now have a much more precise procedure, Laser Vision Correction, with a computer running a Laser removing sub-microscopic amounts of tissue, we can expect much greater accuracy and corneal stability than we saw with Radial Keratotomy.

In the mid 1980's, IBM was looking for Laser technology to etch silicone computer chips. They discovered what we now call the Excimer Laser. The word Excimer is short for Excited-Diamer. The Excimer Laser uses two diamers, or gases, Argon and Fluoride, to generate the Laser energy. When I was in elementary school, I used a magnifying glass to focus the sunlight on a piece of paper, and burn a hole in the paper. A Laser functions on a principle similar to this. However, a Laser uses just one wavelength of light, whereas sunlight has a wide band of wavelengths. Also, Lasers have all the waves "in phase", allowing for very high concentrations of focused energy. Each Laser wavelength has different physical properties. It happens that the Excimer Laser, which is in the ultra-violet range with a wavelength of 193 microns, breaks carbon-carbon bonds. This releases vaporized molecules, without cutting or damaging surrounding tissue. Each pulse of the Excimer Laser removes .25 microns, 0.00004 of an inch, of tissue. (A human hair is 50 microns. The Excimer Laser removes 1/200 of a hair with each pulse of energy.

This is approximately a layer of 30 molecules of tissue.) Instead of making the radial cuts, as in Radial Keratotomy, the Excimer Laser flattens the cornea by removing thin layers of tissue from the surface of the cornea. The more nearsighted the patient, the more tissue removed. The average patient has less than one hair's thickness of tissue, 50 microns, removed in Laser Vision Correction. This does not structurally weaken the cornea as in Radial Keratotomy.

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The Levinson Eye Clinic, in Denver Colorado, and its laser vision correction surgeon, Dr. Richard A. Levinson, M.D., provide the latest technology in eye care and Lasik vision correction surgery for Custom Wavefront Lasik in the Denver and Boulder Metro area. Dr. Levinson and his refractive eye surgery staff use the Visx Star S4 excimer laser for Lasik or PRK refractive eye surgery with Customvue Wavefront Lasik. Contact Dr. Levinson and his Denver, Colorado laser vision correction staff for more information or to schedule a complimentary Custom Lasik vision correction consultation.

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