It was early in the 1990's before anyone even thought about LASIK that we were first with another procedure, ALK.  In Automated Lamellar Keratoplasty (ALK) we used a microkeratome to make a thin flap on the cornea, and then removed a small amount of corneal tissue to reduce severe nearsightedness (sound familiar?).  This procedure was an outgrowth of an even older procedure where the front of the cornea was reshaped using a lathe, that dates back about forty years!  This new procedure was a major advancement, and I published on our results with nine other doctors from around the country, many of whom are leaders in their own community in refractive vision corrective surgery.  What we learned in these procedures made us realize that although our results were promising, they were inexact and needed the refinement that a laser could offer.  This is why we decided to design and build our own laser before there were any FDA approved lasers for LASIK.  The Dishler excimer laser was the first laser in the world specifically designed for LASIK rather than being used as a modification of lasers for other procedures like PRK.  From our experience in developing and performing the first LASIK procedures in Colorado and one of the first in the entire country, we have helped to perfect this technology.  As an investigator in numerous FDA trials for a variety of devices and products our practice has helped to push the frontier of vision correction forward.  There simply are no other LASIK providers in Denver who have participated in real FDA clinical trials for LASIK or Laser Vision Correction surgery.  From this experience we continue to learn more about this amazing procedure that for many people has set them free from the shackles of contact lenses and glasses.

In the days before glasses, people who had poor vision due to refractive error had only one choice, suffer.  They could never see the world clearly even though structurally they had healthy eyes.  Because beyond structure, eyes are optical devices that require the correct focus in order to see properly.  As a quick review, light enters the eye, and immediately is focused by the main lens system of the eye, which is not the lens itself, but the cornea.  Here most of the light bending occurs.  This is further changed by the lens for the final 20% of the focus and a tiny spot of light lands on the sensitive retina.  Unlike cameras which have large sensors with hundreds of square millimeters, all of the light lands on a sensor that is just a few millimeters in size.  From this image that is smaller than the head of a pin, impulses of electrical activity are sent to the brain which we perceive as vision.

In laser vision correction we typically change the outer cornea by a few percent in curvature, sometimes as much as 20% but usually less than 10% to achieve a fine focus that is missing.  Sometimes we alter the shape more in one direction to remove a distortion known as astigmatism.  Here we typically change the shape only 5% in a given direction.  The laser polishes the front of they eye to a new shape by photoablating tissue, that is, it vaporizes a thin layer very smoothly so that a more correct shape is created.  This will work on the front of the eye after the skin is removed, and it is then called PRK (Photo Refractive Keratectomy) or as we like to call it advanced surface ablation -- a much better name.  But learning from our early days of performing ALK, we realized that if we did this correction under a flap, something special happens.  The eye heals very quickly, the vision becomes normal in less than a day and people have a sudden transformation in their vision where they can see like they were wearing contact lenses but without them.  This is because that thin membrane or flap acts like a contact lens and follows the new shape that was created underneath almost instantly.

Not only has an industry been born of this insight, but hundreds of thousands of Americans have been treated by the military to repair vision for readiness to serve in the armed forces.  We have been fortunate enough to be able to treat many active military members and their families.  Some have jobs where critical vision is so important, like sharpshooters, and it is very rewarding in this group especially to give them excellent unaided vision.

There has been a lot written recently about LASIK and like most things there are two sides to every story.  While the vast majority of patients who have had LASIK experience an almost transformational effect on not only their vision but on their overall lifestyle, there are a few who are less satisfied.  For the most part these are people who either should not have had the procedure in the first place or who were in the small percentage of people who had side effects that can occur with any medical procedure.  In addition, many who had this procedure did not have the opportunity to have the newer technology and understanding that we bring to patients today.

In addition to advances in the lasers themselves and our understanding of how to apply them, there has also been advances in diagnostic testing to help select patients who will most benefit from these procedures.

For some in foreign and underdeveloped countries the gift of the discarded glasses from our patients is a welcome treat.  We collect the disgards and send them to agencies who will make sure that those who cannot have corrective procedures can at least benefit from these glasses which are no longer needed.  For our patients it is a happy moment to make this donation, the one when they realize that they do love their eyes and have set them free.