Towards 2020: Refractive surgery of the future

For several decades we have concentrated on making refractive surgery successful and this has involved ensuring procedures are safe, reliable, predictable and stable. The earliest refractive effect observed was the influence of lens couching in myopes who, the English ophthalmologist JT Woolhouse reported, did not require convex spectacles postoperatively.1

The first corneal refractive procedure was an astigmatic keratotomy by Schiotz2 in 1885 and later carefully studied systematically by the Dutch ophthalmologist Lans in 1896 where, in his thesis ‘Experimental studies of the treatment of astigmatism with non-perforating corneal incisions’, he described a variety of incisions and thermokeratoplasty to alter corneal shape.3

Today these procedures are still being used, albeit delivered with markedly different technology such as femtosecond laser. To quote from Ecclesiastes: ‘What has been will be again, what has been done will be done again; there is nothing new under the sun.’4