Laser-assisted in situ keratomileusis (LASIK) has become so popular because it works. It�s the perfect yuppie operation: instant gratification and no pain. However, this procedure will get even better as the technology improves this year. Our success will be tied to how well we adapt to new changes in technology and technique. As a surgeon who has concentrated on refractive surgery for several years now, I�d like to offer three factors that will drive our effort to take LASIK to the next level.

1. Improved diagnostics

As we know, measurement of the radially aspheric and radially asymmetrical cornea is difficult. By using placido imaging, we achieve limited results; corneal topography doesn�t let us evaluate the absolute center of the cornea.

Cross-sectional imaging is a better approach, but current technology doesn�t provide sufficient data points to minutely evaluate the cornea. Now we�re also seeing an attempt to use laser interferometry of the corneal surface. But this method of measurement is still in its infancy.

While technologies develop, we realize more complex challenges are associated with LASIK. We know the anterior corneal surface is the principal refracting surface, but other ocular structures contribute to optical errors. Precise measurement of the total refractive error of the eye, including the effect of those other ocular structures, will be the new priority.

Already, the race is under way to improve diagnostics so that we can improve refractive surgery outcomes. The buzz word today is the �aberrometer,� a technology that provides more information than data points on corneal curvature.

VISX has rolled out its first version of 20/10 Perfect Vision wavefront technology, which uses a wavefront sensor to track and measure the course of multiple light rays through the eye to detect higher-order aberrations at any point in the optical system. Summit is showcasing its proprietary CustomCornea wavefront measurement technology, designed to objectively measure the unique optical aberrations in each patient�s eyes and use a customized ablation pattern to reshape the cornea.

Bausch & Lomb officials will launch its technology later this year. Their �integrated diagnostics� will link a soon-to-be-unveiled aberrometer with Orbscan II and the Technolas 217 laser, slated for FDA approval in the near future.

2. Advanced microkeratomes

The current metal blades of today�s microkeratomes will improve and eventually be replaced by gemstones or high-pressure water jets. Intrastromal ablation, with ultra-short pulse widths, has the potential to create exceptionally smooth flaps or to complete the entire refractive procedure.

3. Exploding laser technology

We�re also far from reaching the endpoint of laser development. As I mentioned, improved diagnostics will permit customization of the procedure. We�ll be able to sculpt complex patterns onto the cornea to provide optimum vision. All of this will be made possible by even more precise lasers that incorporate real time feed-back loops.

The new millennium will also bring many other changes. The current generation of 193nm argon/fluoride gas excimer lasers, for example, may be replaced by solid state machines or even machines that produce a different wavelength, such as mid-range infrared.

Besides providing smoother and customized ablations, evolving lasers will enhance visual performance in other ways, especially in the hands of surgeons who master new technology. We can expect the development of new algorithms for larger optical zones, which will reduce or eliminate glare and haloes and improve myopic vision.

A bright future

The future of laser vision correction is bright as we enter this new century. We�ll be able to correct a wider range of refractive errors with enhanced safety, quality and efficacy. And there is no better procedure to achieve these goals with than LASIK. OM