Refractive Eye Surgery in NYC

Dr. James WynneSandra Belmont, M.D., F.A.C.S., is one of the pioneering surgeons that worked with FDA protocols in the study of the use of lasers to reshape the cornea for the purpose of decreasing or eliminating dependency on glasses and contact lenses. In its infancy, this surgery involved the application of limbal relaxing incisions with a scalpel to reshape the cornea. Nowadays, thanks to the pioneering work of Dr. Belmont and a select few cornea specialists in the U.S., the excimer laser has become the most efficient, precise and least-invasive means of performing refractive surgery. The advent of laser vision correction has improved sight for over 40 million people world-wide to date and counting. Of Dr. Belmont, excimer laser co-inventor Dr. James Wynne has stated that:

“The reason I chose Dr. Belmont to perform laser vision correction on my son is because she is by far the most meticulous; a direct consequence of her training as a cornea transplant surgeon, where attention to detail is paramount. As a co-inventor of the excimer laser, I had the opportunity to observe and interview all of the other laser vision surgeons in NYC.”

- Dr. James Wynne, recipient of the 2013 Russ Prize in Engineering and Technology for the invention of the laser vision correction excimer laser.

Refractive Surgery, a Brief History

RefractiveRefractive surgery is the general term for various procedures that reshape the cornea to allow light to be efficiently focused on the retina. The history of refractive surgery dates back to the 1930s when Japanese ophthalmologist Dr. Tsutomu Sato developed the creation of spoke-like, radial incisions on the cornea to decrease excessive curvature. With the use of a precision, calibrated diamond knife, the technique, now known as radial keratotomy (RK), evolved and was further refined by Russian ophthalmologist Dr. Svyatoslav Fyodorov (c.1960). Common side effects however, included corneal instability and fluctuations in vision. The possible compromise of the structural stability of the cornea was also a very real factor, a function of the profundity and number of incisions required for treatment.

With these shortcomings readily apparent, Colombian ophthalmologist Dr. Jose Barraquer started to consider the possibility of a lamellar (layered) treatment as far back as the early 1940s. Acknowledged by his peers as the father of modern refractive surgery, Dr. Barraquer first used a microkeratome (Barraquer’s own invention: a high-precision surgical instrument that can shave off a disc or create a hinged flap of corneal tissue) to remove a disc of corneal tissue in 1949. The disc was then frozen, ground and polished on a cryolathe (another invention of Barraquer’s) to increase its refractive power and finally set back in place on the patient’s cornea. The procedure, automated lamellar keratoplasty (ALK), proved very effective for high myopes. Vision improved quite quickly after ALK; although there is some initial fluctuation, the healing time was comparatively faster than older alternatives.

By 1975, the first lasers were developed for the purpose of etching microchips. The high precision of the excimer laser made it a natural for surgery. In the early 1980s, the IBM team of Drs. James Wynne and Rangaswamy Srinivasan designed the first excimer laser for application in ablative surgery, building the foundation for PRK and LASIK. This led to FDA studies for safety and efficacy of laser vision correction in the early 1990s. Dr. Belmont was one of the select few doctors in New York City to participate in the studies. The first FDA approval for laser vision correction came in 1996.

Watch a brief video on Drs. Srinavasan and Wynne’s discovery here: