Myopia or nearsightedness is an eye condition that allows you to see near objects clearly but objects far from you appear blurred. This occurs when the cornea has excessive curvature or when the eyeball is too long. This causes the light entering your eyes to not focus correctly.

Myopia may be treated with eye glasses or contact lenses. Unfortunately for some patients, these treatments do not completely solve the problem. Thus, medical practitioners have been constantly finding ways to totally eliminate myopia. Refractive surgery appears to be the most viable option. Here is a look at the journey in perfecting refractive surgery over the years:

Radial Keratotomy in World War II

This eye surgery procedure was pioneered by a Japanese professor due to tremendous pressure to increase the fighting force of Japan. He cut through the inner surface of the cornea and flattened out its curvature to reduce the myopia.

Initially, good results were observed. However, over the next four to five years, dramatic deterioration in vision was noted as the cornea weakened.

Revival in the 70s

In the 70s, Russian surgeons revived radial keratotomy. This time, they used radial incisions into the outer surface of the cornea to avoid the problem of damaging the endothelial cell surface.

However, the procedure still made use of a razor blade fragment held freehand and a depth gauge was used to determine how deep to incise.

American surgeons tried to alter the Russian version to improve safety. They also developed standardized diamond-tipped tools.

Improvement in the 80s

In the 80s, radial keratotomy was still incapable of producing 20/20 vision but it was sufficient to reduce myopia to enable a patient to drive without wearing glasses during the day. The procedure was not compatible with night driving due to severe glare from the incisions. Risks included perforation of the eye if incisions are too deep and farsightedness if the surgeon overshoots. Pain may be felt for one week and vision may be blurred for several weeks. The first clinical trial was conducted in 1985 and it produced positive results initially but by 1990 it was concluded that radial keratotomy just was not a predictable enough procedure.  It was thus superseded by laser eye surgery.

Laser

In the late 80s, doctors began to use lasers to make the incisions for treating myopia. Laser procedures left no marks, unlike radial keratotomy that left scars in the cornea which created halos and glare.

One study tried to remove a part of a myopic cornea, freeze it and then lathe it into a shape to resolve the refractive error before reattaching it. This procedure did not prosper but it led to the development of keratomes or precision instruments used to remove thin slices of the cornea.

Subsequently, photorefractive keratoplasty and laser assisted in situ keratomileusis (LASIK) procedures were born. The FDA approved the excimer laser for surface treatments and this led to a boom in refractive procedures. With LASIK, healing time was cut down substantially and almost all patients can achieve 20/20 vision with just one procedure.

Current Advances

Here are some advances that make the prospects for treating myopia even brighter:

•    Computer mapping of the exact topography of the cornea.
•    Placing artificial implants on top of the natural lens, similar to implantable contact lenses.
•    Orthokeratology has been around for a while but few people have heard of this unique myopia treatment.

There seems to be a genetic and an environmental component to myopia. Genetic studies and ultimately genetic treatments are likely to form the basis of not only myopia treatment but nearly all human conditions and diseases.

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