It’s been 25 years since the first ever laser eye surgery procedure took place and we spoke to Dr. Marguerite McDonald, the surgeon who performed the first laser eye treatment in the world, as well as Dr Steve Schallhorn, Chairman of the Optical Express International Medical Advisory Board (IMAB) on how far the industry has come and where it is going.
1. How much has laser eye surgery changed since you performed the first treatment?
MM The difference is breathtaking. It would be like comparing a vintage motorcar to a modern day Ferrari. In our first laser eye experiments, we worked with one little laser the size of a bread box and we would hand crank the diaphragm! Another big difference was in the early days we didn’t have a tracking system to aim the beam – something we take for granted now, and we used some fairly strange techniques and equipment to keep the eye still during surgery. Eventually, we developed tracking technology by working with NASA engineers.
SS Dramatically. I performed my first procedure in the early 1990s and back then we were performing a simplified version of photorefractive keratectomy. Early procedures were crude by comparison to what we have today. Visual recovery was very slow. A few years later, LASIK was developed which offered much faster visual recovery. Since then, there have been steady, incremental improvements.
2. Can you tell us about the first treatment you ever performed (on a human)?
MM At the time I performed my first treatment, laser eye surgery was still considered an outrageous new idea and we had only been granted permission to treat people who were already blind.
A woman came forward called Alberta Cassidy. She was suffering from a malignant tumour, and required surgery to remove her eye to try to save her life. Before the eye was removed she volunteered to take part in any experiments. I’ve always been amazed by her selflessness, she was facing some very tough times ahead and yet she was thinking about how she could help others. She had 20/20 vision and so she was actually treated to make her eye longsighted.
When her eye was removed 11 days later, I was able to examine the tissue and it was healing beautifully. Sadly, Alberta died soon afterwards of the melanoma, but in her memory I had permission granted to name the new Excimer Laser Research Centre after her.
SS My first procedure was performed on a short sighted Navy SEAL who had many operational problems with spectacles and contact lenses. He obviously could not wear glasses when diving and dry eye limited his contact lens use. His life was changed after laser eye surgery and his experience, along with many clinical studies, led the Navy SEAL community to authorise and adopt the surgery.
3. Do you have a case that is particularly memorable? For what reason?
MM I was given permission to carry out laser surgery on ten blind eye cases after my first ever surgery, Alberta Cassidy. One such case was a patient who had suffered a crushed optic nerve after having brain surgery. Her name was Carolyn, she was aged 27 and blind in one eye.
In this type of case, a random prescription would be put into the laser to treat the eye – one month later, the patient got back in touch to say that she realised she could see in the eye. I didn’t believe her but sure enough, she was able to see in her previously ‘blind’ eye and what’s more, now had 20/20 vision. I realised that Carolyn had been suffering from a rare condition called Hysterical Blindness, first described by Freud. A senior neurosurgeon had told her that she would be blind in that eye after brain surgery to remove a tumour and, led by the power of suggestion, had believed she was – needless to say, it took a bit of explaining, and I have only just started to live it down!!
SS Yes, it was laser eye surgery on a firefighter, actually a damage control officer in the Navy. He wrote me a letter before his treatment describing why he desperately needed surgery. There was an out-of-control fire on his aircraft carrier and there hundreds of firefighters involved in trying to contain it. The fire caused massive damage and there was loss of life. After fighting the fire for several hours, he went to a safe location to change out his OBA (on board breathing apparatus – breathing mask). The instant he took it off, residual smoke and debris in the air got under his contact lenses and caused intense pain and tearing (note: he had been a successful contact lens wearer for many years prior). He had to quickly remove his contacts, but there was no time to get another set of contacts and it was well known that spectacles were not acceptable because it would break the full-face mask seal. So he donned another OBA and went on to help put the fire out. He subsequently received a medal awarded by the President of the United States for heroically fighting the fire ‘while legally blind’ (i.e. without optical correction). He sent me the medal citation and asked if he could have laser eye surgery so he could better perform his job. It was with great satisfaction that I was able to help him by performing the procedure. He stayed in contact for many years afterwards and made it clear that the surgery made him a better firefighter.
4. How do you think treatments will have changed in another 25 years?
MM I believe laser eye surgery will become a routine rite of passage - just as children have braces to fix their teeth, graduates leaving college will one day have laser eye surgery and ditch their glasses/contact lenses.
SS First, laser eye surgery, as we perform it today, incorporates phenomenal technology and the results are spectacular. I have no doubt in the next 10 to 20 years, there will be newer technology that further improves the outcomes of LASIK.
5. Do you think a day will come when we will be able to treat all cases of blindness/impaired vision?
MM We can successfully treat more cases of blindness in 2015 than ever before (most are caused by cataracts, diabetic retinopathy and macular degeneration), but there are still challenges left. In 2015, there are also fewer patients who are not candidates for laser vision correction or refractive lens exchange; we can decrease the dependence upon glasses in the vast majority of patients.
SS Cataracts remain the leading cause of preventable blindness in the world today, especially developing countries. Modern cataract surgery is considered one of the greatest achievements in medicine.
Macular degeneration is the leading cause of impaired vision for the elderly in the UK today, but thanks to recent developments, this disease now has effective treatment options.
6. What is the most common misconception about laser eye surgery?
MM That it is dangerous. There is a lot of bad information out there, on the web for example. I always urge people interested in laser eye surgery to seek information from a reputable source.
SS The most common is that people think contact lenses are perfectly safe while they harbour, what I would consider, unreasonable fear about the laser eye surgery. It is natural to have apprehension but modern laser eye surgery is safe and effective and in my opinion, much safer than wearing contact lenses, especially overnight. A common statement that we hear from patients after the procedure is “I only wish I’d done it years ago”.
7. What do you love most about your job?
MM The change that laser eye surgery can make to people’s lives can be extraordinary. People who haven’t been able to use contact lenses and needed to wear thick glasses their whole life could suddenly see again. It can change their whole demeanour, the way they walk, their confidence and their appearance changes.
It’s also great to be able to help people realise their dreams or career
SS Simply helping people see better!