Understanding the Evolution of Laser Eye Surgery: How Does it Work?

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In the modern world that we all find ourselves in – wandering around with masterpieces of modern technology tucked in our pockets; with the potential to have life-changing surgery at our fingertips – it can be easy to distance ourselves from our history.

I mean, can you imagine a time when you couldn’t ask ‘Google’ to answer a fleeting and inconsequential query at least five times a day? A time when you couldn’t have your grocery shopping delivered to you in a matter of hours? Or a time when Laser Eye Surgery was a complex operation (you know, as opposed to one that can be completed successfully in a matter of seconds)?

Well, I certainly can’t!

And yet, such a time did exist – and not all that long ago. While vision aids have been around for hundreds of years – from the earliest pair of glasses invented in the 13th century to the – let’s face it – terrifying first round of contact lenses (anyone fancy sticking some glass in their eyes?) introduced in late 19th century – the idea which preceded Laser Eye Surgery was only conceived around 75 years ago.

At the time when the grandfather of Laser Eye Surgery, José Ignacio Barraquer Moner, conjured up the idea of a permanent solution to vision impairment, technology was still lagging behind. Nonetheless, the theory behind this early procedure remains extremely relevant today.

So, what is the science behind Laser Eye Surgery, and how did Barraquer’s original ‘keratomileusis’ (that’s “carved cornea” to you and me) work?

The Original Vision Correction Surgery

José Ignacio Barraquer was a Spanish-born Ophthalmologist who pioneered the techniques that would eventually lead to the development of Laser Eye Surgery.

Being an experienced and practising Ophthalmologist, Barraquer was acutely aware of the corneal abnormalities that caused common vision impairments like Myopia (short-sightedness), Hyperopia (long-sightedness) and Astigmatism. Importantly, unlike many of his peers at the time, he was not satisfied with the results of visual aids like glasses and contact lenses.

He believed there was a better way to fix what he saw as a disease. Using his knowledge of the inner workings of the eye, Barraquer developed a procedure that would revolutionise vision correction forever. But these original procedures were not for the faint of heart.

How did it work?

Barraquer’s innovative surgery involved removing the cornea using an early version of a microkeratome (an oscillating blade). The cornea was dipped in liquid nitrogen to make it easier to work with. Then, with the help of a miniature lathe, Barraquer was able to reshape the cornea.

This sculptural process was informed by his knowledge of how refractive errors affect the way that light hits the retina. For example, in Myopia, light falls just short of the retina, leading to blurred vision at long distances. Barraquer theorised, therefore, that if he was able to reduce the steepness of the cornea, the issue would be resolved.

Incredibly, the procedure was a resounding success and yielded reliable results in the treatment of Myopia, Hyperopia, and Astigmatism! This development heralded a new age of vision correction and more people could dare to imagine a life without glasses.

An Era of Development for Vision Correction

While you are probably impressed by Barraquer’s early innovation, the chances are you are also a little bit grossed out. But don’t worry; since the early introduction of vision surgery, the industry has developed beyond recognition.

The most significant difference between vision correction now and 74 years ago is the technology available. As we mentioned earlier, we are now blessed to be living in a modern era where everything is easier, faster, and more reliable than ever before. In fewer industries is this advancement more apparent than in Laser Eye Surgery.

These days, we no longer have to rely on blades to access the cornea and, in many cases, the cornea does not have to be removed at all. Development continues to this day thanks to pioneering experts like our very own Professor Dan Reinstein who is credited with contributing to the continued innovation of the industry.

Prof. Reinstein has had a long career in Laser Eye Surgery spanning three decades. During this time he has helped to pioneer new technology and techniques, including the development of the Artemis Insight 100™ Ultrasound Scanner, now considered to be the most accurate tool for planning the anatomy of any vision correction surgery.

So, what Laser Eye Surgery techniques do we use today?


The oldest Laser Eye Surgery procedure still in use today is also the most similar to Barraquer’s original technique. But don’t let that scare you. PRK has been a go-to procedure since the advent of Laser Eye Surgery in the 80s and is considered extremely reliable.

PRK/LASEK is known as a surface procedure, meaning it involves removing the whole epithelium of the cornea to gain access to the tissue below. This is done with the help of an ultra-precise and near-painless laser. Another Laser is then used to reshape the cornea – using the same theory as first employed by Barraquer.

Read more about PRK/LASEK in our dedicated guide to the procedure, here.


The next significant development in Laser Eye Surgery debuted in the late 1980s. LASIK is less invasive than PRK/LASEK and remains the most commonly used technique to this day. It involves the creation of a flap in the cornea, as opposed to the complete removal of the epithelium. This flap can then be closed, like a door, after the second laser procedure has been carried out to reshape the cornea.

The long-standing success of this vision correction technique has led to it becoming one of the most popular elective procedures in the world. Learn more about this staple of the Laser Eye Surgery industry on our LASIK Treatment Page.


Finally, we come to the latest innovation in Laser Eye Surgery. ReLEx SMILE has once again revolutionised vision correction surgery, thanks to its minimally-invasive, keyhole nature. Unlike LASIK and LASEK (and Barraquer’s technique before them), SMILE does not require surgeons to remove any of the corneal epithelium before reshaping the corneal bed.

Instead, a state-of-the-art Carl Zeiss VisuMax laser is used to create a tiny hole in the surface of the cornea. Through this hole, a series of pulses are applied to create a pathway to the corneal bed. The latest technology makes it possible to reshape and draw out corneal tissue through this microscopic channel, leading to minimal invasion.

ReLEx SMILE has helped to make Laser Eye Surgery suitable for more people than ever before and, incredibly, it still harks back to that original technique dreamed up by José Ignacio Barraquer Moner back in 1948.

A Dedication to Education and Transparency

Here at London Vision Clinic, we strive to ensure every one of our patients is as informed as possible about their treatment. This includes an extensive screening process and detailed consultations in which we determine the best treatment for each individual. With our expert surgeons and clinic consultants on hand, you can be confident about every step of your journey to vision correction.

If you would like to learn more about your options when it comes to Laser Eye Surgery, don’t hesitate to get in touch! Book a Consultation today or speak to one of our clinic coordinators by calling 020 7224 1005.

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