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    Confessions of an innovator

    How ophthalmic breakthroughs evolved from the bizarre to medical, surgical realities


    Excimer laser development

    A number of surgeons had the idea that the excimer laser could be used to reshape the cornea, but no one was using it for that purpose. Lasers contained argon and fluorine gases and the instruments were not readily available in practice.

    “It was a good idea that was useless,” he said.

    Dr. Kaufman and fellow faculty member Marguerite McDonald, MD, had another idea. They convinced VISX to make a laser for use on animals. However, because the laser contained deadly fluorine gas, they had to segregate themselves in a double-wide trailer away from the eye center, so if the deadly fluorine gas leaked, only they would die, he recounted.

    This endeavor to develop the early excimer laser involved the most basic of modifications, such as adding rotating prisms to the laser to avoid creating divots in the corneas from the laser’s hot points of light as well as use of steroids and special solutions. Once the laser worked in animals, only the FDA stood in their way. Vaporizing the corneas of normal eyes was not permitted.

    Ultimately, the first human to undergo treatment was a patient with a choroidal melanoma in an eye slated for enucleation who allowed Dr. McDonald to perform PRK. Following enucleation, they performed histologic studies. This was followed by the same work in a series of blind patients who allowed PRK to be performed despite the absence of a benefit to them to forward this technology.

    “This is the story of the birth of the excimer laser,” Dr. Kaufman said.

    “None of these innovations were straightforward,” he said. “None would be available without these strange machinations, but this is what happened.”


    Herbert E. Kaufman, MD

    e: [email protected]

    This article was adapted from Dr. Kaufman’s presentation as the Jones/Smolin Lecturer at the 2017 meeting of the American Academy of Ophthalmology. Dr. Kaufman has no financial interests to disclose in relation to the subject matter.


    Lynda Charters
    Lynda Charters is a freelance medical writer.

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