Although the European Society of Cataract and Refractive Surgeons (ESCRS) has not always included refractive surgery in its early annual conferences, we certainly have made up for it during the past 10 years. During this time, the refractive committee of the ESCRS has worked hard to incorporate new initiatives including symposia, workshops and wetlabs, a biannual refractive didactic course, prizes for the best refractive poster presentations, and research grants for refractive surgery projects, both in its spring refractive meeting and annual autumn conference in various cities throughout Europe.

From 1996 onward, the evolution of refractive surgery was brought into the ESCRS as it developed. As the founder of the ESCRS Refractive Committee some years ago, I am proud of the work that this society has done to further the refractive specialty.

The ESCRS Refractive Committee actually began as an automated lamellar keratoplasty (ALK) club, after Luis A. Ruiz, MD, of Colombia, developed this technique. In the early 1990s, there were a few European surgeons and a handful of US surgeons who performed this technique. This small group of European surgeons gathered before each ESCRS meeting to discuss results with this technique. At that time, the refractive procedure was managed with a microkeratome only. The ALK procedure consisted of creating a free flap, removing and storing it, and creating a second microkeratome refractive cut based on the flap thickness and replacing the stored cap.

As this ALK club grew, we started holding more refractive sessions each morning before the start of the annual ESCRS meetings. As more people became interested in refractive surgery, we felt it must become an official part of our European organization, in response to which we immediately appointed a refractive committee. Many important people including Emanuel Rosen, BSC, MD, FRCS(Ed), FRCOphth, of the United Kingdom; Ioannis Pallikaris, MD, of Greece; Lucio Buratto, MD, of Italy; Julian D. Stevens, MRCP, FRCS, FRCOphth, of London; and Sheraz M. Daya, MD, FACP, FACS, FRCS(Ed), of London, were members of the original refractive committee. When Dr. Buratto combined the application of laser with a microkeratome-created flap and Dr. Pallikaris demonstrated the safety of the flap technique and coined the term LASIK instead of intrastromal keratomileusis, the operation established itself in Europe. The refractive committee of the ESCRS immediately introduced it into the annual congress. Having such masterminds involved with the original refractive committee was extremely beneficial to what we were trying to accomplish, which was to encourage others to become involved and educated in refractive surgery.

FIRST LASIK
In our institution in Ireland, we were using ALK on both hyperopic and myopic eyes from as early as 1990. Then, on March 17, 1994, Michael O'Keefe, MD, FRCOphth, of Ireland, and myself performed the first LASIK with a Summit laser (Summit Technology, Inc., Waltham, Massachusetts) in Ireland, the results of which we published in 1997.¹ This was followed immediately by Dr. Rosen, and the technique quickly spread across Europe after 1994. Recently, my colleagues and I published a long-term follow-up study on our original LASIK patients from 1994 that demonstrated the safety of the procedure from an ectasia point of view, and the original results were presented at the 1996 Annual Meeting of the ESCRS.^2,3 This was one of the first years that refractive surgery was included as part of the ESCRS conference and main symposia. Responding to this, we were then encouraged by Philippe Sourdille, MD, of Paris, Michael Blumenthal, MD, of Tel Aviv, Israel, and Dr. Rosen to start a separate refractive meeting apart from the general cataract meeting, the first one of which took place in Madrid in the spring of 1997.

Since then, there have been many refractive additions to the annual ESCRS conference. One initiative that began in 1998, which we were quite proud of, were the refractive wetlab workshops, the first series being on microkeratomes, where surgeons could learn the techniques in using, cleaning, and taking care of these sophisticated instruments. At the time these microkeratomes were manufactured by Chiron (now Bausch & Lomb, Rochester, New York) and Moria (Antony, France). Other manufacturers were added later. The interesting thing about these workshops was that they benefited both the surgeons and the industry alike. Surgeons would learn how to better use the equipment, and the manufactures would get tips on what surgeons wanted and how to improve the quality of the blades and working parts. The whole technology improved dramatically as a result of this activity, and in more recent years, the laser companies were included. As a result, present-day activities usually involve joint wetlabs by both microkeratome and laser companies, which are extremely successful and appreciated by many people beginning laser refractive surgery. The success of this activity in later years is partly due to the enthusiasm and dedication of doctors Clive Peckar, MSc, FRCS, FRCSEd, FRCOphth, of Cheshire, England, and Karl Heinz Hannig, who have both perfected the running of these activities at our meetings.

Another relatively recent initiative is our 1-day refractive didactic courses that Drs. Buratto, Pallikaris, and myself started between 1997 and 1998. In 9 years, it has become one of the most highly attended courses every year. In its contents, each specific refractive topic is dissected and taught by the top surgeons in that area. This has included such topics as refractive lens exchange, phakic IOLs, and laser refractive surgery.

ELECTRONIC POSTERS
Because it is impossible to fit a specific number of lectures and paper presentations into each conference, the addition of poster presentations at our meetings has been a huge success. Approximately 3 years ago, the ESCRS transitioned to electronic posters. As chairman of the poster committee, I am delighted that this has enabled more people to present at each meeting and more people to access these posters in a more appropriate manner. We also offer a monetary prize for the best refractive poster presentation, and during my position as treasurer of the ESCRS, I was also pleased that the board approved the introduction of research grants. Since then, each year, a number of grants are given to surgeons who are doing research in refractive and/or cataract surgery.

Approximately 4 to 5 years ago, the United Kingdom and Ireland experienced a surge in commercially run practices carrying out laser refractive surgery, and patients started to use these clinics with increasing frequency. Because surgery was taken out of the hands of the original pioneering centers of excellence, more complications seemed to occur. This resulted in the National Institute of Clinical Excellence (ie, NICE, the equivalent of the Food and Drug Administration [FDA] in the United States) holding an inquiry into the safety and quality of surgery in the United Kingdom. Active members of the ESCRS Refractive Committee and Executive Board, together with the United Kingdom and Ireland Society of Cataract and Refractive Surgeons (UKISCRS) immediately became involved, and quality control guidelines on practices and surgeons performing refractive surgery were introduced with the recommendations from ESCRS members Daniel Z. Reinstein, MD, MA (Cantab), FRCSC, of London, and Drs. Daya and Stevens. The result was that, in 2004, NICE revised their approach to LASIK surgery, approving it as a safe procedure provided that these guidelines were met. Since then, the Royal College of Ophthalmologists (RCO), in conjunction with the British Refractive Society (BRS), have introduced an examination for surgeons who are involved in refractive surgery, which they will require before practicing in the United Kingdom.

In summary, the ESCRS and its Executive Board, Executive and Refractive Committee, and the Programme Committee have made every effort in the last decade to introduce refractive surgery into its annual conferences. As one can see, it has involved itself to an extent in the training and education of young doctors starting up in refractive surgery and in issuing the high standards and guidelines necessary to practice safely on their patients. It also offers very excellent courses and symposia at its annual meetings for the continuing medical education of surgeons in the refractive field and has also, become involved politically to a certain extent in order that the correct standards are maintained from a health point of view in Europe. It is also hoped that the ESCRS will become more involved with the European Union in relation to other refractive issues that are always evolving.

Patrick I. Condon, MCh, FRCS, FRCOphth, is the Medical Director of Waterford Eye Specialists, in Waterford, Ireland. Dr. Condon states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +353 51 844982; fax: +353 51 858676.

1. Condon PI, Mulhern M, Fulcher T, O'Keefe M. Laser instromal keratomileusis for high myopia and myopic astigmatism. Ophthalmology. 1997;8:119-206.
2. Condon PI. 2005 ESCRS Ridley Medal Lecture: Will keratectasia be a major complication for LASIK in the long term? J Cataract Refract Surg. 2006;32:2124-2132.
3. Condon PI, O'Keefe M, Binder PS. Long-term results of laser in situ keratomileusis for high myopia: risk for ectasia. J Cataract Refract Surg. 2007;33:583-590.

• Editor's Note: This article was scheduled to appear in the September Cover Focus: The Birth of Refractive Surgery. We apologize for the inconvenience to Dr. Condon and our readers.