At the recent 2018 Winter AECOS Meeting in Aspen, Colorado, Marguerite McDonald, MD, FACS, gave a wonderful presentation on the first PRK procedure in a human sighted eye, which occurred 30 years ago this March. The events that led to that landmark surgery were like stars aligning. IBM was using excimer lasers to etch silicon chips. Stephen L. Trokel, MD, asked the question: “Could this laser be used to reshape the cornea, thereby correcting refractive errors?” Shortly thereafter, a team at Tulane University started doing PRK on monkeys in a trailer-based laboratory on campus. (To learn why and to find out more about Dr. McDonald’s fortuitous journey into laser vision correction, see Back Talk.) At the same time, an unfortunate patient was scheduled for exenteration for an orbital tumor. Her CDVA was 20/20, and the eye was otherwise perfect. When this woman declared that her perfectly good eye should be used for research prior to its removal, the opportunity presented itself for Dr. McDonald to perform the procedure on a human.
Dr. McDonald performed the surgery, and Stephen D. Klyce, PhD, watched carefully with a scientific eye. They learned much from that first procedure, and, because the procedure went so well, the US FDA fast-tracked human trials. Just like that, laser corneal refractive surgery was born.
Serendipity? Perhaps. But Drs. McDonald and Klyce are at every AECOS Aspen meeting that I have ever attended—always teaching, always learning, and always networking. Fortune favors the brave, or as champion golfer Gary Player quipped, “The more I practice, the luckier I get.” (For more on luck, see Four Principles of Leadership and a Little Luck, Too below.)
Four Principles of Leadership and a Little Luck, Too
This past year, I completed Physician CEO, an executive MBA-type program presented by the Kellogg School of Management at Northwestern University in Chicago. There I met Harry Kraemer, former CEO of Baxter International and author of From Values to Action: The 4 Principles of Values-Based Leadership.
Those principles—knowing yourself (genuine self-reflection), balance (the ability to appreciate different perspectives), true self-confidence (accepting yourself while knowing that there are others with greater skills and successes), and genuine humility—helped create a leader and organization that has a solid foundation for long-term growth and success.
At one of the events where Harry spoke, an attendee asked him to what he credited his success. Instead of giving a review of his book, he stated, “Luck, timing, and being in the right place at the right time.” Talk about genuine humility.
Today, PRK is still alive and is, in fact, doing very well. One-touch PRK has seen growth in numbers, and the results continue to be impressive. The masking effect of the regularizing epithelium is incorporated into the ablation profile, and pain management has improved considerably.
LASIK, with all of its customizations, such as wavefront- and topography-guided ablation, continues to push the envelope, and modern LASIK consistently provides postoperative UDVA the same as or better than preoperative CDVA.
Small-incision lenticule extraction is also gaining popularity. Phakic IOLs such as the EVO Visian ICL (STAAR Surgical) and refractive lens exchange are becoming more commonplace and providing outstanding results.
Cataract surgery has become refractive surgery, and these refractive innovations can all trace their roots back to that trailer on the Tulane University campus.
Where can this journey still take us? The Refractive Surgery Alliance’s mission is to grow the entire refractive market by growing each individual refractive practice. In return, we can bring the benefits of refractive surgery to more people. Included in this mission is a goal to make refractive surgery more affordable and the primary form of vision correction as soon as it is age-appropriate. What a wonderful destination for the journey that started 30 years ago. It is in our hands to make this become reality.
We must all seek and seize opportunities and remain open to innovative ideas; we never know where they may take us. When we reach our destinations, wherever they may be, we will likely realize that the journey was the actual prize all along. Here’s wishing you a journey as interesting and exciting as the destination you dream of.
Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin)
Associate Chief Medical Editor