In all fairness to ophthalmological pioneers, it must be mentioned that even before Dr. Sato’s must travel to project on the retina of elongated eyeballs. Publishing in the 1869 issue of Albrecht von Graefes Arch. Klin. Exp. Ophthalmol., German ophthalmologist Dr. H. Snellen discussed the possibilities of correcting corneal astigmatism. In 1984, Dr. W.H. Bates suggested an operation to correct astigmatism in an article published in the Archives of Ophthalmology. He reported on operatory modifications and furnished a number of cases. Four years later, Dr. L. Lans did the same, also publishing in the Albrecht von Graefes Arch. Klin. Exp. Ophthalmol.
Finally, sandwiching his published report between Drs. Sato and Fyodorov, Jose I. Barraquer, M.D. of Bogota, Columbia, almost thirty years ago developed the two classic procedures, keratophakia and keratomileusis. These were the primary techniques in refractive surgery until radial keratotomy came along. Dr. Barraquer’s report on the subject appeared in 1964 in the Archives of the Society of American Ophthalmology. Herbert E. Kaufman, M.D., Director of Louisiana State University Eye Center, and Marquerite B. McDonald, Assistant Professor of Ophthalmology, Louisiana State University Eye Center, described the two Barraquer operations in the June 1, 1984 issue of Ophthalmology Times. Drs. Kaufman and McDonald wrote: “Keratophakia involves splitting the cornea in half with a microkeratome instrument and putting a small lathed button of donor cornea between the halves. The top of the original cornea is then sewn back into position. This technique was used on extremely hyperopic [farsighted] patients or on aphakes [people lacking crystalline lenses] who were unable to use spectacles or contact lenses.
“In keratomileusis, the cornea is split, and the top layer is removed and shaped on a cryolathe [a tiny grinder that simultaneously freezes tissue]. The reshaped tissue is then reattached without the addition of any donor material …  The  main disadvantage of these  techniques was  that they could be performed by only a few surgeons … use of the microkeratome requires an extraordinary amount of skill and practice, and the cryolathe is an expensive device. In addition, practitioners had to travel to Bogota in the early years to learn the techniques directly from Dr. Barraquer … This situation led to the development of more accessible techniques …”
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