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What is SBK, and is it better than LASIK?

By Joel Hunter, MD | 8/23/17 11:10 AM
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When a couple ophthalmologists first figured out how to get an excimer laser to painlessly and permanently correct vision, they knew it would be a big deal. What would they call it? As I picture it, one of them (probably the nerd of the duo) said, “How about laser-assisted in situ keratomileusis?” After this, I imagine everyone in the room laughed because they thought he was making a joke. Then he looked around and started laughing too so they’d think he was just joking. Once the chuckles kind of died down, someone said, “Guys… let’s never forget this great moment and just shorten the hilarious geek name you said into LASIK.” And so the name LASIK was invented, probably.

LASIK was the best of the best during its wonder years because it took the precision of excimer laser sculpting of the cornea and made it painless. Photorefractive keratectomy (PRK—which has come a long way in comfort and speed) was a predictable, precise way to get good vision with an excimer laser. It just happened to travel its path through a nightmare forest of pain and light-sensitivity to get there. So, when LASIK came along, the collective excitement and joy of refractive surgery patients rose to new heights. Sure, there was a “blade” involved. And sure, it “cut” the cornea and was capable of some “new complications.” But with no pain and near-instant visual recovery, it was the best option possible to most patients when choosing to fix their vision.

Then a new laser came along called the femtosecond laser. It was one that could create the corneal layer that made LASIK quick and painless, but it does it without a blade. And at first, I’ll be honest, it kind of stunk. There was inflammation, it took a minute and a half instead of 10 seconds, and it didn’t always work the way it was supposed to. “Bladeless LASIK” as it came to be called, was a technology in search of a purpose. Not for long though! Since this happened around the turn of the millennium, computers were already getting better and faster at a ridiculous pace. And the new femtosecond laser improved incredibly fast because the technology driving it was improving so rapidly. Bladeless LASIK quickly evolved from being not as good as standard LASIK, to just as good, and then on from there to be measurably better in safety and efficacy.

Around this time, Dr. Dan Durrie and Dr. Steve Slade decided to try and use the femtosecond laser to perform LASIK with different parameters than were possible with a blade. Durrie and Slade are rock star legends in refractive surgery, complete with groupies and sold-out concerts (lectures). So, when they collaborated on this study, it was like Elvis and Michael Jackson decided to do an album together, minus the time travel issues. They used the laser to create a smaller, thinner layer—so thin that it was just beneath the most superficial layer below corneal epithelium. And because those guys are superhumans among mortals, they were able to show this new procedure had equal speed and comfort compared to LASIK, but with less risk.

That superficial layer they chose to go just underneath with the laser is called Bowman’s membrane. And so, they coined the term Sub-Bowman’s Keratomileusis (SBK) for the procedure. SBK has since become the new standard for laser refractive surgery. Interestingly, SBK came along after LASIK had already become hugely popular and been performed millions of times. That, combined with the fact that LASIK is much catchier as a term, means SBK is used mostly in academic circles despite the fact that it’s more precise—both as a procedure and as a name. It means you should make sure you’re getting SBK, but you might have to ask because the legend of the guy who invented the term LASIK continues to live on.

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