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EUROTIMES

| Volume 15 | Issue 7/8

holam A Peyman MD is perhaps best known

for his pioneering work in vitreo-retinal

surgery, including intravitreal drug delivery,

endoresection, development of the operating

microscope with stereoscopic assistant head, the endolaser

and the first 23-gauge vitrectomy system. While he limits

his clinical practice to retinal diseases, he has developed

techniques and instruments for treating a wide range of

ophthalmic conditions, for which he has been granted 116

US patents. “I felt that I could contribute in management of

the diseases affecting other parts of the eye” he says.

one such concept was modifying the curvature of the

cornea for refractive purposes using an excimer laser to

sculpt the corneal stroma or on the back surface of a corneal

cap or flap – the procedure that would become known as

LASIK. Dr Peyman first filed a patent on the concept in July

1985 (US patent 4,840,175) (see figure). After two revisions

of the application, the patent was finally granted in June

1989, about six months before Ioannis Pallikaris MD, PhD

performed the first LASIK procedure on a human eye.

Avoiding scars and pain

Dr Peyman’s interest

in laser refractive surgery dates back to 1977. Then a

faculty member at the University of Illinois in Chicago, his

investigations of the effects of lasers on eye tissues led him

to experiment with Co2 lasers to modify corneal refraction

in rabbits. The laser was applied to the cornea in different

patterns, but all caused significant scarring. “My conclusions

at that time were: 1) We have to wait for the development of

an ablative laser and 2) We should not ablate the surface of

the cornea but, instead, the ablation should take place under

a flap in order to prevent scarring and other undesirable

sequelae,” Dr Peyman says. He published the first paper on

the topic in

Ophthalmic Surgery

in 1980.

Dr Peyman’s interest was piqued again in 1982, when

reading an article, in the journal

Laser Focus

from Bell

Laboratories, describing the photo-ablative properties of the

excimer laser on organic materials. “When I read about the

excimer laser, I thought it would revolutionise corneal laser

surgery. My mind was ready for it,” he recalls. The next year

Stephen Trokel MD, PhD published his landmark study of

excimer incisions on enucleated cow’s eyes, also conducted

at Bell.

In 1985, Dr Trokel and his group published a paper that

described using an excimer laser for radial keratectomy (RK)

on an enucleated human eye. However, RK incisions failed

to heal apparently due to removal of a thin layer of tissue

between the sides of the cut, so most investigations shifted to

surface ablation.

Dr Peyman took another route. “Because of my previous

experience with the Co2 laser, I wanted to avoid surface

ablation thereby preventing the potential corneal scarring

and the pain associated with the removal of the corneal

epithelium that exposes the nerves after surface ablation.

I applied for a patent in June 1985 describing the method

of modifying corneal refractive errors using laser ablation

under a corneal flap.” The filing anticipated several

methods for directing a refractive laser, including “use of a

variable diaphragm, a rotating orifice of variable size, and a

scanning mirror which directs the laser beam towards the

exposed internal stromal surface or the underside of the

corneal flap.”

Dr Peyman tried to get an excimer laser for research from

a firm in Finland, but the device was just too expensive.

However, he was able to evaluate the effects of various

excimer lasers in conjunction with the Physics Department

of the University of Helsinki (1985).

He had also purchased an infrared Erbium-Yag laser

to evaluate stromal ablation under a hinged corneal flap

in vivo in rabbit and primate eyes. He presented the

research at the Association for Research in Vision and

ophthalmology in 1988, and published it in

Ophthalmology

in 1989. By this time he also had moved to Louisiana

State University, where Marguerite McDonald MD and

colleagues were developing PRK. However, as a retinal

specialist, he was restricted and not involved in the project.

Surface ablation continued as the dominant procedure

for some time, and Dr Peyman had little success getting

manufacturers interested in laser ablation under a flap. In

1990, he sold the patent to Chiron. “They purchased it for a

very little amount of money and that was the end of it,” Dr

Peyman says. “However, I was happy that at least someone

liked the concept and paid for my development costs.”

Mitigating LASIK side effects

Dr Peyman still

conducts LASIK research, primarily to address some

shortcomings. “I have always been very aware of the

potential limitations of my invention, and have devoted

considerable time and effort over the years to find ways to

ameliorate them,” he says. Among these have been ablative

and non-ablative inlays inserted under the corneal flap to

allow a greater range of refractive correction

(J Cataract

Refract Surg. 2005)

, and the use of topical cyclosporine to

enhance the recovery of corneal sensation after LASIK

(.J

Refract Surg. 2008 Apr;24(4):337-43)

now as professor of basic medical sciences at the

University of Arizona in Phoenix, Dr Peyman continues

his research in other areas. He is currently developing a

tonometer that can measure IoP and outflow through

the eyelid for patients to use at home, and a pressure jet

injector in which no needle enters the eye for non-invasive

subconjunctival and intraocular injections. Why has he

been involved in so many different projects? “I enjoy

research,” he said.

1- Peyman GA, Larson B, Raichand M, Andrews AH.

Modification of rabbit corneal curvature with the use

of carbon dioxide laser burns. Ophthalmic Surg. 1980

May;11(5):325-9.

2- Peyman GA, Badaro RM, Khoobehi B. Corneal ablation in

rabbits using an infrared (2.9-micron) Erbium;YAG laser.

Ophthalmology. 1989 Aug;96(8):1160-70.

3- Peyman GA, Beyer CF, Bezerra Y, Vincent JM, Arosemena

A, Friedlander MH, Hoffmann L, Kangeler J, Roussau

D. Intracorneal inlay Photoablative inlay laser-assisted

in situ keratophakia ( PAI-LASIK) in the rabbit model. J

Cataract Refract Surg. 2005 Feb;31(2):389-97.

4- Peyman GA, Sanders DR, Batlle JF, Féliz R, Cabrera

G. Cyclosporine 0,05% ophthalmic preparation to aid

recovery from loss of corneal sensitivity after LASIK . J

Refract Surg. 2008 Apr;24(4):337-43.

Gholam Peyman

– gpeyman1@yahoo.com

contact

AheAD of hIs tIme on lAsIk

In 1985 gholam peyman filed a patent on stromal ablation under a flap using

an excimer laser, anticipating much of the procedure’s future development

20 years of lasik

I have always been very aware of the

potential limitations of my invention,

and have devoted considerable time

and effort over the years to find ways

to ameliorate them

“

Gholam A Peyman MD

First page of Dr Peyman’s patent for LASIK

Don’t miss

Industry News, see page 44

by Howard Larkin in Chicago

Courtesy

Gholam

Peyman