Key takeaways:

• Ioannis Pallikaris, MD, PhD, explained how he developed the idea of laser correction under a flap and the first instruments to perform this procedure.
• He also spoke about further advances in the technique.

LONDON — Ioannis Pallikaris, MD, PhD, a pioneering leader in the development of LASIK, delivered this year’s ESCRS Heritage Lecture titled, “LASIK, What Next?”

During his presentation, Pallikaris summarized his more than 40 years of commitment to the art of enhancing vision.

Ioannis Pallikaris, MD, PhD, is honored during the Heritage Lecture by ESCRS president H. Burkhard Dick, MD, PhD.

“I never wanted to be a doctor when I was young. I wanted to be an artist,” he said during the lecture at the European Society of Cataract and Refractive Surgeons meeting. Later in life, he also became a farmer “because I like to eat my own bread,” he said. In between these two, he studied the art of medicine.

Pallikaris is known by the global ophthalmic community as a visionary physician who developed and “baptized” LASIK, changing the future of refractive surgery. Because of his contributions, refractive surgery became fertile ground for new discoveries.

The development of LASIK was paved by the active relationships that a young Pallikaris established with prominent ophthalmologists. His first step in cornea was in Zurich during his PhD research under Rudolf Witmer, who let him express his scientific creativity by using Placido disc topography and a primitive computer to study induced astigmatism after penetrating keratoplasty as well as designing a three-edge trephine for high-precision lamellar cuts.

He later met Jack Coleman, with whom he studied ultrasound velocity for cataract determination during the early era of IOLs. Another pivotal figure in his journey was Svyatoslav Fyodorov in Moscow. With Fyodorov, Pallikaris learned radial keratotomy and considered possible ways to overcome limitations of the technique.

“One of the problems in RK was that you have to advance the incision to 90% corneal depth in order to have sufficient effect from the cuts,” Pallikaris said.

To solve this problem, he designed a trephine with one side shorter than the other to better suit the structure of the cornea, thinner in the center and thicker in the periphery. He also designed a primitive diamond arcutome to customize corneal arcs using topographic data for astigmatism correction.

Then came the excimer laser. In 1987, Pallikaris traveled to Berlin to study the physics of the laser and its applications in refractive surgery with Theo Seiler. Later, he flew to London to advance his knowledge of histology with John Marshall and discussed the idea of using the laser under a stromal flap.

“He told me, ‘Ioannis, don’t do that because you are going to generate about 11 D of astigmatism,’” Pallikaris recalled.

Back in Crete, Greece, Pallikaris researched the effects of the mechanical keratome and laser on the cornea as well as nerve disruption and nerve regeneration. Determined to overcome the limitations of PRK — pain, inaccurate results, haze and regression — Pallikaris pursued his idea of creating a flap in the stroma to reshape the underlying tissue without disrupting the anatomic relationships of the anterior layer of the cornea. He worked on the development of the first primitive instruments for flap creation and published the initial animal studies.

In 1989 the LASIK era began, with Pallikaris debuting his first presentation on the concept at the ESCRS Congress in Zurich.

“That meeting was the most important experience in my career because I was sitting at the same table with the gurus of ophthalmology: Svyatoslav Fyodorov speaking about RK, George Waring about the PERK study, Theo Seiler about the physics of excimer laser, John Marshall about histology and, of course, Marguerite McDonald, who reported on the first PRK done on the human eye,” he said.

In the years that followed, Pallikaris performed his first LASIK procedures in human eyes using the Barraquer-Krumeich-Schwinger microkeratome and Aesculap Meditec MEL 60 laser. The first report on his experience, published in 1994 in the Journal of Cataract and Refractive Surgery, ensured his place in the history of refractive surgery.

From there, Pallikaris researched optics, ocular biomechanics and hydrodynamics; performed foundational work on the principles of ray tracing aberrometry and the development of ray tracing technology; and developed epi-LASIK, in which the idea of using the epithelium as a flap transitioned from alcohol-assisted to mechanical separation by an epikeratome.

As refractive surgery widened its scope to lens-based procedures with advanced-technology IOLs, Pallikaris created the fixOflex ring (EyePCR), which is implanted in the capsule for IOL stability, prevention of posterior capsular opacity and easy exchange.

Science, like art, is a matter of continuous inquiry, and while ophthalmologists strive to target emmetropia, they should know that emmetropia could never be the perfect vision, Pallikaris said. The Greek etymology of the word emmetropia is in-measure, well-proportioned sight, “the perfect imperfection,” he said.

He concluded by quoting Fernando Pessoa, a poet he learned to love thanks to his wife, who gifted him a book to broaden his horizons through literature: “To be great, be whole: don’t exaggerate; Or leave out any part of you; Be complete in each thing. Put all you are; Into the least of your acts.”

Editor’s note: This article was updated on September 27, 2026, to clarify information on the implantation of the fixOflex ring.