To the editor:
The article, "Surface Procedures: The State of the Art" (February 2003), states on page 36, "… as devised by LASEK's inventor, Massimo Camellin, MD, of Rovigo, Italy." Unfortunately, this is not completely correct.

Thirteen years ago I devised a method to make PRK (LASIK had not been invented yet) less painful and heal faster. From my earliest experiences with RK in 1979, I learned that if I replaced as many epithelial cells as I could recover, regardless of their state, back on Bowman's membrane, the cornea would reepithelialize much faster and the patient would have much less pain and for a shorter time. During the FDA study, I heard reports that the drawbacks of PRK were related to the time it took for the cornea to reepithelialize.

In an attempt to solve this problem, in late 1990 I invented a technique of removing a circle of corneal epithelium using a trephine of my design (with the Hoffer cross-hairs à la RK optical zone marker), and replacing the epithelial flap after the PRK ablation had been performed. In January 1991, I asked Storz Instrument Co. (today Bausch & Lomb) to make a Hoffer RK optical marker with a sharp trephine cutting edge with a cutout section to allow the creation of a hinge, so the layer could be flapped back on. They soon delivered two instruments to me. Since PRK was then under FDA investigation, I had no way to try my new procedure. I sent the instruments to Drs. Richard Lindstrom and Marguerite McDonald, who had agreed to look at my idea. While waiting to hear back from them, I presented my surgical procedure at the ISRK Meeting in October 1991 before a very large international audience.¹ I had suggested the use of cocaine to help loosen the epithelium prior to peeling it off. I waited before publishing this to get results feedback from the FDA investigators.

Dr. Lindstrom never reported back to me and I never saw the instrument I sent him again. Dr. McDonald told me that Dr. Herbert Kaufman recommended lab studies with it first, but this didn't pan out, and she returned the instrument to me a year later (See Figure 1). It is interesting to note that Dr. McDonald now performs LASEK. Her instrument: the Storz #SP7-38545 labeled "Hoffer 7 mm Trephine Cutter." The image also shows the Storz engineer's sketch for the instrument and the date of 1/22/91. B&L supplied this drawing to me six months ago.

Since LASIK did not exist then, I lay no claim to the present name of my procedure. I simply referred to it as the "Reuse of Autologous Corneal Epithelium with Excimer Laser (RACEWEL). Dr. Camellin must be congratulated for giving it the name LASEK, pursuing this idea and popularizing it in such a way that it has now reached world-wide acceptance. He must be credited. 

Kenneth J. Hoffer, MD
Santa Monica, Calif.
Clinical Professor of Ophthalmology, UCLA
KHofferMD@AOL.com

1. Hoffer KJ, "Reuse of Autologous Corneal Epithelium with Excimer Laser," Annual Meeting, International Society of Refractive Keratoplasty, Anaheim, Calif., October 12, 1991, at the Annual Meeting of the American Academy of Ophthalmology.