Without the James Webb telescope, Lasik could be stuck in stone age

The world's most powerful telescope, which could allow human beings to see further into the universe than ever before, also played an instrumental role in improving the vision of people back on its planet of origin.

Lasik—one of the most common forms of laser vision-correction surgery—would not be possible in its current form without the scanning Shack-Hartmann system, a sensor tech initially created for NASA’s James Webb Space Telescope, which was launched in December 2021. Last year, more than 800,000 people received laser vision-correction surgery.

Considered the world’s most advanced space telescope—100 times more powerful than the Hubble—the Webb took NASA 30 years and $10 billion to build. It’s common for long-term NASA projects like this to cast off innovations that later advance a number of unrelated fields, as was famously the case with the Apollo program and tech like GPS, microchips, and satellites. Webb’s effect on Lasik is yet another example of this link between space tech and its earthly applications.

“The early days of Lasik were like—remember Galileo, when he pulled out that little handheld telescope and looked up at the sky…? That little, handheld, single-piece thing…we’ll call that the earliest, the first, iteration of laser vision correction,” Christopher E. Starr, MD, spokesperson for the American Academy of Ophthalmology and director of refractive and laser vision corrective surgery at Weill Cornell Medicine in New York, told us.

The scanning Shack-Hartmann system was so powerful that it propelled Lasik from its humble Galileo-esque roots to, Starr said, a system more akin to the Hubble telescope in capability.

Starry-eyed

It all started with mirrors and measurements.

In the early 2000s, the NASA team was trying to figure out how to make a telescope that was as powerful as the James Webb work in the unforgiving conditions of outer space. For that, they needed to build technology that didn’t fully exist yet.

For one, the James Webb telescope’s 18 primary mirror segments had to be shaped hyper-specifically—with no margin for error—in order to capture the clearest, most accurate images of the universe. During the grinding and polishing process, if the team accidentally ground off too much of the mirror’s surface, they would have had to start all over again, costing NASA time and money. But prolonging the process could also increase costs, due to materials and scheduling, so efficiency was key.

“The primary mirror really defines the power of the telescope,” Lee Feinberg, Webb’s optical telescope element manager, told us. Later, he added: “It’s really important when you first start polishing a mirror. The better you understand that entire mirror surface, the more efficiently you can go about making that mirror.”

So, NASA needed a way to measure the telescope mirrors’ deviations (read: imperfections) with unprecedented accuracy. After some digging, an Albuquerque-based company called WaveFront Sciences, which specialized in sensor technology, seemed like a good bet. Between June 2000 and June 2007, the company received more than $175,000 in contracts from NASA.

From this partnership, the scanning Shack-Hartmann wavefront sensor was born.

NASA didn’t actually wind up using the tech as much as anticipated; Feinberg recalled it used only in the early evaluation phase. But that didn’t stop the sensors, which had been created for space exploration, from transforming another industry: laser eye surgery.

In the early days of laser vision correction, patients would receive a few-sizes-fits-all treatment based on their eyeglass prescription. If two people had -3 prescriptions for nearsightedness, they’d receive the exact same surgery—there was no way to customize it further.

But that all changed in the 2000s, once the new sensor tech came into the picture. It allowed for custom measurements of each individual’s visual system, with the ability to study irregularities, in addition to nearsightedness and farsightedness. Suddenly, many people with astigmatism were no longer excluded from laser vision correction.

“It was right when I was starting my professional career,” Starr recalled. He added, “It was a revolutionary improvement to be able to offer custom, individualized treatments, [which], as you can imagine, is infinitely better than just typing in an eyeglass prescription and treating everybody with that same eyeglass prescription exactly the same…All these advanced tools really showed us that everybody’s cornea, and everybody’s eye, and everybody’s optical systems were uniquely different.”

The sensor technology works by sending out individual beams of infrared light to specified points on the retina. If they return in a uniform way, the visual system has no flaws; if they don’t, the sensor can measure each aberration—or deviation from the norm—and the Lasik procedure is individualized accordingly.

“NASA measured their mirrors with this Shack-Hartmann system, and they knew where to smooth and how to treat the mirror to make it more perfect—and we do the same thing,” Starr said. “We measure the cornea and the visual system of one’s eyeball, and we identify the aberrations.”

WaveFront Sciences attracted interest from buyers as its scanning Shack-Hartmann grew more popular.

In 2007, the startup was acquired for $20 million by Advanced Medical Optics (AMO). Two years later, Abbott Laboratories, a medical device giant, acquired AMO—and, by extension, WaveFront Sciences—for $2.8 billion. In 2017, Johnson & Johnson purchased Abbott’s medical optics subsidiary, which included WaveFront. Then, in 2019, once Johnson & Johnson reportedly “ended development efforts” on WaveFront’s laser vision measurement device, members of WaveFront Sciences’ team broke off and created a brand new startup, called—familiarly enough—WaveFront Dynamics. That new company raised a $3 million Series A in August 2020.

Today, the Lasik world has built upon this sensor tech even further. It now offers even higher-resolution scans that analyze 1,257 microrefractions in the cornea—a 5x increase in data points from the initial scanning Shack-Hartmann system. That translates to treatments with a greater degree of customization, allowing people with more severe astigmatism, or with higher degrees of nearsightedness or farsightedness, to be candidates for surgery for the first time.

Thanks to recent advancements that have built upon the foundational sensor tech, Starr said Lasik is now moving on from its own Hubble phase and entering its Webb era—in other words, a time in which the field pushes the boundaries of what was once thought possible.