Advanced Surface
Laser Vision Treatment (Superficial Epi-Laser)
or (AST):
Advanced
Surface Laser Vision Treatment (Superficial Epi-Laser) or (Amoils): No-Cut, No
Flap, Pharmaceutically Modified Surface Epi-Laser for Increased Safety A more precise way of performing
laser vision correction while decreasing its risk.
Laser vision correction has been taken to a whole new level
with Amoils Advanced Surface Laser Vision Treatment (Superficial Epi-Laser).
An exceptional new alternative, this latest improvement should be considered
by anyone requiring vision correction, even those patients who have been
told that they are not suitable for laser vision correction due to dry eyes
and thin corneas. Most of the complications of cap and flap LASIK can be
avoided by the technique of treating the corneal surface after removal of
the epithelium. This removal can be performed with a brush or a superficial
non-cutting epitome.
When performing superficial Epi-laser or surface treatment, the
underlying Bowman's membrane provides a smoother surface for laser treatment.
This smoother surface along with the accuracy of the Allegretto Wave laser, can
provide high performance vision which the patients can rely on both daytime and
nighttime. The vision can be likened to a high definition or plasma screen
television. Since the procedure is non-invasive, it avoids all of the
complications associated with making a cap or flap in the deeper layers of the
cornea. This is especially helpful to patients who are at risk to being struck
in the eye as with fire fighters, police officers, athletes and military
personnel.
The epithelium, the very thin, outer surface of
the cornea is lifted prior to laser treatment. In a few days, a new
epithelium regenerates naturally in its place.
A thicker flap is created extending down into the
stroma, the middle layer of the cornea. After laser treatment, the
flap is returned to its original position.
Benefits of Amoils Advanced Surface Laser Vision Treatment
(Superficial Epi-Laser)
Less Invasive And Non Cutting
Laser vision correction performed on the surface of the
cornea, which is less invasive and avoids complications of cutting the
deeper layers of the cornea. This procedure is safer than cap or flap
LASIK or the wearing of contact lenses.
Safer for Patients with Thin Corneas
A small number of patients are predisposed genetically to
biomechanical weakening of the cornea with subsequent development of
ectasia or induced keratoconus although corneal thickness may
contraindicate cap or flap LASIK, we do not understand completely this
phenomena, but try to avoid performing LASIK on corneas below 500 microns
in thickness and those corneas with abnormal topographies.
Reduce the Risk of Permanent Dry Eyes
All patients undergoing laser vision correction are at
risk to have a worsening of their dry eye situation. Nearly 20% of our
patients present in our office with moderate dry eyes related to age and
environmental factors. Avoiding the cutting of the delicate corneal nerves
reduces dry eye potential.
Better Visual Outcomes In Our Hands at The Shealy Eye Laser
Center
Less retreatments and higher quality of vision at the
Shealy Eye Laser Center. Our patients need to remember that our goal is to
give them high quality of vision with fewer nighttime glare and haloes.
This high performance vision takes standards of vision to a new level
outdating the 20/20 Snellen eye chart vision standard of the early 20th
century. This standard of vision is not relevant to the 21st century
accomplished with eye glasses and superior to vision experienced with eye
glasses and contact lenses.
Amoils Brush Epi-Laser Dr. Raymond Stein, MD, FRCSC, Bochner Eye
Clinic, Toronto, Canada
The Fastest, Safest, Most Accurate Method of Epithelial
Removal
Minimizes dehydration.
Significantly less haze.
Significantly less regression.
Faster healing time, less epithelium removed.
Faster re-epithelialization.
Patient friendly.
No knife or blade used.
Quick and efficient epithelial removal.
Produces easily seen "bull's eye" that aids in centration of
laser.
Leaves smoother anterior stromal surface.
Particularly helpful for post RK/AK patients.
2-5 seconds minimizes total procedure time.
Less patient anxiety by eliminating time consumed scraping.
Will not compromise stromal integrity due to top design.
Eliminates nicks or scrapes to Bowman's Membrane.
Uniform removal of the epithelium centrally and peripherally.
No need for subsequent scrapping.
Performed with patient positioned under the laser microscope.
Epithelial removal in re-treatment.
Steps for use of the AMOILS Brush Epi-Laser:
Place the topical anesthetic on the eye (0.5% Proparacaine).
Center the eye under the microscope and then turn on the fixation
occluder asking the patient to look at the green occluder light. Move the
occluder until the eye is once again centered under the microscope while
maintaining fixation on the light with the non-treatment eye. Tape the
fixation occluder in place.
Unwrap the inner pack containing the Amoils Brush Epi-Laser and mount it
on the neck of the power handle.
Insert a lid speculum
Check that the patient is maintaining fixation on the occluder light and
that the treatment eye pupil is centered under the microscope.
Mark the area of epithelium to be removed with a corneal marker.
Place a few drops of chilled B.S.S. (balanced salt solution) on the
inverted scrubber tip.
Place a few drops of chilled B.S.S. on the patients cornea.
Turn on the device and bring the Amoils Brush Epi-Laser gently in
contact with the patients corneal epithelium using the microscope to keep it
centered.
Within a few seconds the epithelium will be removed in a specific zone
centered around the pupil. Note that the edges of the zone are much smoother
than manual removal methods.
Turn off the fixation occluder before proceeding with procedure
The Shealy Eye Laser Center continually strives to
provide its patients the benefits of the latest advances in laser vision
correction. We are pleased to announce that we are among the first
practices in our area to perform Amoils Advanced Surface Laser Vision
Treatment exclusively for our surface treatments.
Amoils ASLVT is performed on the surface of the
cornea as an advanced treatment by using pharmaceutical agents to aid in
the healing process and maintain corneal health. This avoids dryness of
the cornea necessary for avoiding infection and irritation rather than
involving the deeper layers of corneal biochemistry as seen in
conventional thick flap LASIK. This is truly a bladeless procedure
analogous to trans-epithelial photo refractive keratotomy.
Performing the laser correction on the surface of
the cornea preserves its structural integrity and allows treatment of
individuals who may not be good candidates for LASIK. Many patients, for
example, who cannot have LASIK because their corneas are too thin, can
now have laser vision correction with the same long-term results as
LASIK. Advancements in pharmaceuticals have reduced haze and pain to
acceptable levels comparable to LASIK with the advantage of no cutting
and greater safety. Amoils ASLVT is also an excellent alternative for
individuals who are not good LASIK candidates because of participation in
dangerous sports such as martial arts in which blunt trauma to the eyes
is a real possibility.
The safety and efficacy of Amoils ASLVT have been
demonstrated in extensive clinical trials. Surgeons participating in the
trials reported that their patients:
Achieved excellent visual results.
Recovered their vision faster than typical
patients treated with other surface ablation procedures - but not as
rapidly as LASIK patients.
What to Expect During the Amoils Advanced
Surface Laser Vision Treatment
Once Dr. Shealy has determined that you are a
candidate for Amoils Advanced Surface Laser Vision Treatment, your cornea
will be mapped to determine its current and individual shape. This will
be used to plan the treatment and measure results.
Before the treatment, the only requirements are to
not wear contact lenses up to three weeks prior to surgery and on the day
of surgery do not wear makeup. You will also need to arrange
transportation to and from the doctor's office.
Risks and complications
Amoils Advanced Surface Laser Vision Treatment is
associated with a nominal amount of treatment-related complications. Some
patients who have had Amoils ASLVT have experienced side effects that
have impaired their vision for a few days after the procedure. Although
these risks are relatively rare, they should be taken into consideration
by anyone considering the Amoils ASLVT procedure. Some side effects
include:
Discomfort and/or foreign body sensation which
may cause tearing
Glare, halos and shadowing
Over and under correction
Amoils Advanced Surface Laser Vision Treatment Outcomes at the Shealy Eye Laser Center
Binocular visual acuity averages 20/25 2½ days after surgery, which
meets the legal driving requirement.
Unaided vision averages 20/20 3½ days after surgery.
One month after surgery, unaided vision is 20/20 in 99.75% of
patients.
Retreatments are less than 0.25% after Amoils ASLVT.
Loss of best corrected visual acuity is 1-2 lines of chart vision at
a rate of one per 1000 treatments with no loss of eyes and a gain of 1-2
lines of chart vision in 67 out of 100 eyes.
Within 30 minutes,
most patients are able to see the bottom of our Snellen chart.
This no-cut technology eliminates flap of cap complications because
there are no flaps or caps.
The
treatment is more suitable with thin corneas and dry eye conditions.
Optical zone sizes
can be expanded with surface treatment.
The Shealy Eye Laser Center
treatment of choice for upgrading previous refractive procedures to
include LASIK, RK, ALK, Phakic IOLs, cataract implants, multifocal
implants, accommodative implants, retinal detachment surgeries, and
glaucoma treatments.
Surface ablation comfort has been increased with the use of bandage
contact lenses and new pharmaceutical agents to include Mitomycin-C.
Mitomycin-C has not been found to be deleterious to cornea physiology.
Larger optical zones reduce retreatment rates and make them lower
than LASIK with stellar outcomes of up to -12 diopters of myopia.
Surface treatment
has now been used in a considerable number of cases of corneal ectasia
after LASIK. They were treated with riboflavin-ultraviolet corneal
crosslinking followed by topographically guided PRK to effectively
improve their vision. This was reported by Dr. John Kanellopoulos in
Greece.
Epi-Laser is intended for people with a "safety-first"
mindset who
want to improve their vision and reduce their dependence on glasses or
contact. If you have been told in
the past that you were not a candidate for LASIK because of thin corneas or
tear dysfunction, this may be just what you are looking for. All
patients considering vision correction should undergo a complete examination
by a doctor prior to the procedure.
You're likely a good candidate for Epi-Laser if you:
Safety minded
Have an active lifestyle or occupation
Are interested in a better visual outcome
Other criteria include:
No significant changes in your vision for 1 year
No chronic eye disorders
Not pregnant or nursing
No chronic illness or disease
Patients who are nervous or anxious about
refractive surgery, especially that of cutting a flap or cap
Dr. Shealy's Opinion on Epi-Laser
Clinical Outcomes:
With Epi-Laser there were fewer complaints about
delays in returning to work, especially when the procedure is
pharmaceutically modulated.
The level of discomfort is approximately the same as
LASIK
within the first 24 hours of surgery, however the visual recovery time
is reduced acceptably compared to flap or cap LASIK by about 3 to 7 days.
Dry eyes; about 50% of LASIK patients suffer from
dry eyes which is treated over several weeks with restasis and wetting
drops. The symptoms associated with dry eyes occur less frequently with Epi-Laser since the
corneal nerves are not severed during the procedure.
We perform Surface Epi-Laser about 80% of the time
up to January 2009 and reserve thin flap LASIK and Ziemer Femto LASIK to
higher prescriptions in patients requiring a fast visual recovery time and
in patients where haze is a consideration.
Surgically, Dr. Shealy is more comfortable with the
knowledge that he has not cut the patient's eye, and anxious patients respond
positively to the reassurance of a no-cut, non-invasive 'non-surgery'. Dr.
Shealy also feels that thin flap SBK laser vision correction and Ziemer
femto laser vision correction have definite places to be used especially in
cases of higher hyperopia of 3 diopters or greater, and in moderate to high
myopia of 5 diopters or greater. By this we eliminate haze regression
considerations.
We use Surface Epi-Laser on all of our LASIK patients that
need retreatments due to under/over correction. Removal of the surface
epithelium may be performed by trans-epithelial ablation.
