Advanced Surface Treatment
     The Latest Innovation in Laser Vision Correction

Advanced Surface Treatment has taken laser vision correction to a new level. This latest development is an excellent new alternative that merits consideration by just about anyone requiring vision correction. Advanced Surface Treatment is an especially good option for people who have been previously advised that their eyes are not suitable for LASIK, or whose active lifestyles may have precluded them from having that procedure.

A surgeon performing an Advanced Surface Treatment procedure uses a precise instrument called an epikeratome to gently separate the epithelium, the very thin, outer layer of the cornea, and to leave a very smooth surface for laser treatment. The cornea is then reshaped with an excimer laser. During the healing process, the epithelium is replaced by the regeneration of new epithelial cells over the treated area.

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 Advanced Surface Treatment

• Preserves the Structural Integrity of the Cornea

  • In an Advanced Surface Treatment procedure, the laser correction is performed on the surface of the cornea rather than a deeper layer. Since there is no creation of a LASIK flap, Advanced Surface Treatment is generally considered an even safer procedure.

• Especially Suitable for Patients with Active Lifestyles or Occupations

  • There is no LASIK flap and thus no chance of dislodging it in years to come. This is especially important for patients with active lifestyles, such as athletes, and those with occupations such as law enforcement, fire fighting, and military service, where blunt trauma to the eye is a real possibility.

• Better for Patients with Thin Corneas

  • Working on the surface of the cornea also allows treatment of patients whose corneas are too thin for creation of both a LASIK flap and removal of the proper amount of tissue by the excimer laser.

• Less Likely to Induce or Worsen Dry Eye

  • An Advanced Surface Treatment procedure is more gentle on corneal nerves and thus diminishes the possibility of inducing or worsening dry eye syndrome.

• Potentially Better Visual Outcomes

  • There is also evidence suggesting that wavefront - custom laser vision correction - may actually produce better, more predictable outcomes and quality of vision when performed on the surface of the cornea.

Benefits of Advanced SBK Thin-Flap LASIK

• Has many of the advantages of Surface Epi-Laser in terms of less invasiveness, less worsening of dry eyes with less retreatments and better outcomes compared with less advanced thick-flap LASIK.

• The same excellent results as "bladeless" or FemtoSecond LASIK.

• Faster visual recovery time with greater comfort during the first 5 hours as FemtoSecond LASIK.

• Equivalent visual acuity and quality of vision.

• Equivalent accuracy and predictability of flap creation.

  Femtosecond Laser	One Use-Plus SBK

• Both technologies produce flaps of relatively uniform thickness.

  Scanning electron microscopy (160x) of the stromal bed

• SBK creates smoother surface for the laser to work on.

  SBK N=50 eyes	IntraLase N=50 eyes

• Faster visual recovery with SBK.

Realistic Expectations
The goal of any laser vision correction procedure is to reduce or eliminate your dependence on glasses or contact lenses. Although the recovery time with Advanced Surface Treatment is longer, and for some there may be more postoperative discomfort (which is easily managed by medication), these trade-offs are temporary and certainly worth consideration, especially in light of the long-term safety and potentially better visual outcomes.

It is also important to know that Advanced Surface Treatment does not always create perfect vision and that we cannot guarantee that it will eliminate the need for glasses or contact lenses. As with any medical procedure, there are risks and possible complications.

We will provide you with additional information about the procedure, possible side effects and complications, the postoperative healing course, and possible alternative procedures that will allow you to make an informed decision. Be sure to have all of your questions answered before you give your consent to have the procedure.

The Next Step
Schedule an appointment to have an assessment of the health and unique characteristics of your eyes. This first step toward visual independence, along with a discussion about your lifestyle needs and visual expectations, will help determine if Advanced Surface Treatment is the right procedure for you.

MORE!: Dr. Shealy's Alternative to Epi-Laser & SBK Thin-Flap LASIK!

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About Superficial Epi-Laser

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 Epi-Laser.

Epi-Laser with the Epi-K is an advanced "surface ablation procedure" - the laser correction is done on the surface of the cornea, rather than at a deeper layer, as in LASIK. Using a very sophisticated device called an epikeratome, Dr. Shealy partially separates the epithelium, the outermost skin-like layer of the cornea. This separation is done without cutting and without a blade: blade-less. The epithelial flap is folded back prior to laser correction, is subsequently returned to its original positions, and then protected by a contact lens.

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. Previously the only refractive surgical option for such patients was Photo Refractive Keratectomy, a procedure involving more pain and longer visual recovery time than Epi-Laser.

Epi-Laser 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 Epi-Laser 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.

• Experienced less pain than other surface ablation patients - but slightly more than LASIK patients.

• Had no significant complications.

• Could return to work soon.

Below, we have evidence in the scientific literature suggesting that surface ablation procedures may actually produce better visual results than LASIK as compared to the world-wide statistics.

More information about Epi-K!

Contact us to schedule a personal consultation to determine if Epi-Laser is right for you!

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What To Expect During the Epi-Laser Procedure

Once your doctor has determined that you are a candidate for Epi-Laser, your cornea will be mapped to determine its current and individual shape. This will be used to plan the procedure and measure results.

Before the procedure, 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. The procedure itself is fast, simple and painless:

• Numbing (anesthetic) eye drops are applied.

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The procedure

Epi-Laser involves separating the cornea's outer layer, the epithelium from the Bowman's membrane, in a thin sheet that retains its hinge on the eye creating a thin epithelial flap or cap. The surgeon uses an epithelial separator, called an epi-keratome, to separate the flap from the eye.

After the epithelial flap is made, it is lifted and gently folded out of the way. An excimer laser is used to sculpt the underlying corneal tissue. Then the epithelial flap is placed back on the eye with a kind of spatula. A special contact lens is placed on the eye to keep the flap in place while it re-epithelializes.

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Risks and complications

Epi-Laser is associated with a nominal amount of surgery-related complications. Some people who have had Epi-Laser 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 Epi-Laser procedure. Some side effects include:

• Discomfort and/or foreign body sensation
• Glare
• Halos
• Overcorrection
• Tearing

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Epi-Laser Advantages at the Shealy Eye Laser Center

1. Binocular visual acuity averages 20/25 2.5 days after surgery, which meets the legal driving requirement.
2. Visual acuity averages 20/20 3.5 days after surgery.
3. One month after surgery, visual acuity is 20/20 in 99.75% of patients.
4. Retreatments are less than 0.25% after Epi-Laser.
5. Loss of best corrected visual acuity is nearly 0. We've had one patient who lost one line of best corrected visual acuity that requires a contact lens.
6. Five minutes after surgery, most patients are seeing nearly 20/20.
7. Epi-Laser is superior to Femto LASIK due to no unliftable flaps, non-dissected islands and transient light sensitivity.
8. Epi-Laser vision correction can be performed on thin corneas in patients with dry eyes.
9. Eliminates flap related complications, because there are no flaps.
10. Produces better results than LASIK.
11. Surface Epi-Laser does not produce striae in the cornea. Nearly 100% of LASIK patients have striae which may or may not affect vision.
12. Surface Epi-Laser is more amenable to presbyopic surface procedures.
13. Larger optical zones are created with surface surgery.
14. Surface epi-laser is more upgradeable in the future for other procedures.
15. Surface ablation comfort has been increased with the use of bandage contact lenses and new pharmaceutical agents to include Mitomyocin-C. Mitomyocin-C has not been found to be deleterious to cornea physiology.
16. Larger optical zones reduce retreatment rates and make them lower than LASIK with stellar outcomes of up to -12 diopters of myopia.
17. Patients who have had previous injuries and refractive procedures are candidates for surface surgery and not intrastromal invasive corneal surgery.
18. Patients who have had previous injuries or surgery are candidates for surface surgery but not invasive intrastromal cornea surgery.
19. We do not recommend LASIK for females patients who have had a hysterectomy or have experienced menopause due to the change in their biochemical and hormonal physiology.
20. 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.

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Dr. Shealy's Outcomes as of July 2008

		These graphs show the number of days it takes most patients to see 20/20 after Epi-Laser vision correction. The world rate of 20/20 vision at 120 days and beyond is about 81% with lower ranges of prescriptions of less than 13 of myopia, and +6 of hyperopia with up 6 diopters of astigmatism.
		Outcomes for laser vision correction registered globally in 25,000 patients using available laser and LASIK. The overall retreatment rate is around 20% to 25% without regard to prescription.

Archived Outcomes

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Is Epi-Laser Right For You?

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. Epi-Laser is not intended for everyone. 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

Your doctor can give you the complete list of indications and contraindications and determine if Epi-Laser is right for you.

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Epi-Laser: Ask For It By Name

If you are experiencing problems with your vision and meet the above criteria, talk to your doctor and get a full eye examination. He or she can determine your specific vision problem and whether Epi-Laser is right for you. With this knowledge in hand, you can better evaluate your options.

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Dr. Shealy's Opinion on Epi-Laser

Clinical Outcomes:

• Visual rehabilitation is faster with Epi-Laser by a least 4 days than previously achieved with PRK or LASEK or other procedures that use alcohol.
• With Epi-Laser there were fewer complaints about delays in returning to work.
• The level of discomfort is about the same as PRK within the first 24 hours, but the next 24 hours is much more comfortable.
• 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 do not occur with Epi-Laser since the corneal nerves are not severed during the procedure.

We at the Shealy Eye Laser Center feel that Epi-Laser will account for 75% to 95% of our cases by December of 2006. Epi-Laser will account for all of our surface procedures 90% of the time compared to other surface surgeries.

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'.

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More Epi-Laser Information

We have a wealth of additional information on the Epi-Laser and what it can accomplish, please explore the links below.

Published articles from other leading ophthalmologists about Epi-Laser

• Fine-Tuning the Epi-Laser Procedure; Surgeons make it a more patient-friendly experience.
  An article by Jerry Helzner, Senior Editor, Ophthalmology Management, September 2006

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• Epi-Laser Press Release

• Epi-Laser Brochure

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• An Epi-Laser procedure (Please be patient, the file is 2.11M)
• The One Use-Plus disposable, automated, nasal hinge keratome used in the Epi-Laser procedure (2.34M)
• An computer graphics version of the Epi-Laser procedure (1.5M)

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• Clinical Studies With Moria Epi-Laser - B. Soloway (3.58M)
• Moria Epi-Laser - M. Swanson (7.10M)
• Clinical Study With One Use-Plus - C. Castoro (1.37M)
• Experience with One Use-Plus - M. Swanson (3.62M)
• Clinical Evaluation One Use Large Cut - M. Whitten (180K)
• Thin Flap LSK One vs. IntraLase - R. Duffey (92K)
• ALTK in Management of Ectasia - J. Kanellopoulos (2.59M)

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6036 Trier Road Fort Wayne, IN 46815
Tel: (260) 486-0065 or (800) 644-6393  Fax: (260) 486-3437
email: shealy@shealyeye.com

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