1. Question: Can patients be treated with laser vision correction if they've had Herpes Simplex Keratitis?
   Answer: Dr. Herbert Kaufman has performed the Herpetic Eye Disease Study associated with testing, cultures and treatments. He found 1. oral medications have nothing to offer us for treating stromal disease and iritis, 2. oral medicines did not effect the incidents of stromal disease in patients with herpes epithelial disease, 3. oral medicines did prevent recurrence of herpes in only 1/2 of the patients with recurrent stromal disease. Secondly, he found that steroids benefitted acute disease of the stromal cornea and that there was no damage caused by them. The study also determined that true bilateral herpes keratitis is very rare but can occur. He uses Viroptic for epithelial disease and has a new hope, Ganciclovir, which inhibits viral DNA synthesis for use in the future as it comes in from Europe. Dr. Kaufman feels that patients that have had Herpes are good candidates for refractive surgery in which he performs LASIK. If a patient has active disease, he starts Viroptics a couple days before LASIK and keeps it up for two weeks after LASIK. He will perform laser vision correction surgery in patients that are asymptomatic for a few weeks by giving them oral Valtrex 500mg twice daily for a few days and two weeks after surgery. He's noted no reoccurrences of herpes in these patients with LASIK. Dr. Shealy follows his recommendations at his center.
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2. Question: What traits are desired in candidates for laser vision correction?
   Answer: Candidates for laser vision correction have the following characteristics;
   1. Very unhappy with their dependence on corrective lenses.
   2. Think they are poor candidates for contact lenses.
   3. Believe wearing corrective lenses restricts them in sports and similar activities.
   4. Think they look better without glasses.
   5. Worry about what would happen to them if they lost/broke their glasses or contact lenses.
   6. Would prefer merely functional vision without correction to excellent vision with corrective lenses.
   7. Would be happy if their uncorrected vision could be much improved, even if corrective lenses were still necessary.
   8. Adjust well to change.
   9. Are easy-going; can tolerate disappointment.
   10. Are not perfectionists.
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3. Question: What is the most common complication of laser vision correction, seen in our office today?
   Answer: The primary stimuli to dry eyes in our practice is aging, gender, medications, previous ocular surgery, low dietary omega-3 fatty acids, and artificially dry environments (heating, and air conditioning). Patients feel grittiness, foreign body sensations, blurry vision, and tired eyes when reading. Inflammatory blepharitis and tear deficiency both play roles; however, the number one reason for patients seeking laser vision correction is contact lens intolerance. This intolerance may usually mean underlying dry eyes. Topical restasis starting one month before surgery and combined with a low dose topical steroid post operatively help. At our center we are now placing punctal plugs in our patients nearly all of the time in females with a history of hysterectomy or hormonal changes related to physiological biochemical aging.
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4. Question: How long should I discontinue contact lenses before surgery?
   Answer: Contact lenses should be discontinued to achieve a natural corneal shape before surgery. Soft contact lenses should be out 1 to 3 days prior to surgery. Toric soft contacts should be discontinued 1 week before surgery. Patients with gas permeable hard contact lenses should discontinue contacts until the best corrected visual acuity is obtained.
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5. Question: What is Superficial Epi-Laser or Advanced Surface Treatment (AST)?
   Answer: Advanced Surface Treatment separates the epithelium from the Bowman's membrane, creating a thin epithelial sheet, which is discarded. This makes possible laser vision correction for more patients, especially those with thin corneas or dry eyes. Uncorrected visual acuity was significantly better with cell removal on post operative days three to seven as compared to keeping the epithelial cells intact. This is much safer as compared to cutting procedures like IntraLase, RK, or even mechanical cutting LASIK. All of our patients prefer this to other procedures. Using the Allegretto Wavelight Laser has given us the highest quality of vision compared to other lasers that we have used.
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6. Question: Why has advanced surface treatment (AST) or Superficial Epi-Laser nearly replaced LASIK in our practice at the Shealy Eye Laser Center?
   Answer: Improved equipment, better pharmaceutical treatment, and increased concern over LASIK complications have greatly improved staff and patient satisfaction. Our center has found that the risk for kerectasia has decreased dramatically, especially in patents with no preoperative warning signs. Lifting the LASIK flap for enhancement has, in the past, increased epithelial ingrowth and scarring of the cornea. The rate of epithelial ingrowth has decreased from about 10% to none. Visually significant epithelial ingrowth, when removed, was found to reoccur 50% of the time, causing great problems to our patients
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7. Question: Why does laser vision correction worsen dry eyes in many situations?
   Answer: About 14% of the US population already has dry eyes. The causes of dry eyes may be related to lack of tears or improper tears. As we age, tear production decreases especially after menopause and during pregnancy in women. Contact lenses also result in increases in tear evaporation and general irritation causing contact lens discomfort. A wide variety of medications can reduce tears especially anti-histamines, sleeping pills, decongestants and et all. Autoimmune disease like rheumatoid arthritis can produce Sjogren's Sydrome and is accompanied b y dry eyes and dry mouth. Environmental factors like dust, smoke, high altitudes, work settings, heaters, and air may reduce eye lubrication.
        Below is a check list of dry eye symptoms:
                q Dry Sensation
                q Scratchy, Gritty Feeling
                q Burning
                q Stinging
                q Itching
                q Excess Tearing (Watery Eyes)
                q Mucous Discharge
                q Irritation from Wind or Smoke
                q Redness
                q Tired Eyes
                q Light Sensitivity
                q Contact Lens Discomfort
                q Contact Lens Solution Sensitivity
                q Soreness
                q Lid Infections/Sites
                q Sensitivity to Artificial Tears
                q Eyelids Stuck Together at Awakening
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8. Question: How has Dr. Shealy improved his results with Surface Epi-Laser?
   Answer: Patients are screened for dry eye situations commonly seen in some collagen vascular diseases, aging, and biochemical age related changes, especially in females. We now routinely perform occlusion of the tear duct, known as punctal occlusion in patients who are at risk especially those undergoing LASIK with a cap or flap in ages 50 or above.
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9. Question: What is bladeless All-Laser LASIK?
   Answer: Bladeless, All-Laser LASIK involves cutting into the stromal tissue with a laser. It has the same complications as blade microkeratome LASIK. Those complications are quite extensive to include epithelial ingrowth, dry eyes, structural weakening of the cornea, interface inflammation, and a higher incidence of retreatment.
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10. Question: What are the complications of LASIK when a flap or cap is formed with either a blade or laser?
    Answer: There are four basic complicated outcomes to include:
          • Epithelial defect
          • Diffuse Intralamellar Keratitis
          • Flap slippage
          • Incomplete flap
    The results, in percentages, are as follows are for two well known microkeratome systems:
    
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11. Question: What causes my eyes to be red or bloodshot after laser vision correction?
    Answer: Sometimes the blood vessels in the conjunctiva will break and bleed. Many patients will notice this especially if they have worn contact lenses over a period of years. It usually takes at least 3 weeks for redness or bloodshot to disappear, but please remember this will not affect your vision.
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12. Question: When can I allow water to get in my eyes after laser vision correction?
    Answer: Please allow 10 days to 2 weeks before entering a natural body of water such as a pond, river, lake, or ocean. You may get into a spa or chlorinated pool one week after surgery. You may shower or bathe at any time after surgery; however please avoid getting water or soap in your eyes by keeping them closed while performing such activity.
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13. Question: What type of sunglasses do we recommend?
    Answer: We have found that avoiding high intensity ultraviolet light during the first 6 to 12 months, cuts down on the incidences of corneal haze. This hazing is a mild sun burning of the superficial cornea. We recommend polarized UV sunglasses such as Maui Jim that are available at the Sunglass Hut. Patients that have Surface Ablation should wear these sunglasses for at least one year especially in the mountains or at the ocean for protection from the sun's UV rays. They are especially advantageous for patients who work and drive during dimly lit conditions since they do not reduce light intensity like regular sunglasses during the non-daylight hours.
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14. Question: When will my vision improve after laser vision surgery?
    Answer: All laser vision patients have an immediate improvement in their vision in the range of 20/20 to 20/30 immediately after surgery. The visual improvement seems to be faster with all laser vision correction as compared to AST or superficial epi-laser. Recently we've noticed that the visual recovery time of AST is almost the same as All laser LASIK. This has been due to the improvements in contact lens and pharmaceutical management. At six weeks 100% of our AST patients will see 20/20 and 67% 20/15 or better if normal 20/20 vision was achieved with contacts or glasses before surgery.
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15. Question: When can my son or daughter have laser vision correction?
    Answer: When they are appreciative of the financial cost of having laser surgery and have stable nearsightedness, they are a good candidate. The prescription needs to be stable for at least 6 month before correction can be performed.
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16. Question: What does LASIK "board certified" mean?
    Answer: LASIK board certified means that the doctor has had 50 of his surgical patients evaluated. These patients have been studied and followed up on after surgery for their clinical results for a six-month period and their outcomes have been determined. Three random surgical cases by the doctor have been video taped and have been reviewed by a board of independent ophthalmologists from the American Board of Eye Surgery.
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17. Question: When does the cap or flap heal completely?
    Answer: Caps require patients not to rub their eyes indefinitely or to receive blunt force trauma to the eye. We recommend that a shield be worn for the first 72 hours for the cap to become adherent. We very seldom perform cap or flap surgery any more.
         Caps or flaps never heal completely, so this must be taken into consideration by patients who might be exposed to trauma or striking of their eye. This is especially important for patients in the military, police or fire fighting professions.
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18. Question: Can I wear contact lenses after surgery?
    Answer: The goal of laser vision correction is to eliminate glasses and contact lenses. Very rarely, less than 1 in every 1,000 patients, a contact lens may be necessary for ectasia or astigmatism which may occur after correction. Contact lenses are successful 99% of the time to correct residual prescriptions.
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19. Question: How soon can I wear make-up after surgery?
    Answer: You may wear make-up 72 hours after surgery.
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20. Question: What are the options for financing laser vision correction?
    Answer: We provide no interest financing or low monthly-extended payment plans, through CareCredit.
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21. Question: What is epithelial ingrowth?
    Answer: In 1% to 15% of surgeries, cells may be embedded or proliferate under the flap or cap after surgery. Chronic ingrowth may recur after surgery associated with Intrastromal enhancements about 35% of the time. Some may need anterior lamellar grafts.
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22. Question: What is the presbyopic phenomenon?
    Answer: Presbyopia or loss of focus is age related due to the lens growth, like the layers of an onion that occurs in an incremental fashion as you grow older. This makes the ciliary muscle less able to flex our lens for focusing as we get older.
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23. Question: If I am pregnant may I have surgery?
    Answer: We prefer not to operate on pregnant patients because of perceived liability.
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24. Question: What does the abbreviation LASIK stand for?
    Answer: This means laser assisted intrastromal keratomileusis, which a flap or cap is created with an epithelial separator or microkeratome. This creates a two piece cornea which Dr. Shealy feels alters the biomechanics and corneal integrity. Dr Shealy does not perform corneal transplants or other types of corneal surgery. He refers all of these patients to a corneal specialist if they need further surgery or request such. All corneal transplant procedures eventually require laser vision correction.
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25. Question: What is a microkeratome?
    Answer: A microkeratome is a cutting devise much like a carpenter’s plane. It is used to make a flap from the top layer of the cornea under which the laser is applied in laser vision correction.
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26. Question: If I’m from out of town, can you recommend a hotel in the area?
    Answer: Yes, our office manager can assist you with this information. We offer an overnight at Don Hall’s Guest House with limousine transportation service.
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27. Question: Does insurance cover the procedure?
    Answer: Please contact your local insurance carrier. Your agent is more familiar with your account and coverage policies, so get in touch with them for advice. We are not licensed or qualified to give you guidance in this area.
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28. Question: What is the average charge for laser vision correction in different parts of the world?
    Answer: The cost of traditional flap LASIK surgery per eye is:
     

    Norway	$700 to $1,200
    United Kingdom	$1,500 to $3,600
    Spain	$3,000
    USA	$2,400

    

    The cost of glasses in the United Kingdom, to include spectacle changes every two years, annual examinations every two years, cost $9,800 over a lifetime. Rigid contact lenses, changed every two years, including solutions, tests and exams, cost $17,800 in the United Kingdom over a lifetime while daily disposable contact lenses cost $31,000 over a lifetime. Patients that only need glasses to read will spend $8,100 over their lifetime for reading glasses. The mentality has changed in Europe, once laser vision correction was considered Rolls Royce treatment, but now is considered a better long term investment than glasses or contact lenses.
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29. Question: How does Dr. Shealy feel about operating on one-eyed patients?
    Answer: Dr. Shealy is very conservative and probably would not operate on a one-eyed patient which is the policy of 62% of the ophthalmologists in the United States.
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Outcomes 'Frequently Asked Questions':

1. Question: What has been the experience at the Shealy Eye Laser Center with treating high myopia and average to thin corneas?
   Answer: In Ocular Surgery News 2007, our experience with Surface Epi-Laser was confirmed by showing better visual outcomes.
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2. Question: What can a patient expect for an outcome in the first two to six weeks after laser vision correction at the Shealy Eye Laser Center?
   Answer: We have found that 90% of our patients see as good or better than they did with their glasses during this time period. About 50% of our patients gained vision over their contacts or glasses compared with the global average of about 20%.

   Global Data	My Data
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3. Question: How long does it take to get crystal clear and stable vision after laser vision correction?
   Answer: Thin flap LASIK requires almost 2 weeks to get crystal clear and stable vision. IntraLASIK requires 3 to 4 weeks and is delayed as compared to thin flap LASIK. Epi-LASIK on the other hand requires approximately 60 days to achieve stable and crystal clear vision, but in our hands, the incidents of 20/20 or better increases dramatically over LASIK cutting techniques so that our retreatment rate is 0.25% as compared to 10% with LASIK cutting or flap surgery.
   
   
   
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4. Question: How often are people retreated after laser vision correction?
   Answer: Our re-treatment rate is less than 0.25%. This compares much more favorably than a 5% to 10% rate noted with other lasers.
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5. Question: Describe the pain encountered before and during the recovery period of Surface Epi-Laser surgery.
   Answer: Dr. Markomanolakis, from Athens, Greece, described the mean pain score in 163 patients on the first post operative day. See the following graph:
   
   The mean pain scores remained below the threshold for burning sensation during the first two to ten hours after the operation. At 24 hours after laser treatment, the mean pain score was 0.18 which indicated only mild discomfort, far below the threshold of needing oral medications (4), pain without medication (3), burning (2), and discomfort (1.46). The judicious use of Imitrex, Ambien, and topical steroids make the patient as comfortable as if they had LASIK either with a mechanical keratome or Interlase.
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6. Question: When will I be able to drive after advanced surface treatment laser vision correction and how does it compare with IntraLASIK and surface PRK?
   Answer: Approximately 90% of our patients can drive comfortably 4 days after epi-LASIK laser vision correction. All patients can drive at one week after epi-LASIK laser vision correction with 20/40 vision being the legal driving limit. The uncorrected vision at one month post-operatively is 88% at 20/20 or better. About 42% see 20/16 or better at one month. This study is based upon 1,000 eyes that underwent epi-LASIK surgery, presented at the American Academy of Ophthalmology in Las Vegas in 2006.
   
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7. Question: What are the chances of me seeing better than I currently do with glasses or contacts after surgery?
   Answer: 98% of our patients report seeing better than they ever have with a pair of glasses or contact lenses. They also report seeing better than their friends who have had laser vision correction. This vision is called high performance vision and is achieved with the Allegretto Wave Laser.
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8. Question: What percentage of your patients see 20/20 after surgery?
   Answer: The FDA statistics are listed under the Allegretto Wave outcome sheet.
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9. Question: If I have glare with glasses or contact lenses, how will it be after surgery?
   Answer: Most patient notice a reduction in glare after wave front optimized ablation with the Allegretto Laser! It may take 1 to 3 months for healing to take place.
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10. Question: How many vision correction procedures has Dr. Shealy performed?
    Answer: We have performed over 20,000 laser vision correction procedures and 5,000 to 6,000 refractive procedures related to keratomileusis or incisional keratotomy.
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11. Question: Can I drive the day after surgery?
    Answer: Most of our patients drive the day after surgery to our office. Some patients may feel uncomfortable with driving to the first visit post-operatively. Patients usually can drive pretty well during the day following surgery, the last thing to improve is vision for night driving.
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12. Question: Can I play sports after surgery?
    Answer: We encourage people who play contact sports to have AST, since there is no flap or cap to dislodge. This is also true for police officers and those in the armed services. You will be able to play sports after surgery, but should wear protective goggles for racquetball and certain projectile sports activities.
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13. Question: If I need glasses after surgery, is that included in the surgery fee?
    Answer: No.
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14. Question: When will I be able to start seeing my regular eye doctor?
    Answer: You may elect to see your regular eye doctor after Dr. Shealy releases you.
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15. Question: What is the upper limit of laser vision correction?
    Answer: The combination of frozen BSS to chill the cornea after surgery, a tight bandage contact lens, and aggressive pharmaceutical management has reduced the incidence of pain to the point where 85% of surface ablation patients have roughly the same comfort level as LASIK patients. Use of mitomycin-C has removed significant haze as a complication of surface ablation which is entirely disappeared three months after surgery. Dr. Shealy has performed advanced surface treatment on patients in the -12 to -15 diopter range with great success and in his limited experience, has found these patients achieved 20/20 or better vision.
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16. Question: How does Dr. Shealy treat high myopia?
    Answer: Dr. Shealy prefers to threat high myopia with advanced surface treatment using mitomycin-C. He has treated up to 15 diopters of myopia successfully, but would prefer higher levels of myopia to be treated by Dr. Rozakis or Dr. Hastus who have been performing this type of this surgery for last few years.
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17. Question: What is the treatment of choice for regressed NearVision CK at the Shealy Eye Laser Center?
    Answer: A renowned ophthalmologist who has performed many NearVision CK's has convinced me to allow the patient to fully regress. The regressed patient needs to be treated on the surface by attempting an overcorrection of one half to three-quarters of a diopter. This can cause irregular astigmatism in some patients making their best corrected vision slightly reduced, but it is my best treatment option at this time.
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Physics of the Allegretto Wave Laser 'Frequently Asked Questions':

1. Question: Why did the Shealy Eye Laser Center switch completely to the Allegretto Wave Laser?
   Answer: After owning three excimer lasers, we noted that the Allegretto Wave Laser improved our visual outcomes with nearly 90% of our patients seeing 20/20 or better. Patients noticed elimination of glare and haloes due to the maintenance of the natural shape of the eye. Treatment times became faster and they were more comfortable for the patients. After switching to surface technology, we noted an increase in the quality of vision with the elimination of major complications unique to laser or mechanical-assisted flap LASIK procedures. Visual recovery times were improved beyond PRK with or without alcohol debridement. Patients preferred not to participate in any studies comparing PRK to Surface Epi-Laser according to Canadian ophthalmology experts who had more experience with laser and surface laser technology.
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2. Question: How does higher order aberrations with Advanced Surface Treatment compare with LASIK?
   Answer: Higher order aberrations are less at 3 months with LASIK than with Epi-LASIK.
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3. Question: What are the characteristics of the Allegretto Wave Laser and how does it produce high performance vision?
   Answer: The Allegretto Wave Laser represents flying spot, the latest advance in small beam laser technology. The energy level can be measured at three points within the laser beam path due to it's small spot size. Each spot is half overlapped nine treatment pulses later. This is necessary to provide a clean path for each overlapped ablation spot without interference of the plume emanating from the first pulse. The pattern of pulse placement has a repetition rate of 200 to 400 Hz so that tracking pattern is changed 6,000 times each second, thus providing a very smooth ablation profile resulting in a crisper, less scattered focal point.
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4. Question: How does the Allegretto Wave Laser compare to other larger beam lasers?
   Answer: The Allegretto Wave Laser ablation is applied in a manner to maintain the original curvature of the cornea. The resulting shape factor value, known as the Q factor, results in a -0.41 to -0.61 value. This provides the purest prolate ellipsoid focus for reducing abberated vision.
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5. Question: Why can't larger beam laser produce the same quality of vision as the Allegretto Wave Laser?
   Answer: Larger beam lasers remove larger amounts of tissue within a fixed time period. The ablations must be delivered at lower repetition rates. The effect of lower repetition rates and larger beams results in more corneal dehydration and swelling between pulse placement which is more delayed resulting a less smoother ablation with more crater and ridge formation. The beams tend to be less homogeneous with hot and cold areas adding to the focus scatter. The peripheral ablations result in more spherical aberration and coma causing night glare and haloes and reduced quality of vision as the pupil changes in size.
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Am I a candidate for  laser vision correction surgery?

With today's fast-paced active lifestyles, the need for unimpaired vision becomes more and more obvious and the hope for freedom from glasses and contact lenses is what makes many people consider laser vision correction. Most people have friends or family members that underwent a laser vision correction procedure.

Patients who request refractive surgery want to be less dependent on their glasses or contact lenses. Many patients enjoy sports such as swimming, boating, hiking, and water-skiing. Some elect to have surgery to enable them to become pilots or policemen. Many patients feel visually and socially limited in their every day life activities. Occasionally a patient may have one myopic or hyperopic eye making his or her vision unbalanced. Patients may develop myopia or astigmatism after an unrelated eye surgery, such as cataract surgery; which can be corrected with vision correction surgery at the time of the surgery or afterwards.

Patients should have a prescription that has been stable for approximately 12 months. Therefore, patients as a rule should be 18 years of age or older. There is no upper age limit. Patients with lower or moderate degrees of myopia will have the most immediate and best results most of the time. Most will have near normal uncorrected vision. Patients with very high degrees of myopia can have the procedure done, but may require enhancement surgery following the initial procedure to further refine distant or monovision reading goals. Patients with less that eight diopters of myopia usually select bilateral surgery; while those with higher levels may elect surgery at three to seven days apart. During that time period they may be fitted with glasses or soft extended contact lens. Patients must have healthy corneas. Keratoconous or central thinning of the cornea is a contraindication. Hyperopic corrections may be reduced or eliminated by using laser ablations that steepen the internal layers of the cornea.

However, there are certain people who are less than ideal candidates for laser vision correction. In general, you are not a good LASIK candidate if one or more of the following conditions apply to you:

• Your age is under 21; in this case your growth phase has not been fully completed which means that your eyes can still change.

• You are pregnant or nursing; pregnancy causes changes to your hormone system which can cause your vision to change.

• Glaucoma or high blood pressure

• Keratoconus, a corneal irregularity

• Inflammation of the eye; uveitis, blepharitis or iritis

• Herpes simplex that has infected your eye

• Previous severe injuries on the eye

• Corneal scars or infections

• Certain medications

• Unstable refraction

• Other diseases of the eye such as AMD, diabetic retinopathy, cataract or others

If any of the indications listed above apply to you, make sure you consult with Dr. Shealy prior to considering LASIK. During the consultation with Dr. Shealy, please be sure to mention all medications you are taking and any medical conditions you have that might affect the success of the laser correction.

LASIK is also not recommended for patients with:

• Very large pupils

• Thin corneas

• Dry eye

• Unstable refractive errors

If any of these apply, the right technology or surgery technique may be able to still provide you with a satisfying treatment. These patients are encouraged to speak with Dr. Shealy to find the best vision correction option.

Additionally, an in-depth examination of your eyes, your individual case, your expectations, and your lifestyle will help us better determine if you are a candidate.
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I still have a question.

If you can't find the answers you're looking for on our FAQ page or you have specific concerns about laser vision correction, fill in the following form and Dr. Shealy or a staff member will get back to you as soon as possible.