Frequently Asked Questions

Am I a candidate for laser vision correction surgery?

What are the changes that we've made at the Shealy Eye Laser Center to improve laser vision correction patient and staff satisfaction?

• Refractive surgeons know best according to 2008 survey of the American Academy Ophthalmology
  Richard Duffey, MD
• Laser Vision Correction in The United States Military
• Review of World Literature and Quality of Life After LASIK, 1987 to 2008
  VJO Second Quarter 2008, and Kerry Solomon, MD

High Performance Vision 'Frequently Asked Questions':

1. How does Dr. Shealy and his staff determine that a patient is achieving high performance or high quality vision?
2. How is high quality vision measured and produced?
3. What laser vision outcomes can reduce the quality of vision?
4. What are the chances of me seeing better than I currently do with glasses or contacts after surgery?

Our Technology 'Frequently Asked Questions':

1. Femtosecond Technology 'Frequently Asked Questions':

1. What are the Shealy Eye Laser Center's indications for Ziemer All Laser LASIK?
2. What is the newest advancement in femtosecond technology that has helped the practice at Shealy Eye Laser Center in 2009?
3. What is All Laser LASIK?
4. What are the disadvantages of the femto-second laser?
5. What is All Laser LASIK using the "DaVinci" Femtosecond laser?

2. Mechanical Microkeratomes 'Frequently Asked Questions':

1. What is the rationale for mechanical microkeratomes?
2. How has thin flap LASIK been found to have some additional benefits over femtosecond laser flap production?
3. How does the discomfort with Thin-Flap or SBK LASIK surgery compare to Femtosecond ALL-Laser LASIK?
4. What are the advantages of SBK thin-flap laser vision correction and femtosecond laser surgery?

3. No-Cut AST (Advanced Surface Treatment) or Superficial Epi-Laser 'Frequently Asked Questions':

1. Who can be treated with Surface Epi-Laser?
2. Why is hyperopic Epi-Laser the only chosen treatment at the Shealy Eye Laser Center?
3. What has the Allegretto Wave Laser added to your practice at the Shealy Eye Laser Center?
4. Why did the Shealy Eye Laser Center switch to Epi-Laser treatment for myopia?
5. Why is Superficial Epi-Laser Vision Correction superior to conventional LASIK with cap or flap formation?
6. What occupations require Advanced Surface Laser Treatment?
7. Why did Dr. Shealy abandoned LASIK with cap or flap formation, but will use the DaVinci Femto-second laser and Thin-Flap SBK LASIK if a patient desires LASIK?

4. Laser Vision Ranges of Treatment 'Frequently Asked Questions':

1. How has laser vision correction for high myopia improved since 1994 to the present?
2. Why are more people undergoing laser vision correction at The Shealy Eye Laser Center?
3. What prescription is most likely to need a secondary laser treatment after the initial laser vision correction procedure?
4. Why has the Shealy Eye Laser Center stopped performing conventional LASIK and switched to SBK (Sub-Bowman's Keratomileusis) Laser or AST (Superficial Epi-Laser)?
5. What has been the results of Phakic IOL's?
6. What strategy do we use in determining when to retreat patients eyes after laser vision correction?

5. Complications of Laser Vision Correction Causing Patient Dissatisfaction 'Frequently Asked Questions':

1. What information helps our patients overcome fear of losing their eyes or life in association with laser vision correction?
2. What is the most important advancement in laser vision correction to eliminate over, under, and residual astigmatic corrections?
3. What is the best treatment for recurrent extensive epithelial ingrowth?
4. What has been the dissatisfaction rate in national research studies conducted by Wills Eye Institute in Philadelphia, Pennsylvania?
5. What is the comparative enhanced video imaging assessment of corneal bed texture in LASIK, Surface Epi-Laser, and Thin Flap SBK?
6. What is the most frequent complication other than under and over correction seen with thin-flap laser vision correction?
7. What is the best non-surgical solution for management of keratoconous?
8. How do we treat dry eye conditions either pre-operatively or post-operatively at our center?
9. What is the most common complication of laser vision correction, seen in our office today, as of June 2009?
10. What is the most significant realization of the practice at the Shealy Eye Laser Center in 2008?
11. What is the value of thinner flaps for SBK Thin-Flap laser vision correction in high myopia?
12. What can a person expect for their uncorrected visual outcome on the first day postoperatively with Thin-Flap or SBK LASIK and how does it compare to LASIK with Femtosecond flap making technology?
13. How does SBK LASIK represent an improvement over previous types of LASIK surgery with a cap or flap?
14. How do dry eyes affect the outcome of laser vision correction?
15. Why does laser vision correction worsen dry eyes in many situations?
16. What are the possible goals of Epi-Laser or Thin-Flap, either SBK or Femtosecond, LASIK?
17. Describe what Dr. Shealy's experience has been with different excimer laser platforms.
18. How is farsightedness, hyperopia, and presbyopia best treated in our experience at the Shealy Eye Laser Center?
19. How does the reduction of astigmatism affect the results of cataract surgery, either with a premium multi-focal lens or a standard mono-focal lens?
20. What is the preferred treatment at the Shealy Eye Laser Center for re-treatment if LASIK surgery and Radial Keratotomy surgery has been performed in the past?
21. What if my eye moves during laser vision correction?
22. How does the Allegretto Wavelight platform represent an improvement over lasers we have used at the Shealy Eye Laser Center in the past?
23. What ranges of treatment are possible with the Allegretto Wave Front laser?
24. What if I have questions about the technology at the Shealy Eye Laser Center?
25. If I have a very small prescription, can it still be corrected?

6. Screening Considerations for Laser Vision Correction 'Frequently Asked Questions':

1. What are the absolute contraindications to laser vision correction?
2. How does Dr. Shealy feel about operating on one-eyed patients?

7. Patient Scheduling Considerations 'Frequently Asked Questions':

1. How much time do I need off work?
2. How long does the surgery take?
3. What if I was told I’m not a candidate for laser vision correction by another doctor?
4. If I need glasses after surgery, is that included in the surgery fee?
5. How long before surgery, should contact lenses be removed?
6. What are the major reasons why we reject patients for laser vision correction?
7. When do you perform surgery?
   Back to the top.

Laser Vision Correction 'Frequently Asked Questions' For All Ophthalmologists and Other Eye Care Professionals:

1. How is the integrity of the cornea affected with laser vision correction? 
2. What are the most appealing characteristics of a laser vision center?
3. What is the new assessment model that can assist in selecting patients for refractive surgery?
4. What is an informed consent?
5. Can patients be treated with laser vision correction if they've had Herpes Simplex Keratitis?
6. What traits are desired in candidates for laser vision correction?
7. How long should I discontinue contact lenses before surgery?
8. What is Superficial Epi-Laser or Advanced Surface Treatment (AST)?
9. Why has advanced surface treatment (AST) or Superficial Epi-Laser nearly replaced LASIK in our practice at the Shealy Eye Laser Center?
10. How has Dr. Shealy improved his results with Surface Epi-Laser?
11. What are the considerations that need to be taken into account when prescribing medications pre-operatively and post-operatively for laser vision patients?
12. What is bladeless All-Laser LASIK?
13. What are the complications of LASIK when a flap or cap is formed with either a blade or laser?
14. What causes my eyes to be red or bloodshot after laser vision correction?
15. When can I allow water to get in my eyes after laser vision correction?
16. What type of sunglasses do we recommend?
17. When will my vision improve after laser vision surgery?
18. When can my son or daughter have laser vision correction?
19. What does LASIK "board certified" mean?
20. When does the cap or flap heal completely?
21. Can I wear contact lenses after surgery?
22. How soon can I wear make-up after surgery?
23. What are the options for financing laser vision correction?
24. What is the presbyopic phenomenon?
25. If I am pregnant may I have surgery?
26. What does the abbreviation LASIK stand for?
27. What is a microkeratome?
28. If I’m from out of town, can you recommend a hotel in the area?
29. Does insurance cover the procedure?
30. What is the average charge for laser vision correction in different parts of the world?

Outcomes 'Frequently Asked Questions':

1. What has been the experience at the Shealy Eye Laser Center with treating high myopia and average to thin corneas?
2. 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?
3. How long does it take to get crystal clear and stable vision after laser vision correction?
4. How often are people retreated after laser vision correction?
5. When will I be able to drive after advanced surface treatment laser vision correction and how does it compare with IntraLASIK and surface PRK?
6. What percentage of your patients see 20/20 after surgery?
7. If I have glare with glasses or contact lenses, how will it be after surgery?
8. How many vision correction procedures has Dr. Shealy performed?
9. Can I drive the day after surgery?
10. Can I play sports after surgery?
11. When will I be able to start seeing my regular eye doctor?
12. What is the treatment of choice for regressed NearVision CK at the Shealy Eye Laser Center?

Physics of the Allegretto Wave Laser 'Frequently Asked Questions':

1. Why did the Shealy Eye Laser Center switch completely to the Allegretto Wave Laser?
2. How does higher order aberrations with Advanced Surface Treatment compare with LASIK?
3. What are the characteristics of the Allegretto Wave Laser and how does it produce high performance vision?
4. How does the Allegretto Wave Laser compare to other larger beam lasers?
5. Why can't larger beam laser produce the same quality of vision as the Allegretto Wave Laser?
6. What has been the experience with other ophthalmologists who have used the Allegretto Wavelight laser?
   Back to the top.

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 form at the bottom of this page. Dr. Shealy will receive an email within minutes after you click the Submit button and he or a staff member will get back to you as soon as possible.

Answers

LVC Self Evaluation Test Thinking about laser vision correction? Find out if you're a candidate!

 
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. Keratoconus 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.

A relative contraindication to laser vision correction are 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.
Back to the question.     Back to the top.

What are the changes that we've made at the Shealy Eye Laser Center to improve laser vision correction patient and staff satisfaction?

• Wavefront guided and wavefront optimized with the Allegretto WaveLight Laser.
• Surface Epi-Laser or Advanced Surface Treatment, SBK or Thin-Flap laser vision correction for improved safety.
• Z-LASIK with the Ziemer Laser.

Improved screening:

• Dry eyes.
• Ectasia risk.
• Decreasing nighttime glare and haloes.

Avoiding under and over corrections by defining the limits of laser vision correction.
Back to the question.     Back to the top.     Go back.

Refractive surgeons know best according to 2008 survey of the American Academy Ophthalmology
Richard Duffey, MD

• The segment of the population knows the benefits of laser vision correction more intimately than the lay-public, a refractive surgeon says.
• 35% of refractive surgeons have undergone LASIK or surface procedures such as PRK. This compares to a ten-fold more usage than the lay-public at 3.5% out of the 175 million contact or eye glass wearers.
• The more you know about modern laser vision correction, the higher the likelihood that you would have surgery.
• Additionally 30% of the surgeons spouse, 20% of their children and 40% of their sibling have had laser vision correction according to the FDA since 1996.
• The FDA had special hearing to discuss dissatisfaction and suicides, stating that ophthalmologists should avoid laser vision correction. As refractive surgeons, we feel that this is as far from the truth as it can be.
• Spreading the word. Dr. Duffey said a number of physicians have undergone laser vision correction including urologists, pediatricians, anesthesiologists, and are spreading the interest in laser vision corrections among other physician specialties at a much increased rate.
• Most family members of Dr. Shealy, who has been a practicing refractive surgeon since 1991, have undergone refractive surgery include his brother, his daughters and their families, most of his staff, to validate these national survey claims.
• Dr. Shealy has had keratomileusis for his own presbyopia performed by Dr. Steve Hollis in Auburn, Alabama in 1994. Dr. Hollis has performed over 110,000 refractive procedures.

Back to the question.     Back to the top.     Go back.

Laser Vision Correction in The United States Military

• The US military's decision to adopt laser vision correction-first PRK and then LASIK-to improve it troops' visual function was not taken lightly. It was based on the results of more than 45 clinical trials. 74% were 20/16 or better, 94% were 20/20 or better and 98% were 20/32 or better.
• 41% were positively influenced the patients ability to identify a simulated target at night, while only 3% were reduced in their ability in such.
• The complication rate. Only one of 112,000 patients complained of poor quality of vision, he was retired and was not returned to active military duty.
• The Shealy Eye Laser Center has operated on over 350 military personnel, Army and Navy, who have for the most part benefited from laser vision correction and have performed in Iraq and Afghanistan.

Back to the question.     Back to the top.     Go back.

Review of World Literature and Quality of Life After LASIK, 1987 to 2008
Video Journal of Ophthalmology, Second Quarter 2008, and Kerry Solomon, MD

• A formal study was conducted by the ASCRS (American Society of Cataract and Refractive Surgery), AAO (American Academy of Ophthalmology), and the FDA (Food & Drug Administration). About 2,915 abstracts were studied from all parts of the world with 1,334 of these abstracts determined to be not relevant because that pertained to animal studies, et al. Almost 1,581 abstracts were found to be pertinent with 1,461 of these abstracts written in English and 120 were translated from non-English sources. Of the 1,581 pertinent abstracts, 309 were found to be acceptable from a scientific, controlled studies standpoint. They were grouped as prospective randomized and non-randomized studies and retrospective randomized studies. All of the abstracts were found in the major journals, published around the world between 1994 and 2008.
• The patient study concluded that 95.6% were satisfied and 4.6% were dissatisfied after having LASIK since its inception. The study applied to all patients regardless of whether they were nearsighted or farsighted, or where the surgery was performed in the world. No difference was found in satisfaction whether the survey was performed in the first 6 months after surgery or after the first 6 months. There was a tendency for the satisfaction rate to improve over time and it approached 98.5% over the long term.
• A quality of life comparison was made between patients that wore glasses or contact lenses and those that underwent LASIK surgery. The quality of life comparison compared 104 eye glass wearers, 104 contact lens wearers, and 104 patients that underwent LASIK surgery. The quality of life score in those subjects undergoing LASIK surgery was many fold higher than those who wore glasses or contact lenses. The main complaints of those dissatisfied LASIK surgery patients was nighttime glare and haloes, dry eyes, and under or over corrections.
• The satisfaction of patients who underwent LASIK surgery was higher than patients who underwent other elective cosmetic such as rhinoplasty, breast augmentation, or other cosmetic procedures performed throughout the world.
• The quality of life comparison of the patients undergoing LASIK correction was about the same as those emmetropes who have never had to wear glasses or contact lenses. The quality of life of the LASIK patient approaches that of patients who have never needed glasses or contact lenses.
• The most common areas of dissatisfaction were dry eyes, nighttime glare and haloes, and over/under correction. Nighttime glare and haloes were found to be present before surgery in most patients, but increased to 10% after LASIK surgery. 32% of the patients had dry eyes before LASIK surgery, and 34% had dry eyes after LASIK surgery, which tended to decrease over time.
• 16,000 eyes were studied intensively for adverse side-effects in a clinical study in the United States.
• Over 28 million people world-wide have had LASIK surgery. We find that the satisfaction rate may increase to 98.5%, over time, but we need a goal of 99%+ as we learn more about patients and apply new innovations in laser vision correction.

Back to the question.     Back to the top.     Go back.

High Performance Vision 'Frequently Asked Questions':

1. Question: How does Dr. Shealy and his staff determine that a patient is achieving high performance or high quality vision?
   Answer: When laser vision correction results in higher quality vision, our patients will notice that their vision at night less  glare, haloes, and starbursts around lights at night. One of the first statements that patients say, "Colors are more vivid than they ever seen before with glasses or contact lenses." Color and night vision more define the quality of vision than the 20/20 Snellen Chart in our offices. This outdated vision measurement system is based on black on white and  high contrast targets. Snellen measurements are outdated and were developed in the early 20th century or 1900's. In contrast targets of high quality and definition can be seen today on our high definition or performance televisions.
   Back to the question.     Back to the top.
    
2. Question: How is high quality vision measured and produced?
   Answer:
   1. (Conventional flap or cap laser vision correction performed up until 2006.)
      The quality of  vision is determined through wavefront measurements. With these measurements a grid of light is projected through the optical system to include the cornea  and lens. When these rays of light are bent the scatter is measured  mathematically by Zernike Polynomial coefficients. They are classified in 2nd order (myopia, hyperopia & astigmatism), 3rd order  (tetrafoil  and coma), and 4th order coefficient measurements. A 4th order coefficient  spherical aberration is the major measurement for nighttime glare and haloes, seen primarily when the pupil dilates at night. Any process that  affects the smoothness of the corneal curvature can result in aberrated or distorted visual acuity. If there is no astigmatism, nearsightedness or  farsightedness and the spherical aberration is less than .01, the quality of  vision is extraordinarily high and better than that produced with conventional eyeglasses and contact lenses.
   2. (SBK thin flap or Advanced Superficial Treatment - Superficial Epi-Laser.)
      These advanced procedures address the issue of lower performance or quality of vision after making a cap or flap in laser vision correction. The surface smoothness is maintained by not making a cap or flap, thus decreasing wavefront aberrations. By eliminating the cap or flap some scaring may be prevented as well as making dry eyes worse, which can reduce the quality of vision. Working on the surface may result is less wavefront light scatter and a higher standards of visual quality, crispness, more vivid colors, and better vision 98% of the time than ever experienced with either glasses or contact lenses. Prescription strength is the most important predictor.
   Back to the question.     Back to the top.
    
3. Question: What laser vision outcomes can reduce the quality of vision?
   Answer: In cap or flap laser vision correction striae, epithelial ingrowth, and ectasia may result in an irregular corneal surface and although there may not be much residual prescription, like myopia, hyperopia or astigmatism, the wavefront error will be high producing aberration in the vision, giving vision of lower quality or lesser performance of vision. In surface treatments excess superficial haze also may lower the vision quality. Issues of striae, epithelial ingrowth and ectasia have been negligible with SBK or Sub-Bowman's Keratomileusis in 2009. These issues are taken in consideration at our center.
   Back to the question.     Back to the top.
    
4. 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.
   Back to the question.     Back to the top.

Our Technology 'Frequently Asked Questions':

1. Femtosecond Technology 'Frequently Asked Questions':

1. Question: What are the Shealy Eye Laser Center's indications for Ziemer All Laser LASIK?
   Answer: Retrospective studies indicate a low incidence of complications with the use of the femtosecond laser for flap creation. The complication rate has been projected at less than 1% with the major complication of diffuse lamellar keratitis (DLK) which were successfully treated with topical prednisone drops. Premature break through of the gas has not been seen with the Ziemer newer generation femtosecond lasers. Transient light sensitivity was also noted. At our center we try to reserve All Laser LASIK for greater than 7.5 diopters of myopia. The patient must exhibit adequate corneal thickness and have sufficient tear production. We try to reserve All-Laser LASIK for higher prescriptions and those patients who want a very quick visual recovery time. At our center we feel that it is absolutely indicated in patients who have had inflammation of the cornea and conjunctiva since the incidence of scarring and epithelial ingrowth is less than with bladed technology.
   Back to the question.     Back to the top.
    
2. Question: What is the newest advancement in femtosecond technology that has helped the practice at Shealy Eye Laser Center in 2009?
   Answer: At our center we performed about 6,000 radial keratotomy procedures before 1995. Many of these patients developed hyperopic astigmatism because of the long term stability of this procedure. The Zeimer femtosecond laser has been found to reduce hyperopic astigmatism in previous radial keratotomy patients. Using a laser with a large numerical aperture, low energy and small spot size can reduce or eliminate the risk of tissue coagulation, and can provide a lift easy enough to avoid splitting the RK incisions. Read the entire article by N. Timothy Peters, MD here. An Ohio ophthalmologist has practiced for years, believes that less is better when it comes to applying energy to corneal tissue. The Ziemer laser is a low energy laser which is being traded frequently for older nano-second technology because of less radiation effects signified by less gas production from the plasma gas formation of collagen tissue. It has been found to be helpful with patient with flat and steep keratotomy readings.
   Back to the question.     Back to the top.
    
3. Question: What is All Laser LASIK?
   Answer: All Laser LASIK uses a femtosecond laser to produce the LASIK flap. Small perforations are created that produce irregularities that require tearing of the flap necessary to complete it. Dr. Shealy prefers the Zeimer laser since it places less energy inside the cornea, which produces a smoother stromal bed on which to apply the refractive laser. Alternatives to femtosecond technology would be surface treatments and ultra thin-flap laser vision correction. Higher energy levels of the Intralase may produce opaque bubble layers and diffuse intralamellar keratitis.
   Back to the question.     Back to the top.
    
4. Question: What are the disadvantages of the femto-second laser?
   Answer: Vertical gas blow through, horizontal gas blow through, rough stromal bed, gas bubbles in the anterior chamber, opaque bubble layer, and pocket related opaque bubble layer.
   Back to the question.     Back to the top.
    
5. Question: What is All Laser LASIK using the "DaVinci" Femtosecond laser?
   Answer: The "DaVinci" Femtosecond laser is the newest high-repetition laser that cuts into the cornea making a flap or cap under the surface layers. This cap is then lifted and the Allegretto Wave Laser treatment is placed underneath, in the stroma. It has all the same features as LASIK in which a cap is made with a mechanical microkeratome. Dry eyes and structural weakening of the cornea with flap complications occur.
   Back to the question.     Back to the top.

2. Mechanical Microkeratomes 'Frequently Asked Questions':

1. Question: What is the rationale for mechanical microkeratomes?
   Answer: May 2008 publication, Moria, moria-surgical.com:
   • With the femtosecond laser product, a line has been crossed with the intense barrage of marketing. Marketing from the industry and peers at times has tried to prey on surgeons' fears and has been successful in some cases. I've always been an advocate of the truth above all else. I say what is exactly on my mind. At times, I have passed up some pretty good money, but when I lay my head down on my pillow every night, l sleep well. Because I've always believed in telling the truth even if it's ugly, people value my opinion. If you've already bought a femtosecond laser and have "buyer's remorse" deep inside, hopefully next time a new product comes out you're pressured into buying it, you might consider resisting that pressure and waiting for more data to come out before making a decision.
     Brian Boxer Wachler, MD
      
     • Cost-Effective LASIK: I Choose the Microkeratome
       Stephen E. Pascucci, MD, MACS
       My current preference is for a modern mechanical microkeratome, because I believe that it offers very acceptable patient safety and a cost effective means to have LASIK for the patient and surgeon. The fact that a femtosecond laser LASIK procedure is more expensive does not make it better. To those who claim superiority of a femtosecond laser procedure, I challenge them to show me the data that prove an advantage for patients, as this should always be our ultimate consideration. Until such time, the mechanical microkeratome is not dead.
        
     • Femtosecond Laser Offers Surgical Precision and Versatility, But at a Higher Price
       Stefanie P. Binder, MD & Theo Seiler, MD
       Actually the femtosecond laser is medically indicated in a minority of our patient probably less than 5%. Seducing patients to get femtosecond LASIK as a standard procedure is at least an overkill, if not unethical, according to some. The femtosecond laser has versatility for some medical indications, William Culbertson, MD from the Bascom Palmer Eye Institute said. Considering the added expense of €600 to €1000 more for femtosecond LASIK then conventional LASIK, however there is evidence suggesting that the patient does not necessarily profit from better visual results.
        
     • Femtosecond Laser versus Mechanical Microkeratome for LASIK
       Sanjay V. Patel, MD, Leo J. Maguire, MD, Jay W. McLaren, PhD, David O. Hodge, MS, William M. Bourne, MD
       The method of flap creating did not affect visual outcomes during the first 6 months after LASIK. Although corneal backscatter was greater early after femtosecond LASIK than LASIK with the mechanical microkeratome, patients did not perceive a difference in vision.
        
     • Should We Ditch Our Microkeratomes for Lasers?
       Amelia Tope & Richard J. Duffey, MD
       The femtosecond laser is no better overall.
        
     • Successful Surgery with a Mechanical Microkeratome
       Roy Rubinfeld, MD
       I find the visual recovery with the Moria (mechanical microkeratome) is actually faster than with some femtosecond keratomes. The femtosecond flap creation causes more inflammation and more steroids are required which increase the risk of glaucoma and cataract. Keratomes either mechanical or laser do not do all the work. Re-cutting the flap can cause some serious long-term vision loss. Surface ablation is a good idea to avoid re-cutting or re-lifting a flap.
        
     • Lasers, Mechanical Microkeratomes Contrasted
       Cheryl Guttman & Cesar C. Carriazo, MD
       Femtosecond laser and mechanical microkeratomes both have advantages and limitations. These features provided subject matter for a point-counterpoint discussion on choosing technology for LASIK flap creation. Complication incidence is similar using a mechanical microkeratome or a femtosecond laser, although safety differs. "I think it simply generates revenue for the manufacturer," Dr. Carriazo said.
        
     • Is the Mechanical Microkeratome Dead?
       Evgenia Konstantakopoulou, MSc, George Charonis, MD
       Do not throw your trusty mechanical microkeratome in the wastebasket yet. Mechanical microkeratomes are by no means inferior to the femtosecond laser when flap creation is considered. Certainly, when lamellar graft surgery is considered, femtosecond laser technology is an exciting and promising tool.
        
     • Latest Generation Femtosecond Laser Taps into Growing Market
       Dermot McGrath, Andromachi Frangouli, MSc, Ourania Frangouli, MD
       More precise flap creation, faster performance and an ability to deliver even smoother stromal beds are among the defining characteristics of the current generation of femtosecond lasers, according to researchers.
        
     • Low Complication Rate Found with Mechanical Keratomes
       David Laber & Robert K. Maloney, MD
       Bad flaps are reported with both technologies, and while surgeons aim for no complications, nothing is complication-free.
        
     • A Need for the Mechanical Microkeratome in Refractive Surgery
       Suphi Taneri, MD
       Another issue is the current trend of thin-flap LASIK. This is not advisable with current femtosecond lasers. The reason is the gas bubbles in the stroma, created by the femtosecond laser, may diffuse through Bowman's membrane under the epithelium and obstruct further laser application if the overlying stroma is too thin. I think, when a doubt that a LASIK flap may cause problems, the best advice is to avoid it completely and perform a surface ablation. Surface procedures create the smoothest possible stromal surface, leave as many corneal nerves unaltered as possible, and weaken corneal tectonic stability by the least possible amount. Mechanical microkeratomes are a time-proven technology. They have evolved in their safely, predictability, and simplicity in creating lamellar flaps for the LASIK procedure.
        
     • Point: Should We Abandon Mechanical Microkeratomes?
       Y. Ralph Chu, MD
       Mechanical microkeratomes have evolved in their safety, predictability, and simplicity in creating flaps for LASIK patients. Increased use of surface ablation procedure and having a device that can create both lamellar and epithelial flaps is not only convenient by also critical. From his perspective, this raises the bar for new technologies such as the femtosecond laser as they enter the microkeratome market.

   Back to the question.     Back to the top.
    

2. Question: How has thin flap LASIK been found to have some additional benefits over femtosecond laser flap production?
   Answer: With new generation mechanical microkeratomes, Richard Norden has found that patient operation time is decreased and the uncorrected visual acuity at 10 minutes is impressive with no radiation induced inflammation or pain in his first 50 consecutive patients. Dr. Shealy theorized that less is more when it comes to creating a planar flap in which the thickness is the same through all parts of the cornea. These flaps adhere more readily because they conform to the normal corneal curvature architecture. Unlike thicker flaps produced by femtosecond lasers and older generation microkeratomes, the corneal curvature is maintained in it's natural state. This provides for more safety in case the flap is incomplete due to loss of keratome vacuum. These thinner flaps become adherent rapidly while producing less visual distortions.

Back to the question.     Back to the top.
 
3. Question: How does the discomfort with Thin-Flap or SBK LASIK surgery compare to Femtosecond ALL-Laser LASIK?
   Answer: See our chart:
   
   Back to the question.    Back to the top.
    
4. Question: What are the advantages of SBK thin-flap laser vision correction and femtosecond laser surgery?
   Answer: Read this article.
   Back to the question.     Back to the top.

3. No-Cut AST (Advanced Surface Treatment) or Superficial Epi-Laser 'Frequently Asked Questions':

1. Question: Who can be treated with Surface Epi-Laser?
   Answer: We general treat patients that are up to -10 D of myopia, and up to +6 diopters of myopic cylinder, and up to +4 diopters of hyperopia, and up to +4 diopters of hyperopic cylinder. Our highest mixed astigmatism are about -6 diopters. These numbers may vary depending upon our goal with our patient. Some patients are happy to be have their astigmatism reduced and to correct spherical residual prescriptions with glasses or spherical contact lens.
   Back to the question.     Back to the top.
    
2. Question: Why is hyperopic Epi-Laser the only chosen treatment at the Shealy Eye Laser Center?
   Answer: The graphs below show a comparison between the global subsets of data for the treatment of hyperopia whether performed on the surface or performed with flap or cap formation. Please note that a slight early overcorrection occurs producing initial slight near-sightedness and markedly exaggerated improvement in near vision which over time, two weeks or so, results in marked high performance distance vision.
    

   Global Data; Hyperopic Ablation	Dr. Shealy's Results; Hyperopic Surface Ablation

   We have found that nearly 100% of our selected patients will see 20/20 or better when patients desire distance only correction. Please note that hyperopic Epi-Laser takes time to result in 20/20 or better vision, which is thought to be due to remodeling of the corneal epithelium and heaping up of the surface epithelium as it smoothes over the gap produced in the cornea by the Epi separator. We reserve hyperopic AST to less than 3 diopters of spherical equivalent in 2009.
   Back to the question.     Back to the top.
    

3. Question: What has the Allegretto Wave Laser added to your practice at the Shealy Eye Laser Center?
   Answer: The Allegretto Wave Laser has provided faster treatment times, superior clinical results, elimination of glare and halos, maintenance of the natural shape of the eye.
   Back to the question.     Back to the top.
    
4. Question: Why did the Shealy Eye Laser Center switch to Epi-Laser treatment for myopia?
   Answer: The graphs below show the global data results for the flap or cap LASIK treatment.
    

   Global Data; Myopic Surface Ablation	Dr. Shealy's Results; Myopic Surface Ablation

   Nearly all of our myopic patient will achieve levels of 20/20 or better (100%) with surface Epi-Laser and the use of Mitomycin C when indicated. In 2009, we limit surface treatment to less than -5 diopters aspherical myopia.
   Back to the question.     Back to the top.
    

5. Question: Why is Superficial Epi-Laser Vision Correction superior to conventional LASIK with cap or flap formation?
   Answer: Dr. Shealy stopped using conventional LASIK in 2006 because of it's complications. Dr. Shealy agrees with several leading ophthalmologists like Ming Wang, MD, PhD, that "newer technologies and better medical management of post-op discomfort have allowed us to offer superior results with patient safety in mind." 90% of LASIK complications are related to the flap or cap formation.
   Back to the question.     Back to the top.
    
6. Question: What occupations require Advanced Surface Laser Treatment?
   Answer: The United States Department of Defense recommends no-cut Superficial Epi-Laser for Navy pilots, Navy Seals and Air Force fighter pilots. This is also recommended for patients involved in police enforcement and fire fighting. Recently we've recommended this procedure for Brahma bull riders, ultimate fighters, and patients playing all major contact sports. In 2009, some department of defense workers may have SBK (Thin-Flap laser vision correction).
   Back to the question.     Back to the top.
    
7. Question: Why did Dr. Shealy abandoned LASIK with cap or flap formation, but will use the DaVinci Femto-second laser and Thin-Flap SBK LASIK if a patient desires LASIK?
   Answer: Epithelial ingrowth has been decreased with the use of the DaVinci Femtosecond laser and Thin Flap SBK in LASIK cases involving cutting or cap or flap as compared to using a microkeratome. This epithelial ingrowth occurred in 53% of the patients above 50 years of age. The epithelial ingrowth was statistically greater in retreated patients and was necessary 20% of the time. Our no-cut technique has eliminated epithelial ingrowth and scarring, which can occur when lifting the cap or flap in about 6% of patients, see April, 2007 Ophthalmology Times, Thomas E. Clinch, MD, or see our consent form. Dr. Shealy prefers the no-cut technique since it has eliminated ALL epithelial ingrowth.
        Recent FDA panels have scrutinized LASIK safety data which in many older lasers led to nighttime glare and haloes, predisposition to ectasia, and dryness of the eyes secondary to certain collagen vascular diseases such as rheumatoid arthritis. These safety issues have been addressed by making more superficial flaps with less invasion into the cornea, stroma and nerves. The satisfaction patients have with laser vision correction far overshadows its risks especially when compared to the wearing of thick glasses and contact lenses which have their safety concerns also.
   Back to the question.     Back to the top.

4. Laser Vision Ranges of Treatment 'Frequently Asked Questions':

1. Question: How has laser vision correction for high myopia improved since 1994 to the present?
   Answer: Studies have been conducted for high myopic LASIK in terms of safety and efficacy. 196 eyes of 118 consecutive patients treated for myopia >-10 diopters. The eyes were followed at 3 to 5 months and 10 years after surgery. At 10 years, 40% were still spectacle independent. Almost 30% of the eyes have undergone retreatments. 42% of eyes were within 1 diopter of targeted refraction and 61% were within 2 diopters. The conclusion of the study indicates LASIK is no longer favored as a procedure of choice for the treatments of high myopia. The surgeries were performed with a VISX laser and an automated corneal shaper which are old technology. Many of the eyes that were operated on at this time would have been excluded today from having LASIK. At the Shealy Eye Laser Center, SBK and Wavefront lasers have made the outcomes much more stable and predictable and at our center we will perform laser vision correction for up to -14 diopters of myopia with up to 6 diopters of hyperopia.
   Jorge L. Alio, Am J Ophthalmol, 2008;145:55-64
   Back to the question.     Back to the top.
    
2. Question: Why are more people undergoing laser vision correction at The Shealy Eye Laser Center?
   Answer: The reason why more patients are undergoing laser vision correction at our center, is the following:
   1. Our staff and our technology make us more comfortable in performing the procedures safely.
   2. A larger percentage of patients are achieving vision at levels greater than with eyeglasses or contact lenses.
   3. Laser vision correction is much more cost effective when considering the ongoing cost of eye glasses, contact lenses, and solutions.
   4. Many patients can have their dependence on bifocals reduced to only 5 to 10% of the time.
   5. Dr. Shealy and staff have worked hard to improve the affordability of laser vision correction, decrease the risk of complications largely due to flap making, and they have noted the increased frequency of more skilled professionals like military personnel, police, and firefighters, having these procedures done.
   6. Quality of vision with the elimination of nighttime glare and haloes in most patients and improvement in pharmaceutical agents have decreased the recovery time and improved overall patient satisfaction with the surgical experience.
   7. Patients have improved visual performance, lifestyle improvement, and a greater ability to enjoy lifestyle pursuits.
   8. More ophthalmologists and their families and staff are having laser vision correction for themselves with a penetration rate of 30% as compared with 3% in the normal population, and most ophthalmologists and their families have been positively satisfied.

   Back to the question.     Back to the top.
    

3. Question: What prescription is most likely to need a secondary laser treatment after the initial laser vision correction procedure?
   Answer: It is commonly agreed by ophthalmologists who practice the majority of laser vision correction procedures in America that the most likely patients will be those patients having an prescription greater than 3.5 diopters of astigmatism. These patients have more predisposition to having haze if they have advanced surface treatment or Epi-laser because of the large prescriptions involved. Attempts at our center to reduce astigmatism greater than 6 diopters pre-operative with corneal relaxing has been used successfully.
   Back to the question.     Back to the top.
    
4. Question: Why has the Shealy Eye Laser Center stopped performing conventional LASIK and switched to SBK (Sub-Bowman's Keratomileusis) Laser or AST (Superficial Epi-Laser)?
   Answer: Our clinic has found that wavefront laser vision correction improves nighttime driving visual performance in most of our patients as compared with conventional LASIK performed before 2005. Laser retreatments have dropped significantly by using the laser on the corneal surface or directly underneath Bowman's layer. Retreatment rates have dropped to below 2% and we have seen improvements in the quality of vision after surgery. Our office manager Tom Excell can attest to the satisfaction of his night vision as compared with patients who have had conventional non-wavefront laser vision correction previously in our center or in other centers. Our surgical assistant, Chi Yip, can attest to the improvements in her vision with AST over small prescriptions treated with either glasses or contact lenses.
   Back to the question.     Back to the top.
    
5. Question: What has been the results of Phakic IOL's?
   Answer: Phakic IOL's have been implanted in patients eyes with extreme success for high prescriptions. These implants are the treatment of choice for prescriptions greater than -13 to -14 diopters. Patients can see 20/25 or 20/30 within minutes of the implantation. Most doctors feel that these IOL's have improved their practice. At the present time we refer these patients to doctors more experienced with these implants such as Dr. George Rozakis in North Olmsted, Ohio or Dr. Phil Roholt in Alliance, Ohio. Phakic IOL patients may require advanced surface treatment to correct residual prescriptions as patients who have undergone cataract surgery with Aphakic IOLs. Additionally laser is needed 30% of the time. Please note that 1 in 15,000 patients lose their vision or eye entirely with placement of an intraocular surgery. This is usually due to intraocular infection.
   Back to the question.     Back to the top.
    
6. Question: What strategy do we use in determining when to retreat patients eyes after laser vision correction?
   Answer: We have learned that lifting the flap or cap in a post-LASIK patient increases the risk of infection, scarring or epithelial ingrowth, and other complications that can effect vision like striae and ectasia. Recently we have found that thin flap LASIK greatly reduces the need for striae reduction in that the vision is generally maintained without any loss of best corrected vision. Most of our patients are retreated by surface ablation either with a trans-epithelial approach if we do not want to disturb a previous complete or partial flap. This is especially important in patients who have had associated relaxing incisions or any flap LASIK procedure either SBK or conventional flap LASIK surgery. Mitomycin-C may be employed if no flap was used previously as in the case of high myopia PRK. A bandage contact lens is usually placed over the eye with topical non-steroidal anti-inflammatory drops are necessary and an advancement for healing and discomfort. These surface procedures limit post-operative complications. In previous patients we generally charge 80% of the going present fee for the associated procedure.
   Back to the question.     Back to the top.

5. Complications of Laser Vision Correction Causing Patient Dissatisfaction 'Frequently Asked Questions':

1. Question: What information helps our patients overcome fear of losing their eyes or life in association with laser vision correction?
   Answer: Recent studies have indicated that the suicide rate among patients who have had laser vision correction is actually lower than the general population. Certainly, we extend our sympathy to those families who have experienced suicide after having laser vision correction. Loss of marital status has also been implicated between spouses in which one family member has had laser vision correction. Our psychological interpretation of this phenomenon is not comprehensive or complete. Doctors are only instruments of medical care and are not the ultimate healers or delivery source of healing. In 2007, out of 1.7 million laser vision's performed, no one lost their eye (eyes). The largest malpractice award was $100,000 in one patient, of the 5 cases that went through our court system, the other 4 cases were dismissed.
   Back to the question.     Back to the top.
    
2. Question: What is the most important advancement in laser vision correction to eliminate over, under, and residual astigmatic corrections?
   Answer: The most common complication, less than 2% of the time. Elimination of residual prescriptions and accuracy of lasers improved with eye tracking and beam quality. With the advent of Allegretto "flying spot" technology, we were able to reduce our retreatments from about 15% down to 2%. The advent of flying spot technology allowed us to maintain the corneal curvature with less breaks and interruptions so that when the pupil widened at night, glare halos and visual distortions were decreased. Datalinking, especially with Guy Kezerian, allowed us to develop performance nomograms to determine the specific treatment for each patient prescription. When we switch from broad beam lasers like Nidek and Summit, we were able to determine the range of prescriptions that could be performed with these lasers, which were equal to the more advanced flying spot lasers. Read his article. The following link shows craters and ridges induced by broad beam lasers and how these irregularities were smoothed out with flying spot tech. Click here. The most important factor that we take into consideration in choosing lasers is the amplitude of astigmatism that is corrected with the laser. To date the Allegretto Wavelight laser has been the most effective in treating astigmatism above 3.5 diopters. We also know that the Wavelight laser can reduce higher levels of hyperopia and hyperopic astigmatism. At this time  we now understand the Wavelight laser gives less retreatments for higher ranges of astigmatism and higher degrees of hyperopia and myopia. With lower degrees of astigmatism in myopia we will not hesitate to use broad beam technology since it is equivalent to the Wavelight laser with these prescriptions.
   Back to the question.     Back to the top.
    
3. Question: What is the best treatment for recurrent extensive epithelial ingrowth?
   Answer: Pictured here is a patient who has undergone surgery for recurrent extensive epithelial. The cells were meticulously removed from the stromal bed and stitched with 10-0 nylon sutures. Extensive recurrent epithelial ingrowth has been almost eliminated with thin-flap SBK laser vision correction. We've found that epithelial ingrowth can be resolved with ND-YAG spot application to epithelial ingrowth areas requiring 1, 2, 3 treatment sessions.
   Back to the question.     Back to the top.
    
4. Question: What has been the conventional LASIK dissatisfaction rate in national research studies conducted by Wills Eye Institute in Philadelphia, Pennsylvania?
   Answer: 109 patients and 157 eyes were studied that showed that dissatisfaction seems to have plateaued over the last three years from 2006 to 2009. The two main complaints were: 68% had poor distant vision and 20% had primary dryness of the eyes. Best overall vision was 20/40 or better. Patients were still not willing to wear hard contact lenses.
        The most common diagnosis was; 28% had dry eyes, 12% irregular astigmatism, 9% epithelial ingrowth, 5% haze and scarring, 6.6% ectasia, and 5% over-correction. Most patients with ectasia had been operated on before 2001. Only 25% of all patients that had surgery went on to have enhancements done later. Most were suggested to wear spectacles or contact lens fitting.
   Back to the question.     Back to the top.
    
5. Question: What is the comparative enhanced video imaging assessment of corneal bed texture in LASIK, Surface Epi-Laser, and Thin Flap SBK?
   Answer: New methods of determining the smoothness of the bed architecture was found to be superior in Surface Epi-Laser by Dr. James Lewis and the Wills Eye Surgical Network. Click here for the comparative photos.
   Back to the question.     Back to the top.
    
6. Question: What is the most frequent complication other than under and over correction seen with thin-flap laser vision correction?
   Answer: Laser vision correction when used with mechanical microkeratomes or femtosecond keratomes may result in epithelial ingrowth. What is epithelial ingrowth? Epithelial ingrowth is the growth of epithelial cells under the corneal flap after the flap is replaced at the end of the LASIK procedure. While most LASIK procedures are problem-free, the one type of complication that can occur occasionally is epithelial ingrowth. It may take several weeks to become apparent and it can cause blurred or distorted vision and eye discomfort. The incidence of epithelial ingrowth may vary widely and the occurrence is between 0.5% and 15% based upon many variables. Treatment of epithelial ingrowth is to re-lift the flap and mechanically remove  the epithelial cells. In some incidences dilute alcohol solution may be applied along with a bandage contact lens to seal the flap margin, in severe cases the flap may be sutured down. This traditional method is usually successful but the risk of reccurrence is relatively high due to exposure as it was during the LASIK procedure.
        Researchers in Spain, Jorge Alio, MD has been using the Nd: YAG laser, have found an innovative way to treat epithelial ingrowth that is easier and less invasive than previous corrective measures and decrease the risk of the problem coming back. Over a four year period he successfully treated 200 eyes affected with this new laser procedure. In some cases, a second session was required, usually three weeks after the initial treatment. Dr. Shealy prefers several treatment sessions if necessary and to limit the treatment to 3mm of affected area. There have been no complications from the procedure and no incidences of recurrence. In 80% of eyes the patches disappeared completely, and the visual acuity increased at least one line in 60%. American Journal of Ophthalmology, Vol. 145, No. 4
   Back to the question.     Back to the top.
    
7. Question: What is the best non-surgical solution for management of keratoconous?
   Answer: The term keratoconous encompasses a spectrum of topographical shapes whose only common denominator is central or paracentral corneal steepening. For those patients who cannot be fitted with glasses, 90% of the patients with keratoconus have contact lenses as the best treatment option throughout life. Only 10% of patients with a diagnosis of keratoconus require penetrating keratoplasty or PK. The designs available are gas permeable contacts, large diameter scleral gas permeable lenses, piggy-back contact lenses, and lastly soft toric contact lenses.
   Back to the question.     Back to the top.
    
8. Question: How do we treat dry eye conditions either pre-operatively or post-operatively at our center?
   Answer: We have more advanced artificial tear formulations in 2009 and also know a great deal more about the inflammatory conditions causing dry eyes. According to Kerry Solomon, MD and Paul Karpecti, OD the starting point has been adopted with the use of artificial tears 4 x a day. A course of topical steroids 4 x a day for 2 weeks and then maintenance therapy with Restatis (Cyclosporine ophthalmic emulsion, Allergan) can begin. In patients that have lid margin disease, hot compresses as well as lid scrubs may be used to free up lid secretions. Omega 3 fatty acids in topical azithromycin or oral doxycycline may be needed. Extreme measures may include hourly dosing of preservative-free tears, nighttime ointments and moisture chamber glasses. Please remember that different treatments are required for individual patients depending on their underlying conditions.
        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.
   Back to the question.     Back to the top.
    
9. Question: What is the most common complication of laser vision correction, seen in our office today, as of June 2009?
   Answer: Investigative studies of our own patients and proprietary knowledge of our current suppliers indicate that from 2007 to 2009, there were three incidences of epithelial ingrowth and at least two cases of aborted or non-treated patients after SBK laser vision correction. There were no lost eyes and several patients underwent laser vision correction subsequently. Under correction and over correction occurs less than 1% of the time in our hands and ocular dryness has increased 4% beyond pre-op levels. These patients have been treated with artificial tears, punctal plugs, and the modalities expressed in Question 8. Ectasia has not been seen but is now thought to be secondary to patients predisposed genetically to keratoconus either diagnosed or un-diagnosed.
   Back to the question.     Back to the top.
    
10. Question: What is the most significant realization of the practice at the Shealy Eye Laser Center in 2008?
    Answer: Ectasia or bulging forward of the cornea, can be avoided most of the time by staying on the surface or sub-surface of the cornea. LASIK involving the deeper layers of the cornea decrease acute inflammation and decrease biomechanical weakening. Although not every case of ectasia is preventable, we know that ectasia does not completely disappear due to structural and genetic pre-disposition. There are lingering mysteries to this condition so that ectasia will never completely go away and per say, does not constitute medical malpractice.
    Mark Manus, MD, David Huang, MD & J. Bradley Randleman, MD.
    Back to the question.     Back to the top.
     
11. Question: What is the value of thinner flaps for SBK Thin-Flap laser vision correction in high myopia?
    Answer: LASIK is the procedure of choice for -4 to -10 diopters according to Ioannis Pallikaris, MD, PhD. In almost all cases it is possible to have a residual corneal thickness of more than 300 microns. Almost 50,000 Lasik cases that average -7 diopters in Hong Kong have been treated; 2,535 high myopes ranging from -8 to -16.75 diopters have been followed and fewer than 0.4% were very dissatisfied with the results, less than with low myopes of 1%. The need for spectacles in the high myope group was 3.7% compared to 2.2% in the low myope group. In either group no eye lost no more than two lines of best corrected vision. One eye in the low myope group lost two lines and three eyes in the high myope group lost two lines.
    Back to the question.     Back to the top.
     
12. Question: What can a person expect for their uncorrected visual outcome on the first day postoperatively with Thin-Flap or SBK LASIK and how does it compare to LASIK with Femtosecond flap making technology?
    Answer: See our chart:
    
    Back to the question.     Back to the top.
     
13. Question: How does SBK LASIK represent an improvement over previous types of LASIK surgery with a cap or flap?
    Answer: Better mechanical microkeratomes make flaps more superficial on the cornea. These flaps have a more silk-like smoothness in the top of the cornea as compared with the burlap-like, coarse areas of the deeper cornea. Thus thin flap LASIK is less disruptive to the cornea cutting fewer corneal nerves and giving a higher quality of vision with quicker visual recovery time.
    Back to the question.    Back to the top.
     
14. Question: How do dry eyes affect the outcome of laser vision correction?
    Answer: Surgical procedures can disrupt the production of tears. The lack of continuous tears and reflex tears results in dry eyes. Patients with dry eyes are less likely to achieve optimal vision. In most cases dry eyes are worse especially when making a cap or flap as compared to no cap or flap with surface Epi-Laser. Patents who seek laser vision correction may have underlying dry eye symptoms such as scratchiness, mucous discharge, irritation from wind or smoke, eyes sticking together when awakening in the morning, light sensitivity, contact lens discomfort and contact lens solution sensitivity. Dryness of the eyes occurs as we naturally age along with medications and autoimmune disease such as rheumatoid arthritis. We recommend the use of artificial tears and tear duct plugs in most patients above the age of 47.  This will greatly diminish dry eyes symptoms which are mostly temporary after laser vision correction.
    Back to the question.     Back to the top.
     
15. 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
    Back to the question.     Back to the top.
       
16. Question: What are the possible goals of Epi-Laser or Thin-Flap, either SBK or Femtosecond, LASIK?
    Answer: With any type of laser vision correction, you can eliminate the distortions, minification or magnification effect of glasses. Although contact lenses will provide this relief, we find that the risks and ongoing complications with contact lenses have a higher risk to benefit ratio. This is well documented across America.
    Back to the question.     Back to the top.
      
17. Question: Describe what Dr. Shealy's experience has been with different excimer laser platforms.
    Answer: Dr. Shealy has personally owned four excimer lasers since 1996. These lasers were mostly broad beam laser and removed large amounts of tissue in a short amount of time. Many patients complained of nighttime glare and halos and his retreatment rate was nearly 25%. Visual quality was not possible for large ranges of astigmatism, farsightedness, and nearsightedness. A high rate of flap abnormalities including epithelial ingrowth and scarring occurred. Replacing cutting surgery to surface surgery with Allegretto Wave laser, improved outcomes with better staff, doctor and patient satisfaction. Most of our patients realized that they saw better than ever before compared to their vision with glasses or contact lenses.
    Back to the question.     Back to the top.
     
18. Question: How is farsightedness, hyperopia, and presbyopia best treated in our experience at the Shealy Eye Laser Center?
    Answer: Dr. Shealy has found that surface ablation is absolutely necessary in the treatment of farsightedness when a patient desires the least invasiveness. Intraocular implants may not be centered in the pupil so that when you make a cap, with either a laser or bladed keratome, decentration off the visual axis may occur. The decentration of the cap or flap can be avoided with the use of surface ablation and the area of treatment can be centered nicely along the visual axis which is tracked by the Allegretto Wave eye tracker. Our results have been spectacular and patients can practice monovision by having the non-dominant eye predictably overcorrected, making the patients independent of reading glasses or bifocals 90 to 95% of the time.
         The Allegretto Wave Laser corrects up to 6 diopters of farsightedness with 6 diopters of astigmatism. We've noticed almost no haze formation and a very low retreatment rate as compared to hyperopic LASIK techniques. Since the cornea is more prolate or parabolic after surgery, patients have better near vision than would be expected from myopic LASIK or Epi-LASIK surgery. We have found at our center that large amounts of farsighted astigmatism is better corrected with Advanced Surface Treatment.
    Back to the question.     Back to the top.
     
19. Question: How does the reduction of astigmatism affect the results of cataract surgery, either with a premium multi-focal lens or a standard mono-focal lens?
    Answer: The use of limbal relaxing incisions (LRIs) and laser surface astigmatic correction are necessary to achieve excellent post operative uncorrected visual acuity in cataract patients. In over 1,800 cataract patients, nearly 40% required additional corneal surgery due to greater than .05 diopters of corneal astigmatism.
    Back to the question.     Back to the top.
     
20. Question: What is the preferred treatment at the Shealy Eye Laser Center for re-treatment if LASIK surgery and Radial Keratotomy surgery has been performed in the past?
    Answer: Flap lifting after LASIK surgery is considered obsolete after six months and is not a minor consideration because of scarring complications. Surface ablation is the only present form of treatment used with either LASEK using alcohol, or the amoils epithelial brush. This is also true for cutting procedures like previous radial keratotomy patients. Buttonhole flaps and partial flaps are one of the most devastating complications of LASIK and require off label use of Mitomyocin-C and photorefractive keratotomy to correct patients prescriptions on the cornea surface.
    Back to the question.     Back to the top.
     
21. Question: What if my eye moves during laser vision correction?
    Answer: Our laser performs fast active tracking in which it tracks each of the 200 laser pulses per second 4 times each second, the tracker changes its tracking patterns 6,000 times per second and thus responds to any eye movement.
    Watch our video of the Allegretto Wave in action.
    Back to the question.     Back to the top.
     
22. Question: How does the Allegretto Wavelight platform represent an improvement over lasers we have used at the Shealy Eye Laser Center in the past?
    Answer: Lasers were originally large beams without fast active tracking. Beam quality and fineness of calibration required that newer laser platforms be manufactured with fast active tracking and flying spot technology. These lasers took into account wave front principles to reduce aberrations so that larger optical zones reduces nighttime glare and halos. Recently we have acquired new aberrometry driven capabilities to our laser to reduce preexisting or existing aberrations. Thus the overall quality of vision after laser vision correction with advanced surface ablation and speed of application of the beam determine how accurate the eye prescription is eliminated and how the quality of vision is obtained. We compare our Allegretto Wave Laser results with all the doctors using this laser throughout the world. This allows us to make the best nomograms.
    Back to the question.     Back to the top.
     
23. Question: What ranges of treatment are possible with the Allegretto Wave Front laser?
    Answer: There are two basic types of lasers that include traditional or large beam lasers and wave front based lasers. Wave front based lasers produce a higher quality of vision with more accuracy and re-treatment rates of less than 1%. The Allegretto Wave Front Laser has the largest range of approval of up to 6 diopters of hyperopia with 6 diopters of astigmatism and 13 diopters of myopia with 6 diopters of astigmatism.
    Back to the question.     Back to the top.
     
24. Question: What if I have questions about the technology at the Shealy Eye Laser Center?
    Answer: Dr. Shealy tries to be available at all times for patients and he tries to be one on one with each patient candidate. He is one of a few ophthalmologists that completely dedicates his practice to laser vision correction and does not perform routine eye care or fit glasses and contact lenses.
    Back to the question.     Back to the top.
     
25. Question: If I have a very small prescription, can it still be corrected?
    Answer: Superficial Epi-Laser can be upgraded at anytime in the future since it involves the surface of your cornea. Small corrections of -0.50 sphere to -0.50 cylinder can be corrected. LASIK with cap or flap formation can only be performed once safely, as transepithelial removal of the cells is less invasive and does not lead to epithelial ingrowth secondary to lifting the cap or flap. Laser application on the surface of the cornea in high prescriptions may lead to haze, however mitomycin-C has reduced the tendency for haze in the cut or uncut cornea. Intralase is contraindicated in the cut cornea because the opaque bubble layer may break through weaknesses in the original flap after secondary incisional keratotomy.
    Back to the question.     Back to the top.

6. Screening Considerations for Laser Vision Correction 'Frequently Asked Questions':

1. Question: What are the absolute contraindications to laser vision correction?
   Answer: Patients with active keratoconus are better with surface Surface Epi-Laser and are not candidates for LASIK with a cap or flap. Topographical abnormalities such as inferior corneal steeping of 1.4 diopters or more, patients that have hepatitis B or C and perfectionist patients with unreasonable expectations. This is Dr. Shealy's 'middle of the road' approach to laser vision correction.
   Back to the question.     Back to the top.
    
2. 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.
   Back to the question.     Back to the top.

7. Patient Scheduling Considerations 'Frequently Asked Questions':

1. Question: How much time do I need off work?
   Answer: Femtosecond and Thin-Flap SBK LASIK patients can go back to work the next day and can see almost 20/20 immediately. Most patients require one day off work, however, most patients can go back to work the next day, depending on their job requirements. Almost all patients have excellent vision within two days. Some patients with HUGE prescriptions who can not have LASIK, up to 13 diopters of myopia, require an additional day from work and we recommend that they have surgery Thursday or Friday before the weekend. 98% of the visual recovery occurs within the first 6 to 24 hours after surgery. Patients as a rule recover from their surgery in two days.
   Back to the question.     Back to the top.
    
2. Question: How long does the surgery take?
   Answer: The laser application time is less than 15 seconds, which is less time than is required to pour a cup of juice. The actual operation time is about 15 minutes. Please allow 1 to 3 hours for the pre and post operative surgery process.
   Back to the question.     Back to the top.
    
3. Question: What if I was told I’m not a candidate for laser vision correction by another doctor?
   Answer: We will take other doctors recommendations into consideration and need to know what their recommendations and criteria for laser vision correction would be. We found that advances in technology make many patients candidates for laser vision correction that were not considered to be candidates in the past. All opinions are appreciated.
   Back to the question.     Back to the top.
    
4. Question: If I need glasses after surgery, is that included in the surgery fee?
   Answer: No. Patients are free from glasses 99.9% of the time if they're corrected totally for distant activities. Those patients who have elected to have monovision will wear glasses occasionally for night driving and or reading being free from glasses 95% of the time. Temporary glasses may be necessary for patients that are temporarily over corrected for hyperopia. Patients are responsible for the purchase of glasses, either temporary or permanent, after surgery. Some may occasionally wear contact lenses and in the case of monovision, wear a slight myopic contact lens in their near vision eye for distant activities.
   Back to the question.     Back to the top.
    
5. Question: How long before surgery, should contact lenses be removed?
   Answer: We perform laser vision correction when we've had two consistent validations of the eyeglass prescription. Dr. Shealy performs all of his prescription measurements, but will compare these measurements with the present eyeglass prescription and the prescriptions obtained by automated devices and manual devices. If the prescription has not changed significantly with the patients' eyeglasses within the last 6 months to one year, the prescription is generally stable. Soft toric lenses usually can be discontinued for a period of 7 to 10 days and an accurate prescription can be obtained. Rigid contact lenses may take up to one month per decade of wear, but most patients are able to have laser vision correction with discontinuance of these contact lenses at about 6 weeks. During that period of time a spherical soft contact lens may be put in place or a pair of eye glasses may be prescribed until an accurate prescription can be obtained.
   Back to the question.     Back to the top.
    
6. Question: What are the major reasons why we reject patients for laser vision correction?
   Answer: We reject patients who have unreasonable expectations about laser vision correction and know that 2 to 5% may be unhappy with their outcomes. If we can determine that a patient has forme fruste keratoconus, we will not perform laser vision correction at this time, in 2008. Patients with dry eyes are also not candidates, and we may try to correct their dry eyes but discourage them from having laser vision correction. It is important to know that not all patient have the same visual needs or requirements. Applying a particular technology to one patient may not be the "the cat's pajamas" for the next patient.
   Back to the question.     Back to the top.
    
7. Question: When do you perform surgery?
   Answer: We now perform consultations at convenient times for the patient especially due to their busy lifestyles. Patients who have inability to take off work for surgery during the week can be scheduled early Saturday AM with advanced notice.
   Back to the question.     Back to the top.

Laser Vision Correction 'Frequently Asked Questions' For All Ophthalmologists and Other Eye Care Professionals:

1. Question: How is the integrity of the cornea affected with laser vision correction?
   Answer: John Marshall PhD (FRC) states that more fibers are cut with deeper refractive procedures, whether on the surface or inside of the cornea body or stroma. Since the cornea is under constant stress, we need to pay attention to its cornea biomechanics to avoid structural weakening.
   Back to the question.     Back to the top.
    
2. Question: What are the most appealing characteristics of a laser vision center?
   Answer: At the Shealy Eye Laser Center, we try to be one on one with friendliness and caring for our patients. We offer different laser options so that the patient can decide what might be best for them during our educational process. We are available for follow up for our patients, and have a well trained staff that will take their time to answer your questions without you feeling rushed. We encourage second opinions, however we would like to give our feedback about second opinions so as to not let these opinions heighten your anxiety or degrade our care for you. There can be reasonable disagreements among different ophthalmologists, however all the information should be focused on giving you the best possible care and avoid any dissatisfaction.
        We like to treat patients within the same family structure and feel that our best referral is previously satisfied patients.
   Back to the question.     Back to the top.
    
3. Question: What is the new assessment model that can assist in selecting patients for refractive surgery?
   Answer: Theo Seiler in 1998 described iatrogenic ectasia for the first time. It is estimated that between 0.2% and 0.6% develop ectasia. Based on a review of 150 cases, there are four pre-operative factors in order of importance: topography, predicated residual bed thickness, age, and preoperative spherical equivalent. Each factor was given a point score of 1 (with 0 to 2 being a low risk) in which LASIK or PRK could be performed. With patients at moderate risk (level 3). The potential hazards of LASIK must be discussed. At level 4 LASIK is contraindicated.
        Surface ablation is a low or no risk procedure that requires only topography and pacymetry. Other risk factors should include history of keratoconus, ocular aberrometry. The 4% occurrence of ectasia after PRK is about the same in eyes that did not have any refractive procedure.
   Back to the question.     Back to the top.
    
4. Question: What is an informed consent?
   Answer: Our patients at Shealy Eye Laser Center need to realized that an informed consent is an educational process primarily and a legal document secondarily. Our website is a part of this process and we expect all patients to do their homework. They may download any of the forms from our site and review with another family member. There are risk to benefit ratios with all treatment options. We are truthful and are able to back up our outcome claims. We ask that patients document every thing that has been discussed with them and put it in writing so that they may understand that we have been complete in our information process.
        Please let us know what you don't understand before signing the consent form also know that implant or refractive IOL surgery risks are equal to or greater than cataract surgery.
   Back to the question.     Back to the top.
    
5. 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.
   Back to the question.     Back to the top.
    
6. 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.
   Back to the question.     Back to the top.
    
7. 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.
   Back to the question.     Back to the top.
    
8. 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.
   Back to the question.     Back to the top.
     
9. 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
   Back to the question.     Back to the top.
      
10. 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.
    Back to the question.     Back to the top.
       
11. Question: What are the considerations that need to be taken into account when prescribing medications pre-operatively and post-operatively for laser vision patients?
    Answer: The cost of prescription medicines vary depending upon the brand name of the prescription; however, a savings may be realized by a generic substitute for the brand name, if available. The efficacy or usefulness of a medicine may at times be not negotiable for our patients. Manufacturers at times provide free samples for our patients and we kindly give these to our patients to reduce their cost of laser vision correction. We always consider the suitability of the prescription first, and there are some newer companies which provide more effective prescriptions as a start-up company than those provided by long-term established companies. We will not hesitate to substitute brand name prescriptions in situations when a lower cost, just-as-effective brand name can be substituted. There are generic prescription that are just as effective at a lower cost to our patient and we will use these to save our patients' money whenever possible.
    Back to the question.     Back to the top.
     
12. 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.
    Back to the question.     Back to the top.
     
13. 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:
    
    Back to the question.     Back to the top.
     
14. 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.
    Back to the question.     Back to the top.
     
15. 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.
    Back to the question.     Back to the top.
     
16. 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.
    Back to the question.     Back to the top.
     
17. 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.
    Back to the question.     Back to the top.
     
18. 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.
    Back to the question.     Back to the top.
     
19. 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.
    Back to the question.     Back to the top.
     
20. 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.
    Back to the question.     Back to the top.
     
21. 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.
    Back to the question.     Back to the top.
     
22. Question: How soon can I wear make-up after surgery?
    Answer: You may wear make-up 72 hours after surgery. But please come to the office on your surgery day with a clean face and no make-up at all.
    Back to the question.     Back to the top.
     
23. Question: What are the options for financing laser vision correction?
    Answer: We provide no interest financing or low monthly-extended payment plans, through CareCredit.
    Back to the question.     Back to the top.
     
24. 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.
    Back to the question.     Back to the top.
     
25. Question: If I am pregnant may I have surgery?
    Answer: We prefer not to operate on pregnant patients because of perceived liability.
    Back to the question.     Back to the top.
     
26. 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.
    Back to the question.     Back to the top.
     
27. 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.
    Back to the question.     Back to the top.
     
28. 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.
    Back to the question.     Back to the top.
     
29. 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.
    Back to the question.     Back to the top.
       
30. 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.
    Back to the question.     Back to the top.
     

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.
   Back to the question.     Back to the top.
    
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	Shealy Eye Laser Center Data
   Back to the question.     Back to the top.

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.
   
   
   
   Back to the question.     Back to the top.
    
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.
   Back to the question.     Back to the top.
    
5. 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.
   
   Back to the question.     Back to the top.
    
6. Question: What percentage of your patients see 20/20 after surgery?
   Answer: The FDA statistics are listed under the Allegretto Wave outcome sheet.
   Back to the question.     Back to the top.
    
7. 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.
   Back to the question.     Back to the top.
    
8. 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.
   Back to the question.     Back to the top.
    
9. 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.
   Back to the question.     Back to the top.
    
10. 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.
    Back to the question.     Back to the top.
     
11. 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.
    Back to the question.     Back to the top.
     
12. 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.
    Back to the question.     Back to the top.

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.
   Back to the question.     Back to the top.
    
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.
   Back to the question.     Back to the top.
    
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.
   Back to the question.     Back to the top.
    
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.
   Back to the question.     Back to the top.
    
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.
   Back to the question.     Back to the top.
    
6. Question: What has been the experience with other ophthalmologists who have used the Allegretto Wavelight laser?
   Answer: In the Supplement to Cataract & Refractive Surgery Today, November /December 2006, Roy Rubinfeld has stated that after using 9 different excimer laser systems, he considers the Allegretto Wavelight laser the best laser on the market. The laser's reliability and advance technology provides excellent enhancements and primary treatments. His enhancement rate has been reduced to the 4% range for corrections from +5.00 diopters to -12.00 diopters with up to 6.00 diopters of cylinder, the lowest of any laser he has used. Most ophthalmologists feel that patients night driving symptoms are significantly reduced with this laser.
   Back to the question.     Back to the top.

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. Dr. Shealy will receive an email within minutes after you click the Submit button and he or a staff member will get back to you as soon as possible.