Here is a way to decipher your prescription:

Your prescription is usually written in three numbers; "-3.00 -1.25 x 180" represents a typical prescription for one eye. The first number -3.00 identifies your amount of nearsightedness or farsightedness. The sign indicates whether you are nearsighted (- sign) or farsighted (+ sign). The second number -1.25 identifies your amount of astigmatism. The number can be written either with (+ sign) or (- sign). The third number 180 identifies the axis, which indicates the degree or direction of your astigmatism. An axis of 180 degrees, for example, means the astigmatism is horizontal. Therefore, this prescription means that the patient is moderately nearsighted, with a moderate degree of astigmatism in a horizontal direction.
(Note: Some people only have one number written for each eye. This is when there is no astigmatism.)

Now let’s take a look at a prescription for both eyes: "OD -4.25 -1.50 x 180, OS -4.50 -1.25 x 175, +2.25 Add", represents a typical prescription for both eyes. OD stands for right eye and OS stands for the left eye. The “add” at the bottom of the prescription is for the reading part of glasses that have bifocal lenses. It might be unusual for anyone under the age of 40 to need this. Therefore, a prescription of; "OD -4.25 -1.50 x 180, OS -4.50 -1.25 x 175" indicates that the patient is moderately nearsighted in both eyes, with a moderate degree of astigmatism in a horizontal direction in each eye.

For more help understanding your prescription or to see if you are a candidate for laser vision correction, please call our office at 1-800-644-6393 and speak with Dr. Shealy or a staff member.

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Correcting Vision Problems

Until 1973, refractive error could only be corrected with either glasses or contact lenses. These methods for correction are effective for many patients and are useful in restoring better vision without surgery.

Glasses are most commonly used to correct vision. Patients with a small degree of refractive error can be corrected effectively with glasses to improve their vision. For patients with large amounts of refractive error, glasses are thick, and generally decrease the size of the visual image by as much as 25%. Any large amount of refractive error will distort image size as much as 50%.

Contact Lenses, both hard and soft, are designed to fit directly over the cornea to correct vision. Patients must be adept at inserting and caring for the lenses in order to wear them successfully. The contact lenses may be somewhat irritating to the eyes, and patients occasionally develop allergies to the cleaning solutions. Our center has learned that nearly all patients prefer vision correction surgery to contact lenses and that it is safer for the health of your eye.

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Eliminating Eyewear

Today, laser vision correction is one of the most popular surgeries performed in the United States. Millions of people have lost their dependence from glasses and contact lenses. What many people do not know is how far the science of refractive surgery dates back.

In fact, surgical vision correction started all the way back in the 1970's in Bogota, Columbia. Physicians started to travel to Colombia to visit Dr. Jose Barraquer. He had developed a technique called corneal shaping in which he modeled corneas in order to improve visual acuity.

In the early 1970's, a Soviet eye surgeon, Professor S. N. Fyodorov, reported good results in the correction of myopia after using a surgical technique called Radial Keratotomy (RK). Radial Keratotomy surgery is performed by making a series of fine microscopic incisions on the surface of the cornea in a radial or spoke-like pattern, to flatten the cornea thus focusing light rays on the retina resulting in normal vision.

In the late 1980's Dr. Thomas A. Shealy began to work on refining RK into a better procedure through the development of new techniques and instrumentation. Although the majority of patients could see 20/40 or better unaided, the precision and predictability of the procedure was limited to lower degrees of refractive error. After performing more than 6, 000 procedures, Dr. Shealy began using lamellar procedures developed by Dr. Luiz Ruiz to correct higher ranges of refractive error using the automated lamellar microkeratome. This was also used successfully to treat all degrees and types of refractive error.

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The Laser

More than two decades ago, the excimer laser was invented to etch microchips at IBM's Watson Laboratories. Then, the discovery was made that the excimer laser can also be used to effectively re-sculpt human tissue, particularly the cornea, with a great degree of precision. The excimer laser works in an area 1/100th the width of a human hair and may remove as little as 1/40th of a human cell.

Although no medical procedure is perfect, the excimer laser allows for an unparalleled degree of predictability. Each pulse of the laser can remove 39-millionths of an inch of tissue in 12-billionths of a second. This enables an experienced surgeon to achieve remarkable accuracy while maintaining excellent control throughout the procedure. Today, the excimer laser is capable of treating a wide range of refractive errors.

In the 1990's the FDA approved Photo Refractive Keratectomy (PRK) in the United States for the treatment of nearsightedness and later farsightedness. In PRK the uppermost layer (epithelium) of the cornea is removed before the laser is used to remodel the corneal surface. The epithelium grows back within a few days following the treatment. Even today, many people that have very thin corneas are potential candidates for a PRK treatment.

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LASIK (Laser in Situ Keratomileusis)

In 1998 the FDA approved yet another procedure called LASIK.

In January 1996, we acquired an excimed laser developed by Professor Theo Seiler and have used lasers since then along with a microkeratome as a further improvement in the correction of refractive error. This procedure is called LASIK or Laser Assisted Intrastromal Keratomileusis. LASIK is currently the most common type of laser vision correction procedure, and corrects all prescriptions, regardless of the amount of refractive error. It can be preformed after radial keratotomy, keratomileusis, and cataract surgery to further sharpen vision. We have corrected up to 21.00 diopters of myopia, 7.00 diopters of hyperopia, and 8.00 diopters of astigmatism.

Since 1996 we have acquired and have experience with four different excimer lasers to include Summit Apex Plus, Summit Excimer, Nidek, and the Allegretto Wave Laser. Each has specific features that allow broad beam expansion to scanning beams to flying spots with wavefront algorithms. Our new Allegretto Wavefront Optimized flying spot laser with a 200-KHz tracker has produced a 50% gain in vision over any glasses or contact in our myopic patients, and a 44% gain in vision over any glasses or contacts in our hyperopic patients. "WOW, WOW, WOW" vision has been produced, and the staggering thought of seeing better than anyone has seen before in the history of time is being realized.

Then in 1999, Professor Theo Seiler performed the first wavefront-guided treatment in Zurich on a WaveLight laser. This marks the advent of wavefront technology in vision correction.

Since the beginning of the new millennium, wavefront-guided technology has started to become popular throughout the United States. Prof. Seiler's idea of treating the finest aberrations within the optical system of the eye let many physicians and patients to hope for more. The idea began to take vision beyond the bounds of 20/20.

For the first time since 1999, the FDA approved an entirely new laser for use in the United States: the ALLGRETTO WAVE built by WaveLight. The ALLEGRETTO WAVE was designed in cooperation with Prof. Seiler from the ground up to perform customized treatments with the speed and precision necessary. A first in lasers, the ALLEGRETTO WAVE has wavefront-principles directly integrated into the standard treatment.

Despite all the technological advancements in vision correction surgery, the physician is still the most important factor for a successful and satisfying outcome. The LASIK procedure requires a great deal of technical skill and training to perform properly. Dr. Shealy has performed more than 20,000 vision correction surgeries, was the first surgeon in Indiana and is one of the very few specialists in the United States, to dedicate his practice entirely to laser vision correction. So you will receive thorough care and have access to a highly experienced doctor at the Shealy Eye Laser Center.

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What Were The Advantages of LASIK from 1996 to 2004?

• Painless in-office same-day surgery, with a quick visual recovery (4 to 24 hours)

• 99% return to work within 24 hours, and drive back the next day to be evaluated

• Higher precision with experienced ophthalmologists

• Safer results with less irritation than contact lenses

• Eyes preserved for future upgrade technology

• Nearly 100% satisfaction rate

The advantages of LASIK has been supplanted after the year of 2004 by newer methods and lasers which addressed visual quality. Before LASIK we only had PRK or photorefractive keratotomy which was performed on the surface of the cornea in a non-cutting manner. With the advent of newer lasers that addressed nighttime glare and quality issues, it became apparent that improvements could occur in traditional LASIK or laser vision correction. The first improvement was to improve the beam quality and placement of the beam to maintain the normal curvature of the cornea without interruptions in the refractive surface that could affect nighttime vision when the pupil dilated. Suddenly, patients noticed that their vision was crisper and more in focus and free of visual disturbances especially at night. Thus, older lasers were replaced by newer lasers that addressed visual quality.

At the same time, it was learned that LASIK involving cutting with blades could produce complications like epithelial ingrowth, (ectasias) bulges, (stria) dislocations, and eye dryness by cutting the delicate corneal nerves. With the advent of newer pharmaceutical agents especially mitomycin-C in the year 2007 and the development of non-cutting epithelial separators, patients could regain their functional vision and return to work relatively quickly without fear or safety mindedness. The healing time became two days instead of the usual six to seven days with standard PRK. Postoperative discomfort was reduced by the use of new pharmaceuticals, most of which were non-narcotic in nature. Using these pharmaceuticals along with new improvements in contact lenses nearly all patients were able to return to work and were comfortable within two to three days postoperatively. Only 12% of the patients required narcotic medications after the first 24 hours and a large portion did not take any medications at all. No patients required medication after day two and were quite functional after the second day. LASIK appeared to lead to wrinkling of Bowman's membrane and produced more re-treatments and lesser outcomes than surface Epi-Laser or advance surface treatment. Thus, the Shealy Eye Laser Center abandoned mechanical LASIK in the year 2006 and now offers all-laser LASIK for those patients who do not want the complications associated with microkeratome cap or flap LASIK.

Since 2006, the Shealy Eye Laser Center has been performing surface ablation with amoils brushing or epitome separators which do not physically cut into the stroma of the eye. Some patients who've had mechanical injuries to the eye with metal fragments may be required to avoid cutting into the stroma with a laser or mechanical blade to avoid surface irregularities which may induce regular or irregular astigmatism.

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How LASIK Works

The LASIK procedure is performed under high magnification with an operating microscope. Topical anesthetic drops are administered to anesthetize your eye. Patients remain awake and comfortable. The procedure takes approximately 15 minutes for both eyes, and consists of making a corneal cap to be hinged to the side as laser ablation is performed on the inner layers of the cornea.

Hyperopic corrections may be performed with central cornea masking and selective ablation techniques. A clear shield is then placed over the eye and the patient is observed a few hours to a day later to determine cap position and alignment.

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

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Monovision

Monovision is a technique developed for people with presbyopia in which one eye (usually the dominant eye) is corrected for clear distance vision, and the other eye is corrected for comfortable near vision. Monovision is a process of correcting both your distance and near vision without glasses. This is possible by correcting your dominant eye for distance and your non-dominant eye for near. This process takes about 3 to 6 weeks to adapt to called neural adaptation. Most people in their 40's and 50's do very well with monovision (approximately 80-90% adapt). If for any reason you are not satisfied with your monovision after your treatment, it can be reversed by correcting the non-dominant eye to distance. A reversal can only take place after the eye has fully healed and stabilized - which takes approximately 3 months. A trial of monovision is possible by using a weak contact lens in the non-dominant eye.

Depth perception is usually not decreased along with night vision if less than 1 diopter of nearsightedness is made or retained in the non-dominant eye. This situation is called modified monovision and usually does not affect the distance vision for driving; however, the effect may be bumped up with an eight spot treatment of NearVision CK (conductive keratoplasty) in the non-dominant eye.

All of us will experience presbyopia as we become older and usually patients are affected between age 40 and 48. Younger patients usually have latent hyperopia which should be corrected first before considering multi-focusing implants or NearVision conductive keratoplasty. Dr. Shealy prefers to perform laser surgery before implant surgery or conductive keratoplasty. This is preferred to eliminate all farsighted astigmatism and spherical hyperopia or farsightedness.

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Risks and Benefits

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 eye making his or her vision unbalanced. A patient may develop myopia or astigmatism after an unrelated eye surgery, such as cataract surgery. These conditions may be corrected with refractive surgery at the time of surgery or afterwards.

As with any type of surgery, complications due to refractive surgery are possible. However, since 1974 hundreds of millions of cases have been performed in the world and serious or long-term complications are rare. The most common side effects following laser vision correction surgery include:

• Light Sensitivity (Vision Fluctuation) - your eyes may be very light sensitive and change during the stabilization period (3 weeks). Allegretto Wavefront Optimized ablation has resulted in a 50% decrease in light sensitivity, halos, and night vision glare in comparison to the non-operated eyes before surgery subjectively.

• Glare - you may experience increased glare from oncoming headlights or other bright light sources in the evening or nighttime. This has been reduced by increase in true optical zones with high speed and tracked laser ablations with our Allegretto Wavefront Optimized laser.

• Blurred (Cloudy) Vision - occurs during stabilization; this is caused by central corneal edema due to swelling of the cap and inner corneal layers. Visual improvement occurs rapidly over the first few weeks to yield 20/40 or better unaided vision.

• Regression

• Overcorrection (Under Correction) - patients are frequently slightly overcorrected initially which may make reading slightly more difficult for a day or so in the case of nearsightedness, or in the case of farsightedness distant vision may be slightly more difficult. Overcorrection occurs rarely and can be corrected with further surgery after three months of healing to further refine vision; this is commonly known as a re-treatment. With the Allegretto Wavefront Optimized have reduced re-treatment rates to 0.25%.

• Scratchiness

• Irritation (Dryness) - this occurs during the first few days after surgery, especially the first morning of the day after surgery. Artificial tears provide relief.

• Part-Time Glasses - the overwhelming majority of our patients are freed entirely from glasses, both for driving and reading. Low myopes may feel more of a need for reading glasses. If glasses are required, they may be prescribed depending on individual patient preference and need. We recommend Maui Jim or Polaroid sunglasses after the procedure. The development of presbyopic procedures, in addition to vision correction surgery, such as conductive keratoplasty (NearVision CK), and accommodative intraocular lenses, is growing rapidly.

• Part-Time Contact Lenses - the overwhelming majority of our patients are freed entirely from contacts, however we've had less than six patients have regular or irregular astigmatism that have required contact lenses for correction. Some of our early LASIK patients developed keratoconus which required contact lenses to correct them.

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Process and Procedure Walk-Thru

Where is LASIK done?

LASIK refractive surgery is performed as an out-patient procedure at the Kelley-Fyodorov-Seiler Surgical Center, located in the lower level of the Shealy Eye Laser Center. We have performed more than 20,000 procedures to eliminate eyewear.

Preparing for the Procedure

The pre-surgical consultation provides a basic orientation to vision correction surgery; its risks, benefits, alternatives and complications. A complete examination and specialized testing to determine your candidacy for surgery will be performed.

Hard contact lenses must be discontinued a minimum of three weeks prior to this consultation and soft lenses must be discontinued three days prior. Induced corneal warpage may occur with the use of contact lenses and postpone surgery until resolution occurs.

Many of our patients come from all across the United States and travel for many hours. For that reason, we recommend that you consider having consultation and surgery the same day for your convenience. You can have your consent form filled out and test completed ahead of time.

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Pre-Op Instructions

Prior to the day of your surgery, you will need to make the following arrangements:

• Hard Contacts - Hard contact lenses must be discontinued a minimum of three weeks prior to the pre-surgical appointment.

• Soft Contacts - Soft lenses should be discontinued one to two days prior surgery; however, toric soft lenses should be discontinued two weeks prior to surgery.

• Makeup - Please discontinue the use of eye makeup at least three days prior to surgery; one week is best. Do not wear any makeup the day of surgery.

• Dress - Wear loose-fitting, comfortable clothing on the day of the surgery. Please do not wear earrings.

• Time - Plan to be at the Shealy Eye Laser Center for 1 to 3 hours on the day of your surgery.

• Driver - Arrange for a driver on the day of surgery.

• Sedative - Surgery is easy and "patient friendly" and sedatives are not usually needed for the LASIK procedure. Some patients experience high anxiety with simple medical procedures, such as going to the dentist or having blood drawn. If this is true for you and you are having LASIK, ask one of our staff and we will provide you with a short-acting relaxing agent that can be taken orally before your treatment. Please do not take pain or sedative-type medications before coming to the facility for your surgery.

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Before Surgery

Refer to the patient forms for instructions prior to surgery.