Epi-LASIK
Epi-LASIK, the latest evolution in the technology of laser vision correction, and Dr. Wesley Clement now offer patients the best of two established procedures: LASIK and PRK.

According to Dr. Clement, "Epi-LASIK combines the safety and efficiency of excimer laser surgery to offer patients a blade-free and flap-free surgery. Epi-LASIK also eliminates some of the risks and disadvantages associated with LASIK and PRK".

Dr. Clement went on to explain, "Epi-LASIK differs from LASIK and PRK in how the eye's delicate outer layer, the epithelium, that covers the cornea is separated (intact) prior to applying the excimer laser for treatment. In conventional LASIK, either a microkeratome or a laser is used to create a flap of corneal tissue that is left attached on one side and folded back. The laser is then applied, and the flap is repositioned without the need for sutures". In PRK, alcohol or an amoils brush is used to remove the epithelial layer before the laser is applied. Immediately following surgery, a bandage contact lens is placed on the eye for 4-6 days while the epithelial layer regenerates and regrows."

For Epi-LASIK, Dr. Clement uses a specially designed and constructed instrument that very gently and slowly separates the epithelial layer from the underlying tissue, so he can move it carefully to one side before the laser application. After the laser has been used, the epithelial layer is repositioned protecting the treated surface while the epithelium regenerates naturally leaving no flap. Epi-LASIK removes the need for any incisions or alcohol, and no trauma to the cornea from additional lasers which are required in creating a flap before treatment. Epi-LASIK can be useful in treating people who have thin corneas and may have been told previously that they were not candidates for laser vision correction.

"The reduced risk of complications," Dr. Clement said, "is due primarily to the procedure being flap-free, that is, the creation of a flap is not necessary." Other advantages of Epi-LASIK, according to published reports, are a more stable cornea after surgery, lower risk of dry-eye post-operatively, and a quicker return to normal vision and activity than PRK.

Laser vision correction is one of the most frequently sought procedures in the U.S. Celebrities such as Cindy Crawford, Courtney Cox Arquette and Drew Carey as well as athletes, Tiger Woods, Jeff Bagwell, and Troy Aikman have joined the hundreds of thousands of people who were tired of the hassle and expense of glasses or contact lenses and wanted to reduce, or eliminate, their dependence with laser vision correction.

Charlotte's own sports celebrity, NFL Hall-of-Fame, Joe DeLamielleure, underwent monovision corrective surgery with Dr. Clement to markedly reduce his dependency on reading glasses or bifocals. According to Dr. Clement, "We get many inquiries from people in the 45+ year age range who are not happy using readers or bifocals to see well enough to read or do close work. Many of those choose a procedure called monovision, which is less riskier than implanting intraocular IOLs. PRK, which was the original treatment of excimer laser vision correction, is now recommended by the U.S. Military for its soldiers and pilots because of the elimination of the corneal flap.

LASIK
Whatever the reason, thousands upon thousands of people are choosing to experience life without glasses or contact lenses. From people in their late teens to early 20s, to middle age, to mature adults, technology continues to evolve that meets the demand for glasses-free living. Whether your are nearsighted, farsighted, have astigmatism, or presbyopic, Carolinas Eye Center devotes itself exclusively to the art and science of refractive surgery. Dr. Wesley Clement, one of the area’s most experienced refractive surgeons, continues to be on the leading edge of offering the newest treatments supported by the latest equipment for patients who want today’s state-of-the-art technology.

Good candidates for LASIK are at least 18 years of age, have a stable glasses prescription and are free of eye disease. Status for candidacy for LASIK is typically determined during an initial evaluation by Dr. Clement.

How LASIK is performed
Numbing drops are placed in the eye so the patient should be quite comfortable during the procedure. The patient is escorted into the laser surgical suite where Dr. Clement and his assistant will position the eye under the laser. Dr. Clement will then expose the eye, and next, using a special instrument called an automated microkeratome, Dr. Clement will gently glide the microkeratome across the cornea to create a very thin “flap” of epithelial tissue that is left attached on one side and folded back to expose the inner surface of the cornea. He then uses the “cool” beam of the excimer laser to remove a predetermined microscopic amount of tissue from the central portion of the cornea. This reshaping, or removal of microscopic layers of corneal tissues, will cause the cornea to flatten in the case of the nearsighted eye, thus becoming less steep. When Dr. Clement has completed the reshaping, he carefully folds the “flap” back into place to heal naturally, without the need of sutures. Most patients say they notice almost an immediate improvement in vision, and resume normal activities within 24-hours.

Monovision
As we age, the eyes also begin to show signs of growing older, too. Perhaps the most noticable symptom is the lens losing much of its elasticity and thus, its ability to control and focus light that enters the eye. This condition is referred to as “presbyopia” and generally starts to occur around the middle years, age 40 or so. As presbyopia progresses, the ability to see to read or see objects at close range diminishes, and it is necessary to wear reading glasses, or if already wearing glasses, to switch to bifocals.

LASIK or NearVision CK correction can specifically target the symptoms of presbyopia with “monovision.” One eye is used for near, and the other used for distance. Often, only one eye needs to receive correction in order to see clearly without readers or bifocals. Simply, monovision works because of the role the brain plays in "selecting" the appropriate image needed for near or far vision while ignoring the "blurred" image. Not everyone adapts well to monovision correction, but a short-term trial using contact lenses can simulate the effect prior to making the final decision to have the permanent correction.

NearVision CK
Q: How is CK performed?
A: CK uses radio waves instead of a laser or scalpel to reshape the cornea. CK is performed using a small probe, thinner than a strand of human hair, that releases radio frequency energy. The probe is applied in a circular pattern on the outer cornea to shrink small areas of corneal tissue. This circular shrinkage pattern creates a constrictive band (like tightening a belt), increasing the overall curvature of the cornea. The procedure, which takes less than three minutes, is done in-office with only topical anesthesia (eye drops).

Q: Will my cornea be cut?
A: No. CK is performed without the cutting or removal of tissue. It is a safe, minimally invasive procedure.

Q: Is radio frequency energy safe for use on my eye?
A: Yes. The use of radio frequency energy is one of today’s most advanced surgical techniques. In addition to its use in CK, the technology is being used in prostate cancer therapy, back surgery, and even cardiovascular procedures.

Q: Will my vision improve immediately after surgery?
A: Patients usually notice an immediate improvement in their vision after the procedure. However, it usually takes several weeks for the eyes to adjust to the final level of treatment.

Q: Will my vision fluctuate after surgery is performed?
A: Most patients will experience mild fluctuations in their vision, but few notice it. Any fluctuation will usually subside within a few weeks. Patients who are treated for farsightedness, regardless of the procedure, typically require a longer stabilization period than those treated for nearsightedness.

Q: Are both eyes treated on the same day?
A: For patients who require treatment in both eyes, CK is typically performed on both eyes on the same day. Most patients are comfortable having the procedure on both eyes the same day because the procedure is minimally invasive, takes less than three minutes and is done in-office with topical eye drops.

Q: When can I return to work?
A: The majority of patients are able to return to work and other normal activities the day of their procedure.

Q: What are the risks and side effects of CK?
A: Because CK is minimally invasive and extremely precise, the procedure has exhibited very minimal risk and almost no side effects. During the first 24-48 hours after CK, you may experience some tearing and slight discomfort, including a foreign-object sensation in the eyes. You may also experience initial slight over-correction of vision which stabilizes during the following weeks. However, because CK doesn’t cut or remove tissue, many of the side effects associated with other vision treatment procedures have not been observed with CK.

Q: Are there restrictions after having CK?
A: As with any vision treatment procedure where the cornea is altered, certain precautions should be taken. After the CK procedure, patients should avoid getting contaminated water in their eyes for at least a week. This includes water from swimming pools, spas, lakes and the ocean. When showering or taking baths, patients should keep their eye closed in order to avoid getting soap or dirty water into their eyes. When exercising, sweat should be kept out of the eyes for at least a week.

What is PRK?
As an increasing number of people are taking advantage of technology to correct vision, LASIK has, by far, become the most familiar. But there is another laser procedure, one that has distinct advantages, and can offer the opportunity to see well without glasses or contact lenses. It is called Photorefractive Keratectomy, or PRK, and is actually a forerunner of the Epi- LASIK technique.

PRK was invented in the 1980s, and widely practiced worldwide before receiving FDA approval in the US in 1995. PRK cannot correct presbyopia, the age-related loss of flexibility of the eye’s focusing muscles that ultimately cause the need for reading glasses or bifocals. Like LASIK Laser Vision Correction, PRK uses the excimer laser’s cool, ultraviolet light beam. Now the difference between LASIK and PRK begins. In LASIK, a microkeratome is used to gently create a corneal “flap” that is left attached and folded back prior to the laser being applied to the corneal tissue. PRK does not require the creation of a flap. Microscopic amounts of corneal tissue are removed after the eye’s epithelial layer has been removed either with alcohol or an amoils brush. PRK may be recommended to retain the integrity of the eye, or for patients with larger pupils or thinner corneas.

The two main disadvantages of PRK are: 1) Discomfort in the eye until the epithelium regrows or regenerates; and 2) slower recovery of visual acuity to 20/20.