Caster Eye Center
Specializing Exclusively in Lasik
and all its Variations


ANDREW CASTER MD-ANDREW CASTER MD Voted Best Lasik-Laser Eye Surgeon in Los Angeles by Los Angeles Magazine.




The Most Commonly Asked Questions About Vision Correction

1. What are the odds of eliminating my glasses?
With the newest Custom technology, over 99% of our patients after treatment have 20/40 or better vision without glasses or contacts (which is good enough to pass the driver's license test) and 96% have 20/20 or better vision without glasses or contacts. A large percentage of our patients see better after laser treatment without any glasses or contacts than they did prior to the treatment with the glasses or contacts. No glasses or contacts -- and better vision. These results can be even further improved with a second, fine-tuning procedure, if desired. The general rule is: more accurate results will be obtained in people who require less treatment.

2. Does the treatment hurt?
There is only very mild discomfort during a laser vision treatment, usually less than having your teeth cleaned. During the first few days after treatment, there may be a mild scratchy feeling or no discomfort at all. Almost everyone says that there was no pain (just some scratchiness). Most people say that the treatment and recovery were much easier than expected.

3. Can I lose vision from laser vision treatment? Could I go blind?
This is by far the most important concern of our patients, as it should be. None of our patients has ever lost his or her vision from laser vision correction. None. We are extremely careful and meticulous. Even in the most serious of complications, which is an infection, the vision could usually be restored by performing an additional surgical treatment.

4. How long will it take to realize my final result?
Every patient heals at a different rate; however, the majority of our patients achieve legal driving vision the very next day. Your vision will continue to improve with the final visual results being realized within a week to a few months.

5. Does Lasik correct astigmatism? By the way, what is astigmatism?
Most people who have nearsightedness or farsightedness also have astigmatism, and laser vision correction is routinely used to correct astigmatism as well as the other problems. Astigmatism occurs when the eye is shaped with a little irregularity, like the back of a spoon. Astigmatism blurs the vision at both distance and near. Even large amounts of astigmatism can now be corrected with Lasik.

6. When is one technique better than another?
Although Lasik is preferable for most patients, there are many situations in which "Lasik without a flap" is preferable. "Lasik without a flap", also known as Advanced Surface Treatment, Lasek, Epi-Lasik, and PRK, is better for people with very thin corneas, certain corneal diseases, or people who expect to have eye trauma, such as boxers. As specialists in this field, we offer all of these techniques, and we will advise you about which is best for your particular situation.

7. Are all lasers the same?
Absolutely not! Dr. Caster has used multiple lasers, and currently uses the two premium lasers: WaveLIght Allegretto and Visx S4. We obtain the most accurate results with the WaveLight Allegretto. Unlike all other lasers, all treatments with the WaveLight Allegretto are Custom treatments. Whereas Visx laser treatments have an enhancement rate around 10%, the enhancement rate with the WaveLight Allegretto is less than half of that - around 4%. Other cheaper lasers, or older versions of these lasers, which are commonly used by discount laser centers, are much less expensive to purchase and use, but do not produce the same quality level of vision. Also, the maintenance and calibration of the laser are very important in obtaining the optimal treatment result (we calibrate the laser before every treatment -- many centers perform calibration testing less often).

8. Everyone seems to be talking about Custom treatment. What does this mean?
Custom technology is a major advance in laser vision correction. Glasses and contact lenses correct the eye for nearsightedness, farsightedness, and astigmatism. But the eye has many other imperfections, known as higher order aberrations, which cannot be corrected with glasses or contacts. Custom laser vision correction can treat these additional irregularities of the eye. The result is often vision that is better than can be obtained with glasses or contact lenses, particularly with regard to night vision.

9. If I don't get a full correction, will I be able to have a repeat procedure to improve the results?
Approximately 4% of our patients return for an enhancement procedure. These patients have had a dramatic improvement in their vision, but have not achieved a full correction. "Touch-up" procedures are extremely quick and easy, and there is no additional charge if performed within 18 months of the original treatment.

10. What about the long-term results? Will my eyes deteriorate in the future?
Excimer laser treatment was first performed in 1988. Lasik is a more accurate variation of ALK, which has been performed for over 25 years, and has been proven safe in long-term studies. Extensive testing has been performed around the world by many different sources and it has been conclusively determined that there are no long-term health problems to the eye from these procedures.

11. Are there other procedures or technology on the horizon that I should consider?
There are always new procedures and technologies under investigation. Not everyone is a candidate for Lasik or Custom Lasik. After a thorough evaluation, we will discuss any viable alternative procedures that might be right for your unique visual needs.

12. Will I be able to see anything during the procedure?
Yes. During the procedure, you will be asked to look at a light. Seconds after the procedure is completed, you will notice a dramatic improvement in your vision. Many of our patients say that this is one of the most memorable moments in their entire lives.

13. What if I move during the procedure? What if there is an earthquake?
Patients worry about this a great deal, and their fear is unnecessary. Everyone moves during the procedure. The laser has an automatic eye tracker which follows the eye as it moves. Also, we can instantly stop the laser treatment whenever we want.

14. What if I blink during the procedure?
The eye is held open by a device known as a retractor, which doesn't usually hurt.

15. Do I need to wear an eye patch after the procedure?
No, but you will be asked to wear protective goggles for the first six nights. Some patients may wear a protective contact lens overnight to promote healing.

16. Will scars form from the procedure?
There are only extremely faint scars that cannot be seen except with a microscope.

17. Will the treatment cause cataracts, or influence the treatment of cataracts?
Laser vision correction does not cause cataracts and does not affect the removal of cataracts.

18. Can I have Lasik treatment again, if needed?
Yes. Lasik will not stop the eyes from changing, so if your vision changes years later, you can almost always have a repeat treatment to re-focus the vision. Also, not every person gets a 100% correction the first time, though almost everyone is very close to perfect. At the Caster Eye Center, we bring back approximately 1 out of 25 patients to have a second, "enhancement" treatment. There is no additional fee for this fine-tuning treatment, and almost all of these people are not using glasses or contacts prior to the enhancement.

19. If I don't get a full correction, will I be able to wear contacts after the treatment?
Very rarely, patients do not get a full correction and will want to wear contact lenses. The general rule is: if you could wear contact lenses before the procedure, then you should be able to wear them afterwards. Of course, a repeat laser vision treatment will usually correct the vision and eliminate the need for contacts.

20. Is it better to treat both eyes at the same time, or each eye on different days?
This is entirely up to the patient, as it depends to a large degree upon your schedule and what makes you feel most comfortable. Patients having Lasik usually see very well the day after the procedure, and most choose to have both eyes treated on the same day. Patients having "Lasik without a flap" heal more slowly, so some of these patients choose to have the treatments on separate days.

21. Am I a good candidate for laser vision correction?
Some people should definitely not have excimer laser surgery. These include:

  • People who are very happy wearing glasses or contact lenses. They have no need for the procedure.
  • People under 18 years old. Their nearsightedness is probably still increasing.
  • People whose refraction is significantly changing. Refractions often continue to change through the teenage years into the early twenties. At least two years should pass without a significant change. (A significant change is one-half diopter or more.)
  • People who insist upon a perfect correction. A perfect correction is possible but cannot be guaranteed.
  • Women who are pregnant or who are breast-feeding. Hormonal changes will often cause temporary changes in your nearsightedness.

So, should you consider one of these procedures? First of all, only if you are not in any of the above categories. Second, you must have nearsightedness, farsightedness, or astigmatism. You may have presbyopia as well, but presbyopia cannot currently be corrected with the laser, except through a technique known as blended vision. Third and last, you must want to be free of your glasses or contact lenses enough that you are willing to invest the time, energy and money to understand and undergo the procedure.

Your suitability for refractive surgery, and the best technique for your individual case, can best be determined through a personal consultation. We provide an extensive Pre-Lasik Consultation to determine if you are a good candidate for refractive surgery, and to discuss the pros and cons of each technique in terms of your individual situation.

22. How safe is laser treatment?
When performed by the proper surgeon, Lasik treatments are extremely safe. Like any laser or surgical procedure, these treatments are subject to complications, but the complication rate is very low. The complication rate is much lower when a doctor very experienced in Lasik, such as Dr. Caster, performs the treatment. Most complications can be corrected through eye drops or a repeat procedure.

In order to decrease the risk of complication, we at the Caster Eye Center take many steps that go far beyond the minimum standards of most laser centers. Our laser is calibrated before every single procedure to ensure the most accurate results, whereas many laser centers only calibrate the laser every six patients, or even just once per day. We monitor and control the temperature and humidity in our laser room, which improves the accuracy of our results.

One of the more important steps to avoid complication is in the rigorous testing of our patients. After the brief initial screening exam and prior to undergoing a procedure at the Caster Eye Center, we will perform a most thorough evaluation; some important measurements will be performed two or more times, and will be further repeated if necessary.

At the Caster Eye Center, we will only perform Lasik on you if we believe that we can obtain an excellent result. Approximately 30% of the patients that come to us for Lasik are advised not to have the procedure, because we believe they are less than ideal candidates.

By far the most common complication is under-response or over-response. In the case of an under-response or over-response, the vision will be dramatically better, but a small amount of focusing error still remains. Further laser treatment, known as an "enhancement" or a "touch-up", can then be used to improve the vision further by decreasing the remaining nearsightedness, farsightedness, or astigmatism. There is no additional fee for "enhancement" procedures if performed during the first 18 months after your initial treatment. Enhancements are performed on about 4% of our patients.

About 25% of excimer laser patients will experience optical aberrations during the initial healing phases, including glare, halos at night, or ghost images. In 99% of cases, this will disappear within several months. Careful attention to detail in centration and calibration of the laser, as well as measurement of pupil size, substantially lessens the incidence of optical aberrations.

23. What are the risks and complications of Laser Vision Correction?
There are three common complications that I like to discuss with our patients. Of course, other problems are possible, but these are the major problems:

1) Need for enhancement.
Lasik and Advanced Surface Treatment are not one hundred percent accurate one hundred percent of the time. We get patients very close to perfect almost all of the time, but in around 4% of the treatments we are close to but not perfect. Most of these people can see very well and are not using any glasses or contact lenses for distance vision, but if we can make the vision even a little sharper, that is our goal. In these situations, we like to wait 3-6 months to be sure that we have the final results, and then perform an enhancement treatment. We do not charge any additional fee for this enhancement treatment, as long as it is performed in the first 18 months. If we can make the vision any better, we will offer a touch up. We will do everything possible to enable you to see as well as you are capable of seeing.

2) Dryness.
Increased dryness on a temporary basis is very common after Lasik. Permanently increased dryness is rare. Dryness after treatment is more common in people who have a lot of dryness before treatment, and will often last up to three months. For people who have extreme dryness prior to treatment, we often recommend the PRK version of treatment.

There are many treatments for the temporary dryness following Lasik treatment. The most effective seems to be taking fish oil liquid or pills (or flax seed oil for vegetarians). The omega-3 fatty acids in fish oil makes the tears much more effective and greatly reduces symptoms of dryness.

3) Halos and night vision symptoms.
Night vision issues are not much of a problem anymore since we began using the Allegretto laser. However, this still remains a problem with other lasers (that we do not use), so we like to discuss it.

All people, whether or not they have Lasik, have some degree of halos at night. To prove this to yourself, go out and look at the full moon at night, and you will notice that there is softness to the edge of the moon. We call this a halo. When you view the full moon during the daylight, this softness is not present. In the past, and with other lasers, the halos were made worse in around 25% percent of patients. Although this almost never interfered with the ability to drive or live your life, it was annoying for some people.

With the Allegretto laser, there is commonly a short-term increase in the night halos, lasting for up to several months. However, on a permanent basis, the Allegretto laser is the only laser in which the average patient typically experiences less halos than with glasses or contact lenses. This is one of the major advantages of the Wavelight Allegretto laser over all other lasers being used today.

To see answers to more questions about laser vision correction,
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The Caster Eye Center in Beverly Hills, Los Angeles, California specializes exclusively in Lasik laser vision correction to improve nearsightedness, farsightedness, and astigmatism, including the latest wavefront technology. Dr. Caster was selected by Los Angeles Magazine as the Best Lasik Laser Eye Surgeon in Los Angeles.