Email: January 05, 2005 Q: I have a very hard decision to make. My myophia is -9.75. My cornea is 488 and 479 in another. I was told that it is not enough cornea to do the lasik. A couple of doctors said I could do the PRK and one doctor said that I can't do any of the laser procedures, because they do PRK up to -5.00...( if it is more that -5.00 it is a higher risk for complications) one of the doctors said they do PRK up to -12.00. I am planning to go to a couple of more doctors (I am in San Diego), but I really want to see better and my only hope was that laser procedure. Could you please let me know what you think? Have you done PRK for people like me? Thank you so much A: I have done PRK on people like you. The other option is the new Verisyse phakic implant. Andrew Caster, MD

Email: January 06, 2005 Q: I had Lasik performed in 2001 with a custom laser. Up until that point, my vision was worsening at least every 2-3 years, and i would have to update my prescription. Now my vision is worsening again, to the point that i have to wear glasses. It happened within a matter of a few months. My question is, I know I will have to get an enhancement, but i am nervous about it now. Are there any studies that show the safety of enhancements and the how often they may be performed? I assume i would have to keep getting enhancements every few years. How safe is that? A: As long as there is adequate thickness, you can have repeated enhancements. However, I do not think that it is wise to have any enhacement until your eyes stabilize, which happens in most people by the eary to mid twenties. Andrew Caster, MD

Email: January 06, 2005 Q: Dr. Caster, I had custom cornea performed 7 months ago on both eyes. Was approximately 20/40 in both eyes with no astygmatism. My left eye is perfect. 20/20 and no complications. The right eye healed to 20/35 and had a slightly ghosted image (slightly lower and to the left of the primary). No nightime issues with the original surgery on the right eye as well. After vision stabilized at 6 months, the surgeon indicated that the right eye had a sligh astygmtism (as a result of the healing process) and it could ve very easily corrected by a "slight" enhancement. I had the enhancement to my right eye done just over 1 month ago. I contact was placed on my eye the day of surgery and at a week (after the contact was removed) I was seeing 20/70. I saw the doctor last week and my vision is 20/20...BUT I have some issues. 1. In high contrast situations...i.e. the banner on the bottom of CNN, or black text on a white sign in the distance...I see a complete second image below the first. I can CLEARLY read both. 2. At night, I see 2+ traffic lights and very streaky tail lights. The double image seems to be the worst on computer monitors and when the room is dark and I am looking at a source of light (TV, sign, etc). Its great that my right eye is 20/20, but the double image is a SIGNIFICANT concern. I asked the surgeon id this will go away and he indicated that he "Hopes so". That concerns me greatly. In your opinion, will this most likely go away as my eye continues to heal or was the enhancement done incorrectly? I thought the custom cornea was supposed to make this less subject to error???? You thoughts and experience would be greatly appeciated. I really don't want to have to do "another" enhancement...especially at $750 each time. Thank you in advance. A: The ghosting will probably get better on its own, but it may require another enhancement. I would wait 5 months more. Andrew Caster, MD

Email: January 07, 2005 Q: I was wondering if removing brown eyes and installing green eyes is possible, because I have brown eyes and would like to have a permanent green eyes. Is that possible? A: No. but you can wear colored contact lenses. Andrew Caster, MD

Email: January 07, 2005 Q: Hi, My girlfriend wants to have Lasik eye surgery performed. Her ophthalmologist told her that she is better to wait until after she has children since the change in her hormones from giving birth will reduce her eye sight if she has Lasik eye surgery before having children. Is there any truth to this information? Thanks for any advice. Frank A: Only a very small percentage of women have a change, and the change is very small. So almost all eye doctors say that it is not necessary to wait until after pregnancy. But she cannot have the procedure if she is pregnant or breast feeding. Andrew Caster, MD

Email: January 07, 2005 Q: My wife went in for correction yesterday and they had to abort the procedure because the machine couldn't hold her eyes open. There was some bruising on the white part of the eye and the doctor is planning to wait a couple of weeks for that to heal before trying to re-schedule. Next time he is planning to give her Xantac in addition to Valium and says that if that doesn't relax her enough, he'll be prepared to do a lid (or lip?) lock which deadens the eyelid muscles as a last resort. I've been unable to find anything about the lid lock on the internet (how it's applied, potential side effects, etc). Do you have any information? He said this comes up about once per year and usually the Xantac is enough and that the he had to to the lid lock for the last time about 5 years ago. Since my wife seems to be a bit of a unique case here, any additional information you can provide would be appreciated. A: It is a lid block, which is simply a shot to temporarily deaden the eye muscles. It is safe. Andrew Caster, MD

Email: January 07, 2005 Q: I had regular lasik 5 years ago and now have mild degree of myopia, but troubling dim vision on one eye and double vision on the other. Can custom lasik correct these defects ? If so, what percentage ? Many thanks, S.C. A: Yes. Conventional (non-wavefront) may correct the problems as well. Andrew Caster, MD

Email: January 10, 2005 Q: Can anything to done to help lessen the "halo" and "glare" seen at night? I heard by wearing shooters glasses (yellow tint) will take care of this problem. Thank you A: Some people claim that these are helpful. Andrew Caster, MD

Email: January 10, 2005 Q: My husband had laser corrective surgery about 2 months ago in Istanbul Turkey by a prominent opthamologist who uses the FAKO system. He was treated for astigmatism as well as near sightedness and was told that he had adjusted one eye for better vision far away and the other for close up. The results were fabulous right after the surgery but he is now complaining of double vision and problems with low level lighting. Is this a normail adjustment period or is there something seriously wrong? What do you suggest? Thank you! A: It can take several months for complete adjstment, but he may also need an enhancement. I would see a doctor. Andrew Caster, MD

Email: January 11, 2005 Q: Dear Dr. Caster My wife has progressive systemic sclerosis with crest syndrome. She is interested in lasik eye surgery and has been told by The Filutouski Lasik Institute in Daytona Beach, FL that she is a good candidate for this. My wife does not work and can convalesce as much as needed after the lasik. Do you see any undue risk, as long as she takes great care after the surgery. Thank You, Rick Watkins A: I think that she should discusss this with her rheumatologist. Andrew Caster, MD

Email: January 12, 2005 Q: My daughter had surgery on her eyes, and one rolled. The eye was damaged, and she was told to wait two months for it to heal, and then they could try this again. The other eye went fine. Have you heard of this before? A: It does sometimes happen. Andrew Caster, MD

Email: January 13, 2005 Q: I had LASIK done about 8 days ago and while my vision is pretty good I still see starbursts and halos at night and even some glare around lights in the house no matter what time of day. Should this improve with time and if not is there anything that can. I be done to correct this problem. Im not sure if it matters but I was moderately nearsighted with what my doctor called small pupils. Thank you A: You doctor should have warned you that this commonly happens, and that it gets better. Andrew Caster, MD

Email: January 13, 2005 Q: Am I a candidate or not for Lasik Surgery? My prio exam prescription is as follows. Sphere Cylinder Axis Add +222 -160 165 +75 -75 147 225 I have no depth perception, my eyes do not work together, I somewhere in life injured my eye, yet I do not know when or where or perhaps it may have been from living in CA and having severe reactions to smog. I do not have that here. I have an astigmatism. I don't know if age comes into it but I am 64 years old. My prescriptioin for glasses also has changed since my last appointment but I don't have that one available at this time. It did not change for the better. Please advise me. Thank you, Barbara SHearer A: You may be a candidate. You need a thorough exam to determine if you are a candidate. Andrew Caster, MD

Email: January 14, 2005 Q: With this cutting of the corneal flap, I've heard that the body may respond to the incision by growing layers of cells that blur the vision. what needs to be done to clear up the vision ??? I have 1.5 weeks of blurriness after a correction for residual astigmatism. Is it dangerous to go get a second opinion examination where they apply special eye drops to open the pupil ? A: It is not dangerous to get a second opinion. But 1.5 weeks of blurriness is not that uncommon. Andrew Caster, MD

Email: January 16, 2005 Q: I was wondering if I dye my eyelashes will it effect the lasik surgery? Does the dye cause problems with the lazer A: No, but I would wait for 4 weeks after the surgery to avoid irritating the eye. Andrew Caster, MD

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