Email: February 05, 2005 Q: I am considering LASIK and have already had a consultation. The doctor said I'm a very good candidate. I have been wearing RGP lenses for the last three years and have heard conflicting information on how long I need to be out of them before having LASIK. The doctor that conducted my consultation gave me soft lenses and told me I can wear them for a few weeks and then need to wear glasses only for 3-5 days before I have another consultation. However, I have also heard you need to be out of the RGPs for up to 6 months? I would like to know what the consensus is. Also, is there an organization that will provide actual doctor recommendations/referrals for refractive surgery? I want to ensure I find the best doctor possible in my area (Tampa area). Thank you for your assistance. A: There is no consensus, but one month for every decade of wear is a conservative standard. Try usaeyes.org. Andrew Caster, MD

Email: February 06, 2005 Q: I had Lasik OU preformed in 11/2000. I had it performed twice. The second time was to correct the slight astigmatism. It was sucessfully done. I had the procedure done at Pacific Laser Eye Center. This past year I find my far sight vision getting blurred. I was told by my eye doctor a small percentage of Lasik patients will end up having to go back to wearing contacts or glasses. I love the freedom of not having to deal with the daily care of contacts or glasses however I am afraid to do the surgery again because it didnt last and I dont know if I run the risk of loosing my sight completely. Will a different Lasik surgery be better for me or should I just stick with contacts and glasses? Please let me know. Many thanks for your assistance. Susan Kingham A: There is probably no reason that you cannot have another lasik. Andrew Caster, MD

Email: February 06, 2005 Q: Greetings, My thirteen year-old son was diagnosed two years ago with Esophoria, Anisometropia - astigmatism, and Right Amblyopia. His visuals are OD: 20/400 and OS: 20/20. The treatment is to wear eyeglasses full-time. He has not adjusted well and I am highly concerned about his quality of life and learning. As a parent, I need to understand what corrective options are currently available, or on the horizon. I was warned by his treating pediatric opthalmology that surgery on minors is frowned upon. Is this true? Regards, Rachel E. Diaz A: Lasik is in general frowned upon with children, though some doctors are now doing it. Andrew Caster, MD

Email: February 06, 2005 Q: I had LASIK 5 days ago. The first post op day it was discovered I had "striae" OS. I was seeing 20/20 OD and 20/40-20/60 OS. I got the feeling the situation was quite emergent and was told to return that p.m. where a different surgeon would be refloating my flap. The surgeon rolled the flap back onto itself and then I believe used something called a Q-cell to clean the surface. At no time was any solution used to hydrate the flap. He then proceeded to roll the flap back out and try to flatten it. He was not happy with the results and attempted a refloat one more time, again rolling the flap back onto itself and then flattening it back again. At the completion of the procedure there were still some fine striae (not sure if they are micro or macro) but there was also some inflammation so I was told to used pred forte q 2 h in each eye. A contact lens bandage wasplaced on the left eye immediately post procedure. The following day striae were still present. They decided at that point that the surgeon who did the surgery should evaluate. He determined the surgeon could not have done a better job refloating the flap and he did not want to mess with it as he did not think he could get any better results. I am now being told to wait a couple of weeks, that the vision can fluctuate for up to 6 months post op but my gut feeling is that this eye has been blurry from immediately post op and really has been little change after the refloats. Should I be getting a second opinion? Have you ever done a refloat without using any solution? The surgeon's thinking on my particular case was by not using solution it would keep the cornea "sticky" and that he might get a better result in having the flap stick to the cornea to work the striae out. Obviously I can function at this level of visual acuity, but I am very disappointed the left eye is not "perfect" like the right eye and do not feel I have BCVA in that left eye. Please help me out as I feel the clock is ticking. A: Most doctors choose to use a lot of fluid. If you are concerned, then get a second opinion. Andrew Caster, MD

Email: February 07, 2005 Q: I had laser corrective surgery done about five years ago. My vision went from 20/450 to 20/20. However, my vision has regressed to about 20/40. I am a 37 yr old male. Can I have another procedure? If so, what are the probable risks? A: You can most probably have another procedure. The risks are similar to the first time. Andrew Caster, MD

Email: February 07, 2005 Q: I had Lasik surgery using the VISX Star3 about 1 month ago. I'm 50 yrs old and had my surgery done in Indianapolis, Ind. My vision still is blurry, better than it was, but not 20/20. I have a prescription for glasses now of OD -100+050x100 and OS -100+050x065. My best vision is when I first wake up in the mornings. Once I started reading or usng the computer, I need reading glasses too, then my distance vision worsens and does not clear up until after sleeping. What went wrong? My dr. says to come back in 3 months and if my eyes have stopped changing, then we can do an enhancement. Does this all sound ok? I used to need glasses to see a person's face clearly standing 4 ft. away. Also, I'm currently on HRT and my eye surgeon knew this. Could this be the problem? A: You have a slight undercorrection. If this persists, an enhancement will help greatly. Andrew Caster, MD

Email: February 07, 2005 Q: I'm scheduled for wavfront lasik next week. I've been told I'm a good candidate, but I'm starting to get nervous. What would you say is the most common error or complication, and how would it be corrected. I'm afraid when they go to make the slice, that they may cut it completely off. A: With modern equipment, we do not get "free flaps". the most common problem is that you are close but not perfect and need a touch-up. Andrew Caster, MD

Email: February 09, 2005 Q: Which machine is better and should this be the determining factor between surgeons? Ladarvisoin custom cornea 4000 VISX CustomVue Should a surgeon use a new kerotome blade for each eye or is standard to use the same blade for both eyes? I¿ve been told that I could go either PRK or Custom Lasik. I understand that PRK takes longer to heal. What is the difference in halos and night vision after PRK in comparison to custom Lasik? If my vision does change in the future, can I have another corrective procedure after Custom Lasik or PRK? I have a slight astigmatism, should this impact my decision at all? Are there any other factors to consider between the two procedures other than recovery time? Is there a non biased resource that ranks or names top corrective surgeons? Are there any other factors to consider when deciding on a surgeon? A: You ask a lot of questions. You should consult other surgeons, because the surgeon is the most important factor, who will make many decisions regarding what is best for you. Consider usaeyes.org. Andrew Caster, MD

Email: February 09, 2005 Q: Hello and good day! I am a male in my late 20's. I am excitedly looking forward to having LASIK done. I have done tons of research. I still just have one quesiton. I am nearsighted (myopic) -3.5, and currently have great close-up vision. I find when I wear my glasses or contacs for distance, my close-up vision appears a bit de-magnified. Meaning, when I hold something a few inches from my eyes, it appears a bit smaller, maybe by apprx. .5 times or so. I'm sure you know what I mean. I am wondering what type of outcome usually derives from LASIK concerning this matter. I mean, if I have my choice, I would prefer to lean more towards the best distance vision and continue to deal with the appearance of close-up items as they are currently when I wear glasses or have contacts. I was wondering if by any miracle, I could have the best of both worlds. Not something like monovision, but to be able to keep this great close-up vision and to be able to shoot for 20/20 or better for distance. Just one more thing, what's the ~percentage of achieving 'eagle' vision? And what is the max resolution of the human eye (i.e. 20/10 or even megapixels :) )? Thank you kindly for your time! Sincerely, Peter M Leo III A: Your vision after Lasik will be similar to the vision with glasses or contacts, for both near and far. We are not sure of the maximum resolution of the human eye -- probably around 20/10. Andrew Caster, MD

Email: February 09, 2005 Q: I am currently pregnant and am intrested in getting Lasik surgery. I am sensative to light and my vision is gettting worse during this pregnancy. When can I get lasik and am I canidate? A: You must wait until after you fininsh breast feeding . Andrew Caster, MD

Email: February 09, 2005 Q: I had strabismus corrective surgery at age 6 R eye worse than left & correction involved both at Chelsea Naval Hospital in Boston. I wore pathes both eyes x 6 wks. Since then enjoyed good eye sight until age 49, could still see "double" at times when tired. Then developed @ 49 near first then farsighted problems as well as astigmatism requiring progressive lens correction. I no longer read the 1-2 books per wk I have enjoyed in past & have difficulty seeing when in lighted situations with flourescent lights. I also do not like being in bright lighted situations, have low level light when at home.My eye glass prescription is for +1.00-.50x5 + 0.50 add +2.50. What are my options???? Can I have contacts, surgery? lasix? If lasix is an option, I would like to investigate surgery on east coast. A: I would see a Lasik specialist to evaluate your particular situation. Andrew Caster, MD

Email: February 10, 2005 Q: I'm looking for a second opinion. I just had a Lasik screening and the Dr. suggested that I should also consider PRK. He briefly mentioned that some studies show PRK offers better results. My cornea thickness and pupil size are normal my correction is -4.0. What is your opinion on this? A: For normal corneas and pupil size I would recommend Lasik. Andrew Caster, MD

Email: February 10, 2005 Q: I recently had an evaluation completed on my eyes to see if I qualified as a Lasik patient at Pacific Cataract and Laser Institute. The corneal thickness of my eyes was 496. I was denied for Lasik and PRK due to the corneal thickness. How thick must my cornea be? I know it is also dependent on how big the eyes are. I have the tiniest eyes. Is there an alternative for me as contact irritate my eyes and glasses make me dizzy? A: I would recommend a second opinion. Andrew Caster, MD

Email: February 11, 2005 Q: Is their any problems with LASIK caused by high-G loads on the body, such as in the acrobatic or military flight fields. I think the max G-force I would pull is around 9. A: No, after the Lasik has healed for a few weeks, there should be no problem. Andrew Caster, MD

Email: February 11, 2005 Q: I had custom lasik with the Alcon Ladarvison 4000 just over a month ago, and am currently overcorrected in both eyes. The left is about a +3.00, and the right a +1.00 (although this eye was supposed to be intentionally undercorrected for monovision). What type of enhancement would you reccomend it this refraction is the "final result"? My Doctor mentioned possibly CK, but doesn't that "wear off" over time? What sucess does this have for my situation, and are there any other options? A: I would recommend a repeat Lasik, non custom, in 3 months. Andrew Caster, MD

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