Email: March 05, 2005 Q: I had LASIK performed on both eyes on 1 Mar 05. The right eye went fine (procedure was almost stopped, I had some pain when the speculum was inserted, but after 3rd attempt was fine once it was in place). Left eye had a major problem. The surgeon tells me that I moved my eye (I don't remember moving it, and sure didn't do it on purpose!) as the microkeratome made the incision, resulting in the flap being cut through the center of the cornea up through the upper edge of the cornea, completely removing the flap. The surgeon recovered the flap and replaced it on the eye and applied a contact lens to hold everything in place. He tells me that I will now have a scar across the center of the visual axis and they may be able to go back after at least 3 months and do PRK or LASIK with a deeper flap. As it stands right now. my vision is about 20/40 right eye, corrctable to 20/20 and may improve once the swelling of the cornea goes down. My left eye however is much worse than when I started, about 20/400 corrected to 20/40. Wearing glasses I can function, but with extreme dificulty. I have several questions: 1. How common is this? 2. What are my odds of anything resembling normal vision if I attempt PRK in a few months? (LASIK is not even a consideration, no more blades for me!) 3. Was this my fault, or was there something the surgeon did wrong? Equipment failure? Thanks Gary A: Unfortunately, this does occur, although very rarely. Typically, the vision returns to an excellent level after a few months. Repeat treatments are very successful. Andrew Caster, MD

Email: March 07, 2005 Q: My vision is 12 diopters in one eye and 13 in the other. I was wondering if I could get Lasik to improve my vision. I do not expect to complete improve all 12 diopters, but just want to reduce the great amount of myopia. Can I do lasik? What's the highest degree of myopia that you can perform lasik and does it make it more risky? Also, is this a one -time only operation. Say, a candidate has it and then comes back in 2 years, can they get correction for the remaning myopia? A: Usually, 10-12 diopters is the maximum, but it depends on other factors that can only be determined by a doctor. The new intraocular lenses are also an option. Andrew Caster, MD

Email: March 07, 2005 Q: Why is LASIK surgery so controversial? What are the negative outcomes of it? The information you provide will be used in a collage research paper! Your credentials will also be requested. Thank You A: There is extensive information on my website, www.castervision.com. Andrew Caster, MD

Email: March 07, 2005 Q: How long do the effects of custom (wavefront) lasik last? Is the vision loss progressive as you get older? Would it progress back to what my presciption is now or will the worst case senario still be better than my presciption now? A: The results are permanent, but will not stop the naturally occurring changes in your eyes. Andrew Caster, MD

Email: March 07, 2005 Q: Hi! I read an article about someone in the paper(lost copy) who had lasik surgery but it was more advanced than 20/20. It cost more but gives you eyesight like that of a bird of prey?? Please tell me or do you know what this surgery is called Thanks kindly, Gary A: It goes by the general name of wavefront, though sometimes it is referred to as Custom surgery. Andrew Caster, MD

Email: March 09, 2005 Q: Does intralase cause presbyopia or accelerate it? I am 30 yrs old, have a minor form of astigmatism and near sightedness. While I have successfully passed the eye screening testing and am a good candidate, another reputable doctor advised me not to do the Lasik as it would make me need reading glasses and could impair my close up vision which is near perfect. Is this true? Help, my surgery is scheduled for March 21 on the East Coast. Thanks tons!! A: Intralase or any other form of Lasik does not cause presbyopia or speed it up. Anyone who has excellent distance vision who is 45 or older has some presbyopia and has some trouble seeing up close. If you have on glasses or contacts to see far away, you can take them off to see up close, which is something that you cannot do if you have your distance correction fixed with Lasik and no onger wear glasses or contacts. Andrew Caster, MD

Email: March 10, 2005 Q: Had Lasik done March 5...From a minus 6.50. Vision received was approx 20/25. After only one month, vision regression has me back to approx minus 1.50....What are causes, what is prospect in future...Do I have future procedure at 3 Months out or will same thing happen? A: We don't know why some people have a regression. It is less likely that it will happen after your enhancement. Andrew Caster, MD

Email: March 12, 2005 Q: Monday (this 14th) I am having Wavefront Lasik at TLC here in St. Louis as many people ay my work have had this done 1 just a week ago and have nothing but terrific things to say about Lasik and TLC. I am 37 now and have worn Acuview 2 week contacts for 17 years (-3.75 and -4.00) which has stayed the same for 17 years. BUT when I was 16 I had Keratoconus and keratius (at the same time) Very blinded by light with my poor eyes looking like they were bleeding. Had to wear glasses then, RGP lenses for a couple of years and then the Acuviews. While my corneas are steep (8.4), they are as thick as they need to be (4.70 and 6.03) so the Dr. felt that he could see where someone might think I had keratoconus becuase of the irregular shape in the left eye and my steep corneas. He did not think that I had had it or that if I did I had a very mild case that was caught quickly. I also want to know if the flap they cut heals up or remains loose forever since they do not use stitches. So any thoughts? The info on the proceedures on the web are VERY conflicting and there is virtually no info about those diseases and Custom Lasik out that I can find. Any help or thoughts would be most welcomed! I must say the Dr. himself re-perform some tests. I did feel like he was looking for any reason that the proceedure could not be done - since I told him right off the bat about the illnesses and first thing he said was that Lasik - Wave front or other wise - was absolutly conterindicated in keratoconus people. And they have a very expensive machine that specifically looks for the disease - and while me left cornea was irregular - it was not thinned out as it would be with the disease. Much thanks for any advice - Jennifer A: Kerotoconus does not go away. But the diagonosis of keratoconus could have been wrong many years ago. If in doubt, get a second opinion. Andrew Caster, MD

Email: March 12, 2005 Q: I am based in the UK. I had the test to see whether I am a candidate for Lasik/Lasek yesterday. When they put the anaesthetic drops in they said I had had a reaction and that the epithelium cells had "broken up". They said this was very rare. They were unable to measure my corneal thickness so they are going to do this next week using different drops. The doctor said the drops used first had probably been too "toxic" for my eyes. My question is whether this is going to affect my suitability for lasik/lasek? Many thanks Mimi A: Ity may. It may be better for you to have Lasek rather than Lasik. Andrew Caster, MD

Email: March 13, 2005 Q: I have macular degeneration in my right eye. Is it ok to still get lasik treatment? A: Yes, but depending on how bad the macular degeneration is, your result will be limited as far as the final vision is concerned. Andrew Caster, MD

Email: March 14, 2005 Q: I had Lasik on both eyes 2/17/05. Using both Intralase and CustomCornea. The results gave me great distance but very poor near. Expecting this to get better over time, today my vision is blurry and hazy. My near vision requires me to wear reading glasses for anything less than 8 ft away. My contacts gave me better vision. My next follow up isn't until 4/8/05. I am concerned. If I had my contacts on right now, I would have taken them out and wore my glasses, now I don't have that luxury. Drops have not helped today. Again, up until today, my distant vision wasn't blurry, just now my near is awful. I am 44 yrs old but was I to wear reading glasses for everything? A: Go back to see your doctor sooner, and pose these questions. You may need an enhancement. Andrew Caster, MD

Email: March 14, 2005 Q: Dear Sir, I have been experiencing some flashes in the corner of my right eye. It kinda reminds me of a lightening flash. This happens once in awhile. What would be causing this. It began about two or three months ago. I am 72 years of age and have been wearing glasses 40 years. Thank you. Mary A: It is due to traction on the retina. Usually it is not serious, but you should see an ophthalmologist. Andrew Caster, MD

Email: March 14, 2005 Q: Why would I have epithelial cells growing under my flap from my LASIX surgery? A: It just happens sometimes, more commonly in drier eyes. Andrew Caster, MD

Email: March 14, 2005 Q: How long should you wait for your perscription to remain unchanged before considering surgery? What if your vision changes after the surgery? What is it I hear about the "flap" and the hazards of accidentally poking an eye after surgery? Is it a permanant risk, or just within the healing period? Should I look for the most expensive facility I can afford, or is there a reasonable point at which I can assume I get the best care and more money is not a factor? If I wait longer to have surgery performed, will the technology used in the procedures develop and result in better results with less risk? Thank you for your time. A: You ask a lot of questions. Your vision should be stable for at least one year. If your vision changes later, then a touchup will be needed. Andrew Caster, MD

Email: March 15, 2005 Q: Dr. Caster, I recently heard about a new procedure called: Advanced Surface Ablation / Advanced Custom Cornea. I found no articles or reviews about it anywhere. Do you know if it is safe and effective compared to Lasik? A: This is the same as Lasek, which is a variation of PRK. Andrew Caster, MD

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