Email: September 06, 2005 Q: Hello Dr Caster, Well, I can't quite believe this will actually get to you, but if you're reading this, then wow, that's great! I have one simple question. I live in London and only one clinic performs Lasik with intralase. Is using a laser to cut the cornea better than a microkeratome? The internet postings are quite conflicting on the matter, but as an expert, what is your take on the topic? I'd be most grateful for your help. Thanks so much, Yours, Sheridan A: There is controversy as to which is better, the keratome or IntraLase. In any event, they are very similar. I personally prefer the keratome. Andrew Caster, MD Caster Eye Center Beverly HIlls, California

Email: September 07, 2005 Q: I am very interested in having Lasik for my near sighted eyes with mild astigmatism (-6.75 in each eye). I have hypertrophic scarring, though, (not actual keloids) and have been told by a surgeon 6 years ago that I couldn't have it done because of my scarring. Have any of you done lasik on pts with keloids or hypertrophic scarring? I really want to have it done, but do not want to go blind. flikfick@hotmail.com A: The current knowledge is that keloid formers or hypertorphic scarring patients can have Lasik without additional risk. Andrew Caster, MD

Email: September 07, 2005 Q: Can a person with nystagmus, amblyopia, and high astigmatism a candidate for lasik surgery? A: Possibly. It would depend on the exact situation. Andrew Caster, MD

Email: September 11, 2005 Q: What happens if you switch between wearing your contact lenses and glasses before the intial consultation? A: The treatments are best performed with your eye in its natural state, after the effect of contacts (which push on the eye) have worn off. So it is great to switch out of your contacts prior to the intial consultation. Andrew Caster, MD

Email: September 11, 2005 Q: Hi, thank you for taking the time to read this email. I'm very interested in fixing my nearsightedness with one of these procedures but I'm wary for two reasons. First, I have noticed lately (last year or so) that my eyes have become more sensitive to light. I will retain a high contrast image for several seconds sometimes. I'm wondering if this is a condition of some sort and if it would affect my candidacy for corrective surgery. Secondly, I've used contacts off and on for 13 years. After a few years of using them I noticed that whenever I put them in, my eyes would almost instantly become tired and later that day when I took them off, I would be much more tired. A little about myself: I'm 27, male, white, my grandfather died of diabetes, however I've never been diagnosed with it. I'm in front of a computer for work, and often for fun. thanks again! Nate. A: Sensitivity to light, as you describe, is probably a variation of normal, but an exam is needed. Also, many people get tired with the contacts on. Right now, I don't see anything to prevent you from being a good candidate. Andrew Caster, MD

Email: September 12, 2005 Q: Dear Dr. Caster, I just had lasik consultation. The doctor told me since I had lasik done 3 yrs. ago,they might do a PRK instead of custom. He said that the surgeon might have problem with reopening the flap since it's been 3 yrs.Is PRK as good as custom lasik? Thanks. A: PRK takes longer to heal, but is otherwise just as good. I would suggest that you see the surgeon regarding this issue. Andrew Caster, MD

Email: September 15, 2005 Q: Dear Caster, I need an enhancement.Is it safe to cut a new flap? Can the doctor reopen the old flap manually?Thanks. A: Usually you can reopen the old flap, which is preferrable. Andrew Caster, MD

Email: September 16, 2005 Q: I have a question, that i cant seem to find in studies, that maybe you could help me with. Is it a fact that watching tv in the dark is not good on your eyes and will have an effect on your eyes in the long run, or is it a myth? Please respond by email. Thank you for your time! A: A myth. Andrew Caster, MD

Email: September 16, 2005 Q: Is there a most benificail age to receive eye correction surgury? Often people over 45 or so seem to need bifocals or reading glasses. Is this change of vision due to aging addressed with LASIK surgury? A: The need for reading glasses is not cured by Lasik, but can be addressed for the appropriate person with monovision. There is no ideal age that is preferable for Lasik. Andrew Caster, MD

Email: September 17, 2005 Q: 3 weeks post op lasik Nidek laser. right eye perfect 20/20 occasional blur but great. Right eye, some discomfort one week post op eye ached, senstive to light vision 20/25 but blurry, even the big "E" on the chart, still that way- they tell me its still healing should it still be that blurry? A: It can certainly be blurry for several months. Andrew Caster, MD

Email: September 19, 2005 Q: I was planning to Hongkong to perform lasik surgery. I had pre-lasik exam in 2 hospitals. Unfortunately, the results are rather different. The first hospital (Hongkong Sanatorium and Hospital)(by dr. Ivan)(Aug 10, 2005) Right eye - 12.00 (myopia) - 4.00 (astigmatism) 175 (axis) 539 micron (cornea) Left eye - 9.50 (myopia) - 2.50 (astigmatism) 168 (axis) 538 micron (cornea) The second hospital (St. Paul)(by dr. Ho) (Aug 12, 2005) Right eye - 10.75 (myopia) - 3.00 (astigmatism) 175 (axis) 529 micron (cornea) Left eye - 9.00 (myopia) - 1.50 (astigmatism) 180 (axis) 529 (cornea) Dr. Ivan said I'm not a good candidate because of the corneal thickness and if I keep insisting on having lasik, the quality of my vision will be drop which I might not drive at night because too blurry, glare, or halo. He recommended me to keep wearing RGP contact lenses. While Dr. Ho said, my left eye can perform lasik but not with my right eye. He said, if I'm willing to wait for a while, there will be a new machine arrive, it's called epi-lasik. What I want to ask : 1. Why the prescriptions I have in 2 hospital within 3 days are not the same? 2. Can I actually perform epi-lasik as to dr. Ho's recommendation? 3.Why my vision hasn't stable yet since I'm almost 28 years old this year? (I've already worn eyeglasses since 1st grade of primary school)? Thank you, Terecia Elshinta A: With your high prescription, it is not uncommon to have varying measurements such as this. Hopefully, either doctor would perform more measurements before treating. Your right eye is at the higher range for laser vision correction. It is possible with epi-Lasik or PRK, but you may have more glare or halos than a person with a lower prescription. Andrew Caster, MD

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