Email: October 25, 2004 Q: After my first Lasik I was 20/30 Three days ago I had an enhancement and I am still so blurry. I use Restasis as well. Can you have a second enhancement? or is it too risky? I am 54...have a fairly thin flap, but was ok for the first two. A: Usually, more than one enhancement is possible. Andrew Caster, MD

Email: October 25, 2004 Q: I've wanted Lasik surgery ever since I heard about it for the first time. Well, I'm at a point financially when I would be able to do it. However, my mom had read somewhere that this time of year (fall) is a bad time to get the procedure done. Unfortunately, she can't remember where she read it or why it was a bad time. I live in Minnesota, so I'm wondering if it could have something to do with the weather!? Also, I work as a surgical technologist, so with the air flow in the OR, I'm slightly worried about my eyes getting dried out during surgery. Any suggestions? A: The temperature and humidity in the laser room must be controlled to compensate for changes in weather during the year. If this is done, there is no concern about the time of year. Andrew Caster, MD

Email: October 25, 2004 Q: Dear Andrew This is Asif Ansari from Pakistan. I am 34, Male, and wearing glasses since I was 13. My vision is -4.00. My questions are: 1) Should I go for LASIK? 2) What are the advantages and disadvantages in this procedure? 3) How long healing process going to take? 4) My niece, who's 10, also -4.00, Can this surgery be good for teenagers as well? 5) My elder sister, 38, has vision of -6.00. What is your advise for her? Thank you for your time. Best Regards Asif. A: Each person needs to be examined. No Lasik for someone whose eyes have not stopped changing, which usually is at least 18 years old. Andrew Caster, MD

Email: October 26, 2004 Q: I have been diagnosed with Keratoconus. I am in the early stages of this disease. I would like to know if there is a Laser Treatment (like Lasik) for my problem. A: There is no laser treatment at this time. Experiments are taking place with corneal rings and collagen cross-linking. Andrew Caster, MD

Email: October 26, 2004 Q: I am legally blind in my right eye with full peripheral vision due to an eye injury. Before the injury I had Lasix surgery done and saw perfectly. My left eye was left untreated and I still have an astigmatism. Can I get Lasix surgery in my left eye???? A: It is not recommended to have Lasik when the other eye is legally blind. Andrew Caster, MD

Email: October 27, 2004 Q: I had CK to correct my up close or reading distance vision. I never had any problem with my distance and in fact considered it perfect or so the test showed before surgery. Now after this procedure my reading sight is just okay and actually I still prefer my glasses if I want to thread a needle or do any up close project, and my distance sight is now just okay and while I can see it is not perfect like before. The doctor keeps telling me it is my brain that is not adjusting. Also I should mention he only did my dominant eye. I don't know I'm not exactly happy with the result and now I feel more comfortable with glasses for night driving. My doctor feels that another what he calls bonus dot might overcorrect my problem or make it worse. He also suggested I get the other eye done. I would be want to go to another doctor. What is your opinion. Thank You A: I would get another opinion before having further treatment. Andrew Caster, MD

Email: October 27, 2004 Q: I had my custom view lasik procedure done about 2.5 months ago. I can see 20/20 but its hazy and now I notice momentarily when I put in my eye drops (refresh plus or bion tears) , I see clear. It doesn't last but a few seconds. What could be wrong? FYI, my vision before the procedure was 20/600 w/astigmatism in one eye. I'm in my late 20's. Aside from eye drops, should I still be resting my eyes more frequently? A: There is no need to rest your eyes. Eyedrops are good. You may need more time to heal, or you may need an enhancement. Andrew Caster, MD

Email: October 27, 2004 Q: hello, my name is luke. I have been told I suffer from Blepharitus (I'm sure you know all about that) I'm being treated for it and nothing seems to be working. The problem I have is that I dont think I suffer any more pain or discomfort than any other person with healthy eyes, however, my eyes are very red, very bloodshot, appear very sore, and are a pinky colour on the best days. My question is, is there any kind of surgery laser or not, that could remove unwanted and unsightly red veins from the eyes leaving them looking white and healthy? Also is there any research being done to tackle this problem because I feel that as soon as someone finds a way of doing this they will make a fortune. Thank you for your time. Luke A: No surgery is indicated. Sometimes treating dry eye or other conditions associated with blepharitis is helpful. Andrew Caster, MD

Email: October 27, 2004 Q: I've been using contact lenses for the last 26 years.But lately , I started to suffer from dryness in my eyes.So I've started to use ''natural tear drops'' since August 2004. But, I still have eye dryness. Is this condition a contrindication for Lasik Surgery?If I prefer to have this surgery, what type of problems may arise? A: Many people who have lasik successfully have dryness with their contacts, and that is why they have lasik. But dryness ater lasik is more common if you have dryness before. Andrew Caster, MD

Email: October 29, 2004 Q: I had laser treatment on both eyes now three times. The first time the right eye semed to be ok the first two times but this third time my left eye is better. The reason they weren't able to finish all at once is because i had bleeding inside of my eye and now it's been two weeks since my last laer operation and i see the blood spot and it blocks my vision on the right eye. Is that normal? The doctor told me to sleep in a 45 degree angle at all times but i was wondering if i could also sleep sideways or if i MUST sleep almost sitting up? A: These laser treatments are not for getting rid of glasses, but are for another condition in your eye. You should consult with a retianl specialist. Andrew Caster, MD

Email: October 30, 2004 Q: I have -3.5 vision in both eyes and am interested in having LASIK surgery when I visit the states. Is it safe for this procedure to be carried out the day before a long haul flight. Do you need to have a referral from a US based specialist. and what are your rates? Thank you in advance. Ms McKenzie A: Many of our patients do travel to us from outside of the United States. Please contact Diane in our office. Andrew Caster, MD info@castervision.com

Email: October 30, 2004 Q: I plan to have Lasik next week. I have been approved. My age is 55. I have a congenital nestagmas. Do you think I should have the BLEND or far away correction. Thanks Doug A: Whether to have monovison or not is a very personal decision. Pleasediscuss this thoroughly with your eye surgeon. Andrew Caster, MD

Email: October 31, 2004 Q: Is it true that there is a higher chance of overcorrection with custom PRK than with conventional PRK in the case of a patient with mild myopia? (Right Eye: Sphere -2.25, Cylinder -2.00, Axis 15) (Left Eye: Sphere -2.25, Cylinder -0.25, Axis 170) Thanks! Sulman A: No, there is no difference in overcorrection rates, if the proper adjustments are made. Andrew Caster, MD

Email: November 01, 2004 Q: I recently had a Lasik exam. My left eye is -1.75 and right eye is -1.25 with a slight stig. Cornea thickness in left is 501 and right is 504. I read that a thickness of 500 is considered borderline, is my cornea too thin??? A: No, your cornea is not too thin for Lasik. Andrew Caster, MD

Email: November 03, 2004 Q: I found your name on the All About Vision Web site and had a quick question for you. I was wondering if you had any first hand knowledge of who is the largest (in sales volume) Lasik provider to individuals in the U.S. or in the world. I am trying to do some market research as I am trying to introduce an idea to help them generate revenue. I would appreciate any help or suggestions. Thanks so much, Dave Gilman A: TLC is a chain and may be the largest.

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