Email: May 31, 2006 Q: Hello - I had a consultation for LASIK with a surgeon yesterday. He said that I am a good candidate and the only "word of caution" is about my flat corneas. He said that there is a chance that I may have problems with night vision. He also recommended traditional vs. custom LASIK. Any advice? Also, do you know any statistics on patients with Flat cornea in terms of night time vision? Thank you in advance. Sue S. A: There has been some concern that flattening the cornea beyond a certain range could result in some decrease in the quality of the vision, particularly at night, but this is not known for sure and is in fact debated. Andrew Caster, MD

Email: June 02, 2006 Q: Hello doctor! I have a question regarding the eye sight of my father and I would appreciate if you would be able to help me with this. About 6 years back my father was unable to clearly see with both his eyes. He could see black spots and was unable to clearly see the persons standing in front of him. For example if he was looking at the face of a person, he would only see the persons shoulders except the face. We did approach an Ophthalmologist who recommended that we go through a Lasik treatment and it would be cured, but after the Lasik treatment, the eye sight worsened and now his vision has deteriorated and he can only see blurred images. I would like to know if there is a treatment for this? Would appreciate your help or any recommendations. Thanks and have a great day! A: It is necessary to know what the medical diagnosis of his problem is. There are many different conditions with different treatments that could be cause of his problem. Andrew Caster, MD

Email: June 05, 2006 Q: One doctor said I shouldn't wear my contacts 3 days before going in for them to measure my eyes and do the consultation (PRK - my cornea is too thin for the newer Lasik) - another said I should wear my glasses for 2 weeks and then go in - another said only 24 hours. This has me nervous - what is correct??? I wear disposable soft lenses 24/7 - I throw them away after 2 weeks and put new ones in. A:There is no absolute agreement within our profession as to how long people should stay out of their contacts. For extended wear users, I take the more conservative approach of 10-14 days without the lenses. Andrew Caster, MD

Email: June 05, 2006 Q: Hello, I would like to know whether there is a possible way to change your eyes color. Is there any? Could someone change the color of their eyes or otherwise reduce/degrade their eye pigment? I look forward to hearing from you as soon as possible. A: There is no safe way to change your eye color at this time. Andrew Caster, MD

Email: June 06, 2006 Q: I have Keratoconus on both eyes and I really would like to get surgery on my eyes. I want to know if this can be done to me. A: People with keratoconus are recommended not to have laser vision correction, except in extremely unusual situations. Andrew Caster, MD

Email: June 10, 2006 Q: I had lasik surgery 1 month ago and at my follow-up appointment, my surgeon said he had deliberately undercorrected my eyes (OD -1.00, OS -.50) so as to delay the need of reading glasses (I'm 40 next month). First of all, he didn't discuss this with me previously, and now he's prescribing driving glasses. I could tell my vision wasn't corrected but thought I just needed more time. Is this a legit philosophy? If I'm going to need reading glasses in the future anyway (I don't now), why didn't he just correct me to 20/20 so I could have good vision for a few more years?? Should I seek enhancement? What would my vision be anyway based on the above (20/40??) Thanks for your time. A: It is common to undercorrect one eye only, which is called monovision. However, I think that this is something that should be discussed with the patient, and the patient should choose it if they want. You do not have to have one or both eyes undercorrected, and can have an enhancement to have the vision optimized for distance. Andrew Caster, MD

Email: June 15, 2006 Q: Hello my name is Iacobescu V. and I live in Romania. I'm 23 years old and I suffer from short-sightedness. My test results with a topcon are: for the right eye S- 6.25 C- 5.50 A 25; for the left eye S-16.25 C-5.50 A129. And I have congenital ectopic pupils. This may influence the result of the intervention how much? And if the operation is not possible what is your advice {what you will do in my case}. And my ectopic pupils can be fixed ,how? Please send me an email as soon as posible. A: There are some laser procedures that can be helpful in some cases of ectopic pupil, but there are limits. Your prescription in the left eye is too high for laser vision correction. All procedures, including phakic implants, are limited by the ectopic pupils. Andrew Caster, MD

Email: June 20, 2006 Q: Dear Dr. Caster, I'm a 28yo man living in Italy. I'm writing to ask a question I hope you'll be so kind to answer soon, as it is really important for me. Let's figure that a man you have never seen before is sitting in front of you in your office. Would you (or an average colleague of yours) be able to state and certify, without any doubts: 1) whether the man had laser surgery or not 2) what kind of surgery he had (LASIK, LASEK, PRK, epiLASIK, bladeless LASIK or others)? I'm asking this because I want to have optical surgery and I would choose LASIK, but this kind of surgery is not allowed where I work. We are checked up once per year and I wish to know whether an average doctor, visiting me four or five months after the surgery, would be able to say with no doubts "you had LASIK", or would he be compelled to ask me "which kind of surgery you had?" to be sure. Obviously the greatest thing would occur if the doctor wouldn't be able to state you had laser surgery at all! Thanks in advance for your reply, that I hope to receive the soonest you can. Dr. Maccaus A: By performing a corneal topography test, it can usually (but not always) be determined that a person had some form of laser vision correction. Looking at the eye under a microscope, an eye doctor can sometimes (but not always) see the edge of the corneal flap, whether the flap is made with a keratome or the IntraLase laser (it is typically easier to see the edge of the IntraLase flap). In the case of LASEK, PRK, or epiLasik, you can sometimes see the minor haze that often occurs, but of course that haze could be due to other things, so a doctor could not say for certain that these procedures took place. Andrew Caster, MD

Email: June 20, 2006 Q: I am asking on behalf of my girlfriend. She was told that her cornia are too steep to have lasik eye surgery done on her. I was wondering if this is true, and/or if this will be possible in the future. Any help or information will be greatly appreciated. Thank you and I hope to hear from you soon. Sincerely, Walea K. A: There are certain levels of steepness of the cornea which would preclude a person from having laser eye surgery. However, it is important to view these in terms of the overall correction needed, as well as the overall curvature. So I cannot answer your question without examining the patient. Andrew Caster, MD

Email: June 21, 2006 Q: Hello, I want to get my glasses removed. Current LASIK machine available is VISX STAR S4, can you please tell me if it is the right/best machine to for LASIK treatment. My glass number is -5. It would be nice getting your expert advise. Thanx! kapila A: -5 is certainly correctable with the Visx laser, which is an excellent laser. Andrew Caster, MD

Email: June 27, 2006 Q: Dear Dr. Caster: While I am aware you are not a veterinarian, I am hoping you may be of some help to me. My 13 year old Siberian Husky was recently diagnosed with a severe cataract in one eye, and a small one starting in his other eye. I have made arrangements for a consultation but not until October-vet extremely bogged down. I am taking him in for a second opinion Thursday, but for the record, would such a severe cataract allow the human eye to see? My husband nor I see any cloudiness at all. And would you feel that $3500.00 to be a bit much to remove one cataract, and $500.00 for the other eye if done at the same time, plus $165.00 for evaluation, plus more for preop work up? And what say you about waiting until October? A: With severe cataracts you can often see shapes, but little detail. Extremely severe cataracts, which you might be able to appreciate as a whiteness where the usual black pupil should be, will cause only an ability to discern light from dark, no more. Whether you choose to have your dog undergo the surgery is only a choice that you can make. Andrew Caster, MD

Email: June 27, 2006 Q: I am a 23 year old and very near sighted in one eye. My doctor says that the use of a glasses will give me a double vision. According to him, since only one eye is affected, the use of a corrective lens will only affect the other eye. Is LASIK an alternative? What do you Suggest? RTA A: Lasik may indeed be a good solution to your problem. The double vision caused by the glasses is much less likely with a contact lens, or with Lasik. Andrew Caster, MD

Email: June 27, 2006 Q: I already have dry eyes but would like PRK surgery, what are the possible effects of going ahead with the surgery? Does having dry eyes increase the risk of infection permanently? A: Dry eyes are very unlikely to be made worse with PRK. Dry eyes, at least after the first 3 months, are also very unlikely after Lasik, but even more so after PRK. Andrew Caster, MD

Email: June 27, 2006 Q: I am a insulin dependent diabetic for 25 years, been on the insulin pump for a little over 4 years. Is Lasik surgery even an option for me? I have worn glasses for 10 years. No retinopathy. A: In the absence of retinopathy and other indications of problems from diabetes, and under good control, I believe that lasik is a viable option. Andrew Caster, MD

Email: June 27, 2006 Q: I am having lasik surgery done on both my eyes tomorrow with Drs. Rose in Costa Mesa, CA. I have been told that I have slight dry eyes (which has made wearing contacts awful). I have been taking flax seed oil and using sustain eye drops for the last week to help. Do I have a high chance of having severe dry eyes after lasik? Will they be uncomfortable? My doctor did not mention any risk of severe dry eye after lasik to me, so I am guessing that isn't a concern? Any advice would be great! Thanks, Hillary A: Dry eyes are a concern after lasik, and are more of a concern in people who already have dry eyes. The key question is: how dry are your eyes without any contact lenses? If they are dry without contact lenses, then you should consider having "lasik without the flap", as this is much less likely to worsen the feelings of dryness. Andrew Caster, MD

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