Email: November 03, 2004 Q: my vision is a+4.75 with astigmatisim in both eyes, how many procedures with my vision type have been performed with lasik and was sucessful? intially laskik was more for nearsightedness candidates? A: Lasik for your range is at or slightly above the maximum what most doctors recommend. Andrew Caster, MD

Email: November 04, 2004 Q: I have completed the lasik eye surgery, with 20-20 and 20-30 vision the preceding day after surgery.After two weeks of eye drops 3 times a day and no physical exercise, my eyes have worsened. 20-50 20-50 after 1 month 20-100 20-100 after 3 months. I have a rigorous jogging and weights routine after my intial 2 weeks of relaxing and eye drops. I was told my eyes have healed too quickly which have given this outcome. What is your opinion.? Is there an eye drop that could slow down the healing then? Does the steriod eye drop speed up the healing? A: Your result probably had nothing to do with your exercise. You may need an enhancement. No further drops will help. Andrew Caster, MD

Email: November 04, 2004 Q: Hello Dr. Caster. I am 16 and I have Macular Degeneration, and I was wondering if this will effect my sight in the next few years. It was diagnosed about a year ago, and I'm starting to notice that my eyes are getting really tired at around 4:00 pm. Is this a side effect of the macular degeneration? Thank you for your time, Faith Elderkin A: Yes, the tiredness may be a sign. You should see a retinal specialist. Andrew Caster, MD

Email: November 04, 2004 Q: Dr. Caster During the time before Lasik eye surgery when your eyes are being tested (when you look through different lenses to read letters on the wall), is it better to have your eyes dilated, undilated or do the test in both circumstances? If the answer is both and the results are a little different, which answers do you go with (the dilated or undilated)? What kind of results (numbers) would be considered close together enough not to worry? What numbers would want you to take the test again? A: Both should be used. If the numbers are different, I believe that you should redo the undilated and then use that number. Andrew Caster, MD

Email: November 05, 2004 Q: It is been a month since my LASIK surgery. I have large pupils and I just found out the halos, starbust that i am experiencing in my night driving IS NORMAL. Is anything out there to correct this? I used to like driving at night. NOT ANYMORE. A: It should get better over the next 3-6 months. There is also a drop, Alphagan, that can significantly improve the halos. Andrew Caster, MD

Email: November 06, 2004 Q: I went on a consult @ a local facility. I was somewhat happy with the dx yet I had a question about PRK. I have one eye whose thickness is ok and one that is border (495) Is this worth getting done? I don't want to be left w/too little cornea tissue. The cost is $5100. I don't want it to be a "waste" of money as well. Seems like I may be better off wearing glasses if there is a high risk involved. Please let me know. Thank you A: 495 is fine, depending on your prescription as well as other factors. Go get another opinion. Andrew Caster, MD

Email: November 06, 2004 Q: My name is Enrique Arrieta, I live in Bogotá, Colombia. I have Keratoconus and my eyecare practitioner took me to laser surgery three times. When I went to surgery I did not know that patients with keratoconus should not have laser vision correction. Would you please tell me since when is it well known that keratoconus patients should not have laser vision correction? Thank you very much! Regards; Enrique A: It has been known for several years. Andrew Caster, MD

Email: November 06, 2004 Q: In a previous question you suggested that after LASIK surger, boxing was not an option as the flap could be displaced. Will that flap ever heal completely? I do karate, minimal contact, but think I would prefer PRK. Can you box or do martial arts after PRK method or is there no safe combination of contact sports and Laser surgery? A: Masrtial arts after PRK is fine, but I would not recommend Lasik for anyone who expected to get hit in the eye, such as a boxer. Andrew Caster, MD

Email: November 07, 2004 Q: I had a CustomCornea Lasik procedure last Monday (Nov.1) with a very reputable opthalmologist. The procedure went well, and she stated the next morning at post-op that my flaps looked good. But I was still blurry, with some hazing, ghosting, haloing, and light sensitivity. She thought I might have dry eye, and gave me drops with which I have been treating my eyes. To date, the blurriness has persisted, both up close and far away. I still have some haloing, but not as bad, the light sensitivity is gone, and most of the ghosting. There is still some haze. I am a 56 year old female with alot of myopia and astigmatism and an apparently "weird" prescription. I wore hard contacts for 40 years (yipes!) The doctor had me wait over 3 months, without contacts, before she received very close prescription results in the 2 final exams, a month apart. I won't see her for two more weeks, and I realize I can call her office, but I can't wait! I understood up front the complications and the possible need for a second surgery at some point (how long would I have to wait?) I'm fearful that this is the best my vision is going to be. I saw very well with my contacts, but they always made my eyes red and I could never close my eyes for very long. So I opted for the Custom procedure, and was labeled a good candidate. Is it possible I am still healing and the vision will become clearer and better, or are most people usually alot clearer right after surgery? It is very frustrating, as I cannot see well enough to drive. My job requires lots of close paper and computer work all day long. I immediately started working the day after surgery, and I am really struggling, altho my old simple reading glasses help a little. Was that a mistake on my part to start working again so soon? Any feedback from you would be so appreciated - I'm really concerned and am worrying too much! Thank you for your time. Sincerely, Barbara Fuller A: I would hope that your doctor, who is reputable, would have clearly informed you that there is a healing period, more so with Custom Cornea. Your healing doesn't seem very unusual. You should get better over time. Of course, you may need a touch-up, which should not be done usually before 3 months. Andrew Caster, MD

Email: November 07, 2004 Q: I'm 28 and am thinking of having PKK to correct my vision. Is there a concern for patients who have the PRK procedure and want to have children in the future. I heard that during pregnency your hormones change the can cause your vision to change. Is it better to wait till after giving your pregnencies are finished? A: Pregnancy can change your prescription, but only in unusual cases. I would not wait. Andrew Caster, MD

Email: November 08, 2004 Q: how do you treat epithelial ingrowth and what causes it? A: The epithelial ingrowth must be removed, which is accomplished by lifting the flap and wiping it out. We do not know the cause. Andrew Caster, MD

Email: November 09, 2004 Q: hello dear doctor, i'm 28 years old guy and i live in iran.i'm sorry to say that i'm iranian,maybe you think that wow iranian?but you can trust on me! i wanna know can i do lasik surgery at my age?i have nearsightness,i mean i can see everything in near but can't see far.will happen any problem or side-effects for my eyes in future if i do lasik surgery?what's difference between lasik and lasek surgery?which method is the best for my eyes.which clinic or doctor do you know in iran to do that for me? thanks alot and best regards A: You probably can have Lasik. You must find a good doctor. Andrew Caster, MD

Email: November 09, 2004 Q: Hi, I'm just hoping to get another opinion on a concern I have. I'm 25 years old and 6 diopters myopic with about 1 diopter astigmatism. I absolutely hate contacts and have scheduled to have intralasik done (I prefer intralasik over lasik since it "supposedly" is less invasive on your cornea cells especially since I'm so myopic). I have it scheduled to have it done in florida at Dr. Filutowski Cataract and Lasik Institute. They are the only place in florida who actually perform intralasik and not only lasik. But my concern is... I have ALWAYS been told that you should not wear your contacts for 2 entire weeks before the full exam and lasik procedure because I know contacts change the shape of your cornea affecting the prescription so they must be removed for a certain amount of time before having the procedure done. But when I spoke to Dr. Filowtowski's staff they all told me that I do not have to remove my contacts for 2 whole weeks and that 3 days is the new rule they follow and that 3 days is perfectly fine. Are they wrong? That can't be right? I wear soft toric contacts and they told me that I only need to have my contacts out for 3 days before the exam and procedure, BUT I was 100 certain that it must be 2 weeks. Who is correct? Now I am very confused. I'm having the full exam on dec.1 and then the intralasik will be done a week after the exam on dec.7 If I stop wearing my contacts 1 week before the full exam will that be okay? Because I'm going to be out of town and can't wear my glasses before then unfortunately and I don't want to reschedule the intralasik because they don't have anything else available for quite some time. Are you sure 1 week is enough without contacts? They told me 3 days is plenty and now I'm a bit confused. So I fiqure if I do the 1 week thing I will be just fine? Thanks for your time and opinion, Ashley A: I believe that 7-10 days is the minimum, but there is no hard and fast rule. Although intralasik doctors claim that it is better, there is a big difference in opinion regarding this. Andrew Caster, MD

Email: November 09, 2004 Q: I recently had Intralase Allegretto Wave LASIK surgery. I notice that my left eye is crystal clear and my right is at 20-40 5 days post surgery. How long does it normally take before a person knows whether they will need enhancement to bring both eyes nearer to good longterm correction; and is it more difficult to do an enhancement on an Intralase flap? A: It usually takes at least a month. Enhancements can be done easily on intralase flaps. Andrew Caster, MD

Email: November 09, 2004 Q: I have heard that the results of conventional LASIK as far as needing touchup are better than for custom LASIK. I have heard the statistics that 1 in 10 need touchups with conventional whereas 5 in 10 may need touchup with custom. Please give me the statistics. A: For my practice, the percentages of touchups are equal for conventional and Lasik. Andrew Caster, MD

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