Email: November 17, 2004 Q: I had radial keratotomy about 10 years ago. My distance and near vision have deteriorated to the point that I wonder if I am a candidate for Lasik now. Is it possible to do Lasik once I've had RK? A: Yes. Andrew Caster, MD

Email: November 17, 2004 Q: I just had the LASIK. The doctor told me to use an eye drop called B.S.S. for the next 3 months. What is it? Can I stop using it after a month? A: BSS is a salt solution. Other artificial tear solutions may be even better. Andrew Caster, MD

Email: November 19, 2004 Q: I just had an eye exam at a local lasik plus office. I was surprised to find out that I have a large pupil (7 for one eye.7.2 for the other); and my cornea thickness is less than ideal which is less than 540mm. Mine is 527mm for both eyes (also unusual). My prescription strength is 5.25 for both eyes. My eyes are healthy. No issues on the texture of my front and back cornea. And I am 40 years old. Should I still go for LASIK surgery? Unfortunately, the surgeon did not examine me. They have another eye doctor do the examination but he does not do surgery. He recommends the Bausch & Lomb laser treatment, or Wavefront (custom). I am not sure I am a good candidate based on my large pupil size and cornea thickness. Plus I am 40. I will appreciate your opinion on my case. Thanks a lot. A: I would suggest that you go to a higher quality center, where you will be examined by the surgeon and where you can have a discussiion with the surgeon. This is not a situation to cut corners to save money. Andrew Caster, MD

Email: November 19, 2004 Q: Hi, I am facing a dilemma as to which Lasik surgery to have. One clinic says I'm a candidate for Wavefront Lasik (one reason being I have a thicker cornea) but they use the traditional microkeratome method. Another clinic says they will use the new Intralase machine but will do a normal Lasik surgery since they haven't seen any added benefit from doing Wavefront surgery. My eyes are about -2.5 and -4 with only a little astigmatism. I have been wearing soft contact lenses for many years and although I'm told my eyes are not producing enough tears, I haven't felt much discomfort as yet. Can you advice which one would be better for me? I worry about the diminished night vision which I hear can be a problem after surgery. Thank you in advance for a very prompt answer since I am booked for surgery immediately! A: Wavefront can produce better night vision results. Personally, I am not convinced that there is any benefit from the IntraLase, and I do not recommend it. Andrew Caster, MD

Email: November 20, 2004 Q: Can a person with lazy eye syndrome go for lasik surgery to correct near or far sightedness? Thank you. A: Yes, if the lazy eye is only a little "lazy". Andrew Caster, MD

Email: November 20, 2004 Q: I had LASIK surgery on both eyes on 11/11/04. Today is 11/19/04. My origional Rx for both eyes prior to surgery was -3.25. I had monovision done as I had worn monovision contacts in both eyes for a year and had no problems. My surgery was on a Thursday and on Saturday my vision, in both eyes deteriorated to the point that I called the Dr. and was examined that evening. I was told I had some inflammation and a slight haze over the cornea and that 1 out of 10 patients have this problem after LASIX. My Econopred Plus 1 was increased to every 2 hours for the next 2 days. My near vision is good and I don't have a problem with it but my far vision is blurry. I had to go back again and be refracted so I could get some glasses so I could drive. My Rx is now a -0.50 in the Rt. eye and a -1.25 in the Lt. I am concerned that this will not improve. This is creating a great deal of anxiety for me as when wake in the morning I can see very clearly in the morning for about an hour but then my vision will slowly worsen. What information can you give me about this and is there anything to do except wait like the Dr.'s are telling me? Thank you. Gwynn Cox A: You need to wait, and you may need an enhancement to get the ideal distance vision. Andrew Caster, MD

Email: November 21, 2004 Q: i had lasik surgery 11-15-04. my vision is somewhat foggy but my biggest concern is letters on tv, freeways signs, reading material are very blurry and this makes me very anxious. is this normal? my eyesight was near sighted and i had astigmatism, left eye twice as bad as right eye. the people at the eye center tell me it will take 3-4 months for my vision to clear. my doctor said i will need reading glasses because of my age - 58.iam fine with reading glasses, but this blurry vision hasn't improved in one week.iam kind of 'freaking out'.please advise A: You should have been advised that it can take 3-6 months for the vision to stabilize. If it is not ideal at that time, an enhnacement is needed. Andrew Caster, MD

Email: November 21, 2004 Q: Hello Doctor, I have been told that I am a candidate for the Lasik procedure eventhough I am stable glaucoma(candidate?) however, I would prefer the Intralasa instead of the custom lasik since it creates the flap with the laser instead of the blade. I have been told that it is better with the keratome for me. Is this true? Also, I have been told that I would not be entitled to the lifetime correction guarantee even though I am told I am a good candidate. My question is should my quote be lower if I am not entitled to the lifetime guarantee?? I understand that in future if I were not to be considered a good candidate, even with the guarantee, I would not exercize that option but I want the choice. Please advise me if these policies vary with surgeon?? Thanks A: I don't think that IntraLase has an advantage or a disadvantage. As far as the lifetime guarantee, that is a contractual issue. Andrew Caster, MD

Email: November 22, 2004 Q: Whats the best surgery for a nearsighted 21 yr old college student: lasik or lasek? A: It depends. Lasik is more commonly chgosen. Andrew Caster, MD

Email: November 22, 2004 Q: I'm an 18 year old who is interested in PRK. My contact lens prescription is -4.75 in both eyes. Is a procedure a good idea for me, or are there other options? Also, what would be the average cost of such a procedure? A: Lasik is a possibility. Andrew Caster, MD

Email: November 23, 2004 Q: Dear sir How are you I am writing from Mongolia located in the Central Asia. I wear +5 and +5.5 glasses. I would like to make LASIK vision correction. Please send more details. Price, procedures and ETC. Hope to hear from you soon. With best regards A: We do not do Lasik on such a prescription. Andrew Caster, MD

Email: November 23, 2004 Q: Hello, i suffer with severe dry eye syndrome and find it difficult to tolerate contact lenses. i participant in contact sports so glasses are not ideal for me. is there any refractive surgery that i could have that will not make this condition worse? many thanks and kind regards. jessica pickford A: PRK does not make the dryness worse. Lasik can make it worse in some cases. Andrew Caster, MD

Email: November 23, 2004 Q: I live in Bakersfield and have narrowed my search down to 2 doctors. I have a significant astigmastism in both eyes, however I am told I am a "good candidate for LASIX." Which equipment is better for me, LADAR or VIRY II?? Or will the operator truly be dependent on my outcome? Thanks for your input. A: If you are using the newest versions of the LadarVision or the Visx, it does not make much difference. Andrew Caster, MD

Email: November 25, 2004 Q: I had wavefront lasik performed on 11/19/04. At my follow up appt. the next day, my vision was approx. 20/30 although I couldn't see any of the lines clearly and was guessing the letters on the smaller lines - 20/40, 20/30. I still am squinting to read traffic and street signs and cannot see as clearly as my neighbor who is 20/20 or my husband who is also corrected to 20/20. I suspect that my actual vision is really closer to 20/40 or 20/50. The surgery was VERY expensive - done at Duke. Is this the best I can expect? I certainly hope not or I will be disappointed. My visual correction was -2.00 in both eyes with a manifest of -2.25 in both eyes and I was also astigmatic - -1.75 in both eyes. What is your opinion on whether I can expect any more improvement? Thanks. Linda G. A: Your eyes should improve over time. If they do not significantly improve, then an enhancement will be performed to improve your vision. Andrew Caster, MD

Email: November 27, 2004 Q: I have a pretty high level of myopia, which I use lenses and glasses to correct. However, at night I am bothered by double-images of things, especially lights. They're not really halos; more like a mirror image on top of the original...the farther away I am, the greater the separation of images. Is this a corneal aberration, and can any type of Lasik procedure correct it? A: This may be due to astigmatism. You should obtain a consultation. Andrew Caster, MD

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