Q: How important is the technology for your Lasik surgery? A: There are several important components for a successful Lasik treatment, and the technology used is clearly a critical part. The technology has improved significantly since the earliest days of laser vision correction. Even with the older technology, excellent results were obtained. But the newer technology helps us to treat a wider range of patients with fewer side effects. Wavefront (also known as custom) treatment is probably the biggest improvement in Lasik technology, and I would recommend that you only consider having a treatment using wavefront technology. Wavefront is a method of measuring irregularities in the vision cannot be corrected using glasses or contact lenses. By adjusting for these irregularities, vision can be obtained that surpasses the vision with glasses or contact lenses. Wavefront technology is more important in situations with higher levels of vision abnormalities, so some doctors say that it is not worth the extra expense in patients with lower levels of vision impairment. I take a different view: I would like the best outcome possible for all of my patients, so I only perform laser eye surgery using the custom, wavefront technology. Newer testing technology has also contributed to better Lasik. Approximately one in 2,000 people have a genetically weak cornea, a condition known as keratoconus. Patients with this tendency can have unusual results from Lasik treatment, so we want to identify these people before we perform the treatment. There are several newer technologies that enable us to detect those people who might have early stages of this condition. Of course, no technology is useful without its proper application. Here is where the doctor cannot be replaced. I cannot stress enough the importance of the training, experience, and judgment of the doctor. It is the doctor who selects the technology, the doctor who decides which technology to use for which patient, and the doctor who is responsible for programming the equipment with the specific treatment for each individual patient. Judgment is critical if the technology is to be used to obtain the best possible results.

Q: Teen Lasik: I am under 18 years old. Can I have Lasik? A: The short answer is: yes, you can have laser vision correction, but it might be better to wait a few years. One of the key points to understand about laser eye surgery is that it will not stop the eyes from undergoing naturally occurring, age-related changes. So Lasik can completely correct the vision, but if the eyes are still changing, then they will change whether or not you have Lasik. Obviously, the vision will not be very bad if the eyes undergo a small change after they have been corrected, but in such a case they will no longer be perfect, and a repeat Lasik treatment might then be a good idea. In cases of nearsightedness, which is the most common vision problem, the vision typically worsens for 5-10 years, and then stabilizes. The age at which it starts to get bad, and the age at which it stabilizes, varies from person to person. For some people, the vision will stabilize at age 16, but for others it is not until the early or even mid-twenties. If we know that your vision has stopped changing for a year or two, then it has most likely stopped changing for good. If this is the case at age 17, then you can have Lasik and most likely will not need further treatment in the future. But it might be better to wait a few more years, at least until after age 18, just to be sure. The other negative to having laser vision correction below the age of 18 involves the issue of keratoconus, which is a genetic condition in which the cornea is weak. This condition typically begins to appear in the teenage years or early twenties. The younger we perform the Lasik treatment, the more likely that a person might have the genetic component and develop this rare condition after we have performed the Lasik treatment, and we would prefer to know beforehand whether the person has this weak cornea condition. Typically, there are subtle signs of this condition by the age of 18 or so. Approximately 1 in 2,000 people have this condition. Although it runs in families, there are many cases without a family history. Of course, if the vision changes after the Lasik treatment, then a touchup can be performed if desired (unless you have the weak cornea, keratoconus condition). Some sports, such as waterpolo, really cannot be performed with glasses or contact lenses, so some athletes less than 18 will have laser eye surgery for this reason.

Q: Lasik for over 50 year olds. What are the differences for Lasik for those under 50 and those over 50? A: The laser vision correction procedure is the same for those of us under 50 years old and for those of us over 50. However, there are important differences that must be understood. The most significant difference is the issue of “old eyes”, or presbyopia. Presbyopia is the farsightedness of what is now middle age that affects every person around the age of 45. The exact age that people begin to notice these age-related problems does vary, with some beginning as early as 40 years of age and others not noticing until age 50, but it is important to understand that this middle age farsightedness affects everyone eventually. Presbyopia is a loss of the ability to adjust the focus from far to near. So, if your eyes are naturally adjusted for distance, you will begin to notice problems with small print up close. Likewise, if you wear glasses or contact lenses to adjust the vision for distance, with your distance correction on you will begin to have problems with fine near vision. Laser eye surgery cannot correct this age-related farsightedness. So, if we adjust the eyes for far, a person over 50 will need reading glasses. Usually, these are the magnifying glasses that you can buy cheaply from the drug store. Alternatively, a person can elect to have blended vision, also known as monovision. With blended vision, one eye is adjusted for near vision and one eye is adjusted for distance vision. Many people use contact lenses to achieve blended vision, and the same can be achieved with laser eye treatment. A simple in-office test will determine if blended vision is appropriate for you. For some patients over 50, particularly those with a great amount of farsightedness or those with cataracts, laser eye surgery might not be the best option. Another technique, in which the crystalline lens inside the eye is removed and replaced, might be a better choice. This surgery is the same as a cataract removal. It is more involved that Lasik, but is still very easy for the patient with a very quick recovery.

Q: Which lasers do you consider the most advanced for Lasik? A: The two top FDA approved lasers are the Alcon Wavelight Allegretto and the Visx S4. Both of these lasers give excellent results. Both use the custom, wavefront techniques. We have both of these lasers for use at the Caster Eye Center. However, even though both lasers are excellent, we still strongly believe that the Alcon Wavelight Allegretto laser is the better choice in most situations. The results with the Allegretto laser treatment are just a little better than with the Visx laser. The retouch rate with the Allegretto is very, very low -- lower than with the Visx. It is difficult to compare touchup rates between different doctors, because different doctors have different standards for performing a touch-up. However, almost all doctors who use both lasers find they have a lower touchup rate with the Allegretto. The Allegretto laser is also better in the subtle but important aspect of night vision side effects. All people, whether or not they have laser eye surgery, have small halos around bright lights in the dark. When you demonstrate to any person who has not had Lasik the small softness of the edges of bright lights in the dark, they typically remark that this is just how they have always seen. Whereas the Visx and most other lasers will make these halos a little worse after Lasik, the Allegretto laser on average improves the halos to be better than before Lasik. In fact, the Allegretto laser is the only FDA approved laser that actually improves the natural halos and makes them on average less prominent. This is one of the main reasons why we prefer the Allegretto laser over all others.

Q:  I just had LASIK done a week ago on Jan 8. My right eye is 20/20 but my left eye remains a little blurry. Will that improve with time or should I call my LASIK surgeon for a check up? How long does it take for one's new vision to stabilize? Thank you, Renu R. A: I would wait until your next scheduled appointment. If you are concerned, you can go in earlier for an exam. I would not be worried. It will probably get better, or an enhancement can be performed. Andrew Caster, MD

Q: Hi Doctor Caster, I am currently a college student who is on his way to becoming a Marine officer. It's always been my dream to be a pilot and fly - but my eyesight is not quite up to par (it's around 20/40 from what I've been told, nearsighted, with a refraction of -3.50 and I believe -4.00 in the other eye). I've heard that the Navy has a study program for individuals who want to get PRK/LASIK and I was wondering what the risks of the surgery are. I was also wondering if you have heard of anyone in my same position, or operated on someone who had wanted to become a pilot. It would be helpful if you knew anything about the Navy's program - but general information on the surgery is just fine too. Thanks. A: It is important that you obtain information from the Navy directly, because they are continually changing the details. Lasik and PRK have been permitted by the Navy. For details about the risks, etc. please review our website, www.castervision.com. Andrew Caster, MD

Q: Hello, I have a question regarding LASIK eye surgery. I really want to get my eyes corrected, as I hate wearing glasses. I wore contacts for about 5 years and suddenly one day had a lot of trouble with itchy and uncomfortable eyes and have since been wearing glasses. I've been to numerous optometrists and none of them have been able to find contacts that don't irritate my eyes or tell me what the problem is. My current optometrist diagnosed me with dry eyes and said I would probably have to continue with eye drops for the rest of my life. My eyes only get really dry when I use computers for long periods of time. In your opinion, could I ever be a candidate for eye surgery. How would you go about fixing the dry eye problem? Thanks very much, anything you can tell me would be great! Jennifer A: There are many medications that can be very helpful with dry eye. Patients with dry eye can have laser eye surgery. For some, Lasik will be better, and for some, Lasik without a flap (Advanced Surface Treatment) is preferable. Andrew Caster, MD

Q: I had the Lasik (flap and zap) procedure in June of 2002. I had -7.50 in one eye and -8.00 in the other. My surgeon at UCSD, Dr. Schanzlin, indicated I would more than likely need a follow-up procedure. Is it safe to have another one 5 years later? If so which would be the best kind to have? I have astigmatism, but no other cornea issues. I have noticed my vision has changed in the past 2 years. What would the best option be for me? A: The best option is probably Lasik or Lasik without a flap (Advance Surface Treatment). this would depend on your exact measurements. Andrew Caster, MD

Q:  Is there anyway someone could be put to sleep when this is done. My kid has this eye thing and it makes him sick when people play with there eyes. People always tease him because they put there finger on there eye and he throws up. Thanks! A: No you must be awake. However, you can be medicated fairly heavily, which takes away a great deal of the fear. Andrew Caster, MD

Q:  I had LASIK surgery on Aug. 2004 at age 50. I was told that if it wasn't successful, a revision was guaranteed. Within 1 year my vision was the same as pre-op. & the surgeon said a revision was possible but chances were fair that it could do more harm than good but the decision was ultimately up to me. Given those odds I chose not to revise & I believe that the original guarantee is moot & I should receive a refund. Do you agree? Thanx! A: This is an issue between you and your doctor. Andrew Caster, MD