Q: Is Intralase Lasik surgery the only one that does not use a blade? I've been researching and trying to find a good doctor that doesn't charge more than $3,000, but the charge for the intralase surgery by one doctor is $4,590 for both eyes. Am I looking at the wrong method for the price I can afford or at the wrong doctor in terms of affordable prices? Another doctor charges $3000 for both eyes using the LADARvision excimer Laser System. Does the LADARvision use a microkeratome blade to cut a flap or is that one also done by laser? Thank you for your time. A: You can have PRK (or its cousin LASEK) which does not use a flap, but takes much longer to heal and generally costs about the same as Lasik. The flap is made either with a keratome or with the IntraLase -- there is really very little difference. Andrew Caster, MD www.castervision.com

Q: My pupil size is 7.28mm in one and 7.78 in the other eye. My no is -2.5 D sphere with - 0.25 cylinder. Corneal thickness is 596 microns. Is my pupil size a relative contraindication to Lasik (wavefront) A: It is a relative contraindication, but a minor one. The more problematic combination is large pupil and large nearsightedness, which you do not have. We treate people like you commonly, with the undrstanding that you are more at risk of having greater halos than a person with smaller pupils. Of course, you probably have greater halos now because of your larger pupils. Andrew Caster, MD Caster Eye Center

Q: Hi, I just wanted to know the estimated number of people who had the Lasik eye surgery in 2004? Is it growing more popular? A: It is estimated that 1.4 million procedures were performed in the United States in 2004. The number is growing. Andrew Caster, MD www.castervision.com

Q: I have a lazy eye. Is lasik surgery possible on people with lazy eye? A: It depends on the degreee of laziness. YOu will need to be examined by a Lasik specialist. Andrew Caster, MD Caster Eye Center

Q: I had Lasik performed about 5 years ago to correct nearsightedness in both eyes. A few months after the procedure, I had a revision performed on my right eye. The eye was over-corrected which led to both farsightedness and nearsightedness. In addition, I had epithelial cell growth so the doctor had the re-lift the flap to remove the excess cells. I am now 35 and the vision in my right eye seems to be getting worse. Both my close and distance vision are getting blurrier especially in dim light. I was originally told that four re-lifts was a maximum that should be done due to the possibility of wrinkling of the flap and other possible complications. Keeping in mind that I also had excess epithelial cell growth, what would you recommend I do to "fix' the vision in my right eye? A: There is no absolute limit on re-lifts. I would suggest that you see an experienced Lasik surgeon who can examine your eyes and then give an opinion. Andrew Caster, MD www.castervision.com

Q: I am 77 and although I have good eyes generally and only a minor vision correction in my bifocals, the fact remains that my near or reading vision simply isn't good enough in my reading prescription. I am a PhD and need to do a lot of reading - but I simply can't get a good enough focus for periods of extended reading by way of my bifocals.. Dr. Henry A: You need to get a throurough eye examination, and possibly a better pair of glasses. Whatever is holding up your vision needs to be addressed. Andrew Caster, MD

Q: I had lasik May 27, 2005. I was very nearsighted -10. The Alegretto Wave was used. The surgeon said the goal was 20/15. After the surgery, on Day 2 my vison was perfect. It has been bad since. I had the surgery out of town, so my follow ups are with a doctor near me in Florence AL. 6 days after surgery he said he thinks I have DLK (but that it isn't like the DLK he has seen before) he increased the steroid drops to every 3 hours. At 10 days after the surgery, (last Monday) he said my eyes look better but it isn't gone, he decreased the the drops to 4 times a day. He said I was 20/20 with both eyes. I told him that everything is very blurry and he told me to forget about how I saw before. That does not sound good. I am so sad. My vision has gotten even worse since Monday. The Dr. who did the surgery hasn't looked at the information about me that was faxed to him yet and I have called twice. My vision is VERY VERY blurry, & hazy. I would like your opinion. My question is do you know of any cases similar to mine where a person's vision has gotten alot better with no blurriness? If so, do you know how long it took for that to happen? PLEASE TELL ME SOMETHING. Is there any chance this will resolve or can be fixed? I deeply regret that I have done this.At this point, I'd do anything if I could put those glasses back on. Thank you so much, Marcia A: I would not panic, but I would go to an experienced Lasik surgeon to obtain a second opinion about your current care. What is done now can be very imnportant to how your vision turns out. If you have to travel to get the opinion, then that is what you have to do. Andrew Caster, MD www.castervision.com

Q:  Hi, sorry for the length of q. but I recently had my LASIK eligibility exam, and was told that I am a borderline patient. I'm 31y.o and -4.00 in both eyes. The "red flag" in my case was due to symmetrical problems in my left eye, with the topographical irregularities in the bottom half of the cornea being much greater than the top. Though I hadn¿t worn contact lenses for 2 and a half weeks, initially she thought that it may be due to lens wear and asked me to come back in another 3 lens-free weeks, which I did, but the symmetry hadn¿t changed, (-42 vs. ¿32, I think). The surgeon believed that this shape of my eye would lead to a condition know as ¿aktasia¿ / ¿ektesia¿ (spelling?), and that within 2 years of LASIK, my vision would deteriorate, as if the structure of the eye could not support LASIK. Otherwise, I fell within normal parameters (corneal thickness, pupil size, etc). She also said that if the situation had of being reversed, i.e. top being greater than the bottom, than it wouldn¿t be a problem. Does any of this make sense to you, and does the deterioration of vision mentioned include a loss of Best Corrected Vision? Any advice, or suggestions of other procedures that might be apt in my case? Thanks, Robert. A: I agree with your surgeon. Lasik may not be best for you. Some people with this situation are having PRK, but the long term risks have not been determined. Andrew Caster, MD www.castervision.com

Q: My sister had RK surgery on her left eye that didn't heal properly in 1995 or there abouts. A week ago she had cataract surgery in that same eye and the Dr. stitched the cornea stretching it to try and improve the vision she see's double with lines streaking down with distortion. He wants to do another surgery doing the same procedure in another direction. Her map photo's are looking worse than before the surgery. My question is: Is there another procedure that is more compatible with her condition. It seems like he is experimenting and i don't have a good feeling about it and neither does she. A: I would suggest that you get a second opinion from an experienced RK and Lasik surgeon. Andrew Caster, MD www.castervision.com

Q: I am 30Yrs. old and would like to have lasik Vision Surgery.I don't know which one to choice between "Bausch&Lomb 217Z - Zyoptix"and "Schwind-Corwave / ORK-Cam Lasik". please advise me if there is any other better alternative for the above. Thank you. Khalid Al Zubaidi. A: Pick the best doctor and then go with his or her advice. The doctor uses the machine and is the most important factor. Andrew Caster, MD www.castervision.com