Q: Dr, Castor, I chose your name since I live in Southern California when not on assignment as I presently am in KC, Mo. My questions, 1. I have a lot of astigmatism with +5.75 cylinder in the right eye & +4.25 in the lefteye, sphere is -2.5 R & 3.25 L. I see 20/20 with glasses. Can I expect to have the majority of my astigmatism removed with one surgery or is it likely I will need an enhancement procedure done? 2. If enhancement is needed, would the enhancement surgery be more or less risky than the first? 3. Given the above parameters, would I be a good candidate for wavefront lasik? 4. If enhancement is needed, how long between surgeries is required? Would I or should I wear glasses between the initial surgery & the enhancement? 5. Is there a limit to the number of enhancements that can safely be made? Please advise, Thanks, Jay Rackley jay.rackley@siemens.com A: It is necessary to exam you to determine more factors before a definite answer can be given, but it does appear that you are a candidate for Lasik. Wavefront is not currently available for your prescription, and even if available, may not be the best choice for that prescription. Most likely, you will not need an enhancement, though it is possible. Most people waiting for an enhancement do not use glasses in the meantime. Usually, it is best to wait 3-6 months before getting an enhancement. Enhancements involve less risk that primary surgeries, and the number is based on the thickness of the cornea. Andrew Caster, MD Caster Eye Center www.castervision.com

Q: 51 yr. male with previous RK who is now experiencing farsightedness. Can LASIK be used to correct vision in this case. A: Yes. Lasik will help the hyperopia type of farsightedness, but not the presbyopia type. Monovision Lasik is a possibility. Andrew Caster, MD www.castervision.com

Q: Thank you for helping out. My sister is coming to the US, and wants to get LASIK done there a month before she comes here. I believe that she needs a 3-month checkup. How much will this cost, roughly, at your center? A: It would be best if you would give us a call at 800-444-5241. Andrew Caster, MD Caster Eye Center www.castervision.com

Q: I just went to the Doctor's office and they told me that since my eyes are at 490 and 486 respectivly I would only need to do PRK and not lasiK. He said lasic if basically for people with 530 or better. Is that correct? A: There is disagreement regarding this. For some doctors 500 or 530 may be the lower limit. For others, 450 or 480 is the lower limit. It also depends on the amount of correction that you require. Thre is no accepted answer regarding this. Andrew Caster, MD www.castervision.com

Q: as me doctor has said my eyes are: od = 1.25 - 0.75 / 165 os = 1.5 - 1.75 / 175 I want to know whether to undergo LASIK or LASEK?? A: Either would be a possibility. Andrew Caster, MD www.castervision.com

Q: At what age do you have to be to get the Custom LASIK? A:  You can have the Custom Lasik at the same age that you can have the conventional Lasik. We like to wait until your eyes stop changing, which is usually after 18 years of age. Andrew Caster, MD www.castervision.com

Q: it is better that you email me but my name is justing barton and i am thinking about getting prk done and i was just wondering how soon after the surgery should i be able to drive and my prescription in both eyes are -2.50 if you can give me a probable answer i would apprecitate it A: For PRK, probably around 7-10days. 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

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:  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