Q: Dear Caster, I need an enhancement.Is it safe to cut a new flap? Can the doctor reopen the old flap manually?Thanks. A: Usually you can reopen the old flap, which is preferrable. Andrew Caster, MD

Q: I have a question, that i cant seem to find in studies, that maybe you could help me with. Is it a fact that watching tv in the dark is not good on your eyes and will have an effect on your eyes in the long run, or is it a myth? Please respond by email. Thank you for your time! A: A myth. Andrew Caster, MD

Q: Is there a most benificail age to receive eye correction surgury? Often people over 45 or so seem to need bifocals or reading glasses. Is this change of vision due to aging addressed with LASIK surgury? A: The need for reading glasses is not cured by Lasik, but can be addressed for the appropriate person with monovision. There is no ideal age that is preferable for Lasik. Andrew Caster, MD

Q: 3 weeks post op lasik Nidek laser. right eye perfect 20/20 occasional blur but great. Right eye, some discomfort one week post op eye ached, senstive to light vision 20/25 but blurry, even the big "E" on the chart, still that way- they tell me its still healing should it still be that blurry? A: It can certainly be blurry for several months. Andrew Caster, MD

Q: I was planning to Hongkong to perform lasik surgery. I had pre-lasik exam in 2 hospitals. Unfortunately, the results are rather different. The first hospital (Hongkong Sanatorium and Hospital)(by dr. Ivan)(Aug 10, 2005) Right eye - 12.00 (myopia) - 4.00 (astigmatism) 175 (axis) 539 micron (cornea) Left eye - 9.50 (myopia) - 2.50 (astigmatism) 168 (axis) 538 micron (cornea) The second hospital (St. Paul)(by dr. Ho) (Aug 12, 2005) Right eye - 10.75 (myopia) - 3.00 (astigmatism) 175 (axis) 529 micron (cornea) Left eye - 9.00 (myopia) - 1.50 (astigmatism) 180 (axis) 529 (cornea) Dr. Ivan said I'm not a good candidate because of the corneal thickness and if I keep insisting on having lasik, the quality of my vision will be drop which I might not drive at night because too blurry, glare, or halo. He recommended me to keep wearing RGP contact lenses. While Dr. Ho said, my left eye can perform lasik but not with my right eye. He said, if I'm willing to wait for a while, there will be a new machine arrive, it's called epi-lasik. What I want to ask : 1. Why the prescriptions I have in 2 hospital within 3 days are not the same? 2. Can I actually perform epi-lasik as to dr. Ho's recommendation? 3.Why my vision hasn't stable yet since I'm almost 28 years old this year? (I've already worn eyeglasses since 1st grade of primary school)? Thank you, A: With your high prescription, it is not uncommon to have varying measurements such as this. Hopefully, either doctor would perform more measurements before treating. Your right eye is at the higher range for laser vision correction. It is possible with epi-Lasik or PRK, but you may have more glare or halos than a person with a lower prescription. Andrew Caster, MD

Q: Can u become blind from lasik surgery? A: It is theoretically possible, though I am not aware of any situation in which it has happened. Andrew Caster, MD

Q: I have been diagnosed as a glaucoma suspect. I've done a visual field and HRT and my doctor tells me I'm ok to receive lasik to correct my vision; however, I'm concerned that lasik may aggravate glaucoma. I'm concerned about the high pressure experienced during the surgery. Are there any studies done correlating onset of glaucoma with lasik? Do you recommend lasik surgery? A: There is no proof regarding this, but most Lasik surgeons that I have spoken to believe that it is okay to have Lasik if you are a glaucoma suspect. If you have advanced glaucoma with extensive visual field loss, then Lasik should be avoided. Andrew Caster, MD

Q: I am 49. I have always had a mild nystagmus, am nearsighted, and have an astigmatism. My best vision is achieved looking slightly out the right side. If I had to guess, I would say about 5 degrees or so. At that angle my eyes do not twitch too much. I wore hard contacts for 20 years, and my vision was 20/30 with hard contacts. During the other years when I wore glasses, the best vision correction that I could get was 20/40. The difference in my vision with hard contacts as compared to my vision with glasses was quite noticeable to me. I had LASIK surgery in 2000, and my vision after is 20/40. I would love to get my vision to 20/30, as it was when I wore hard contacts. Why did hard contacts give me better vision than glasses? Someone once told me that it was because I had two problems: (1) bad focal length (near-sighted) and (2) a poor quality, not smooth lens surface. He told me that I had a very bumpy outer eye surface. Glasses only treated problem number one. Hard contacts helped with both problems. If this is true, then I was hoping that PRK might be an option for me to get a better quality "lens surface". Since my LASIK, my eyes are drier than before, but I am able to get by with no eye drops. Any general advise? Any idea if it is worthwhile for me to look into PRK? Thanks. A: I would suggest that you get an opinion in person from a very experienced Lasik/PRK surgeon. It may be possible to further improve your vision. Andrew Caster, MD

Q:  what is the most current or up to date machine for having custion surgery done on your eyes? A: There are several machines that are all current and up to date for custom lasik. These include Alcon LadarVision, Visx, and Bausch and Lomb. Andrew Caster, MD

Q: Which treatment is best for someone whos vision is very farsighted? A: There are several treatments, and this would depend on the exact details of the patient. Lasik, PRK, and natural lens replacement are all options. Andrew Caster, MD