Q:  I will be 39yo in 2 months and am considering LASIK surgery and need advice. Some history: around age of 5 developed OD strabismus [in-turning] for which I was patched. Had the OD strabismus corrected in 1987 but am still left with the amblyopia. The alignment of my eyes is almost perfect. I have significant night halos that are decreased by 90-95 by use of glasses. My RX is OD: +5.75/-2.75/176 and OS: +3.50/-0.50/169. Corneas are 560+mm thick and the "k value" was good enough that no one was concerned about "button holing" the cornea with use of the microkeratome. Pupils dilate up to greater than 9mm [9.3mm if I recall correctly] My questions: 1) is it better to have the flap made by intraLASE technology since I need quite a large flap b/c my surgery occurs on the corneal periphery? 2) What laser? I am concerned over a) optical/treatment zone size, b) transition zone - helps prevent night vision/peripheral light refraction problems and c) beam size - smaller is better correct? Then there is the ability to have a custom wavefront procedure versus standard lasik. I've done research on the Alcon Ladarvision, VISX S4 [IR] and the Allegretto wavefront lasers - I'm sure there are others. What, if any, laser technology will best address my vision correction needs. Lastly, my expectation going into this was to just knock a couple of diopters off [have it equal the left] of my right eye to improve the cosmesis when wearing glasses. Was not really considering having the left eye done. I now realize that the night halos will likely not be improved by the surgery b/c of multiple factors [pupil size, treatment zone limitations, etc. . . ] but will the use of glasses at night [for driving] post-op decrease the halos as they do now? Thank you. A: You could have surgery on the right eye to make it more equal in prescription to the left. It really makes very little difference which technology you use regarding IntraLase or keratome, or the three lasers you mentioned, all of which are very good. It is really more a matter of surgeon preference than some easily measureable difference in quality. My pesonal preferences at this time for you would be Alcon LadarVision with the Bausch and Lomb keratome. I would recommend that you focus your attention more on the doctor. That is the all important factor, and there are important differences in quality. Find the best doctor, and then go with his/her recommendations regarding technology. Andrew Caster, MD www. CasterVision.com

Q: If I have myopic with no astigmatism...does this fix my night blindness as well? A: The vision at night after laser vision correction is most often similar to the vision before the surgery with your glasses or contacts. Andrew Caster, MD www.CasterVision.com

Q: I have decided to have Lasik surgery in 2006 (have already put the money in my flexible spending account) and also want to have an eyebrow lift. At my Lasik consultation, I was told to have the eyebrow lift first by at least 3 months. However, I am not ready to have the eyebrow lift and don't want to rush into the surgery. Will it be a problem if I have Lasik first and then later have the eyebrow lift? A: It should not be a problem. Andrew Caster, MD www.CasterVision.com

Q: Back in 2001 I wanted to get lasik. I went in for the testing and the first thing the Dr. did was looked at my previous surgical scars. He told me that keloid formers are not eligible for surgical corrective procedures. Is this still a problem or are there alternatives? Today, I am wearing glasses due to the frustration with contacts not working with my active lifestyle (swim,ski,etc.). A: The more current information is that Lasik is not a problem for keloid formers. Many doctors are not aware of the newer information. Andrew Caster, MD www.CasterVision.com

Q: Dear Dr. Caster, I am seriously considering lasik for myself. But I am nervous about the stabilizer put on the eye. How long is this on and is it painful. Thank you Donna B. A: The flap creation takes about 20 seconds. There is a feeling of "pressure", but most people say that it does not hurt. You can also have the "Lasik without the flap'" though the healing pattern is a little slower. Andrew Caster, MD www.castervision.com

Q: I had LASIK in 1998. My vision was great but then started to get worse about a year ago. I also have large pupils and have had night halos since the procedure. Could I have another procedure now to help both problems? A: You can most likely have a procedure to correct the distance vision, which may also help with the night halos. Andrew Caster, MD www. CasterVision.com

Q: I have chosen and scheduled an appointment for an eye care center based on a recommendation. My questions are these: I noticed on one of your previous answers that you recommended against a "low-cost" center, as they will not be as thorough. I didn't have any reservations prior to reading your answer, but now I am a little worried, as the center I will be treated at utilizes advertisements in coupon books and is a lower cost than another local center I had contacted. Specifically, I have been asked to pay $1500 using the Nidek procedure, $2500 for Ladar, and $2900 for Custom Wavefront (all of these prices are for both eyes and are for using a microkeratome). I was opting for the Ladar, as I was recommended against the Nidek due to my astigmatism and pupil size (my pupils are about a 7.5, and my base curve is a 7.52 for the left, 7.50 for the right, with a diameter of 9.50 for both eyes, and a power of -5.50 for both eyes). I am under the impression that price ranges depending upon whom they're quoting and what the prescription is, which I assumed was an industry standard based upon the prescription of the applicant. However, I later contacted a "higher-end" facility that quoted me $2800 per eye regardless of prescription, and it was explained that price is based solely on the technology used. This makes more sense to me, though the price is presently out of my range. Is it in your personal opinion that I should wait until I can afford that higher price with the, presumably, newer technology and equipment and more "thorough" surgeon? In regards to recovery time, and assuming I proceed as planned with the current laser eye center, I am also scheduled to see a play the same evening after getting the surgery. Someone else will be driving; however, I was wondering if sitting in a darkened room would adversely affect my recovery. A: Sitting in a darkened room after surgery will not hurt your eyes; I usually recommend that people go home and rest afterward, but you could go to the play if you feel like it. You will more or less get what you pay for with this surgery. There are cheaper ways and more expensive ways to do the surgery, and genenrally the more expensive ways are better. This is your vision we are talking about, not some consumer item that you will only use for a few years and then replace. So don't scrimp on quality. Andrew Caster, MD www. CasterVision.com

Q:  Dear Doctor, I have had LASIK surgery on 6-March2006 which is about ten days from now. I have been treated from nearsightness and astigmatism as well .In my follow up appointment the day after surgery, the doctor checked my eyes ,the left one was 6/6 the right one was 6/9 and he told my that the right eye will be 6/6 after 10 days at least. I was having a large degree of astigmatism 2.75 on the right and 2.5 on the left and about -1.5 on the left and -1.5 on the right, but after one week I noticed that my right eye is really improving as the doctor said but unfortunately the left eye, which was perfect at the beginning, started not to be that accurate and look a bit hazy and blurry, it also keeps fluctuating when I try to focus on some thing. This was coincide with some thing like jelly suddenly appeared on the white of this eye,so is there any explanation for that or is there a connection between this jelly like spot and the hazy vision on this eye. I am regularly applying my cortisone drops and the artificial tears drops as prescribed by the doctor, so could you please explain what was wrong with my eye? What makes it good at the beginning then start to be blurry like that? Is there a connection between this jelly like stuff on the white of the eye and the blurry vision that coincide mainly with it? Thanks a lot , Amal A: I cannot comment about the jelly, because I cannot see it. But every person heals at a different rate and in a different pattern. If you heal in a pattern that results in some astigmatism, then you may need an enhancement. I would ask your doctor for an explanantion of what is happening. Andrew Caster, MD www.CasterVision.com

Q: Hi, I am researching about LASIK for my 8th grade graduation project. It is a very important project that I need to complete to graduate. I was wondering if you could please help me answer some questions for my project. I would really appreciate it so much!! Below are some questions I really need help on: What positive impact does LASIK have on the society? Who benefits from it? How is it important? What negative impact does it have on society? How will LASIK improve or evolve? Is it being experimented on animals? Thank you so much for your time! I really appreciate it!! From, Brieanne S. A: If you would like to call me, at 310-274-1221, I would be very happy to answer all of your questions. Andrew Caster, MD

Q: I've been wearing contact lenses for about 2 years now and currently my degrees are -4.25 on both eyes. I don't know if thats bad or not and whether I should get lasik surgery or not. I hate wearing ccontacts and just want my vision to be normal again. I am looking into getting lasik surgery but REALLY REALLY afraid that I might become blind as a result. So what are the chances that I might lose my vision permanently and what are the percentage of patients that went blind after surgery? Would you say that Lasik is a very safe procedure? Are the chances of losing vision very high? A: Although over 10 million Lasik procedures have taken place in the United States, I am not personally aware of a single person that has become blind from Lasik. It is theoretically possible, but obviously the chances are very, very low. Andrew Caster, MD www.CasterVision.com