Ask the LASIK Surgeon
Do you have a question about LASIK? Use the form below to send it to Dr. Andrew Caster.
Dr. Caster dedicates his practice Caster Eye Center in Beverly Hills, Calif. exclusively to laser vision correction. He has been chosen by Los Angeles Magazine as the "Best Laser Eye Surgeon in Los Angeles," chosen by W Magazine as one of two top LASIK surgeons in the United States and voted by other physicians as one of the "Best Doctors in America." He is well known throughout the United States for his achievements in LASIK treatment and has performed more than 30,000 laser vision correction procedures.
Each week Dr. Caster will choose the best questions about LASIK to answer, which will be published on this page. Please remember that some questions can't be answered unless an eye doctor sees your eyes in person.
Please note that only pre-LASIK surgery questions will be considered. If you've already had LASIK and have questions please consult your surgeon. Before submitting your question please review the archived Q&A below to see if your question has already been answered.
To find the Q&As most helpful to you, please click on one of these subjects:
- LASIK and High Myopia, Hyperopia or Astigmatism
- LASIK and Age Limitations
- LASIK and Eye Conditions, Allergies and Other Health Conditions
- LASIK and Presbyopia
- LASIK After Other Eye Procedures, Including Laser Eye Surgery, Cataract Surgery and Corneal Transplant
- Laser Eye Surgery and Pregnancy
- LASIK and Higher Order Aberrations
- LASIK Exam and Preparing for LASIK
- During the LASIK Procedure
- Length of Downtime After Surgery
- LASIK Risks and Complications
- PRK and RK Eye Surgery
- Which Laser Eye Surgery Is Best for Me?
LASIK and High Myopia, Hyperopia or Astigmatism
A: Laser vision correction is not appropriate for all refractive errors, and doctors differ in what they consider the maximum amount of myopia, or nearsightedness, that should be treated.
Some doctors consider -8 D to be the maximum, but in the United States the FDA has approved LASIK to treat up to -12 D.
Some patients with myopia of -10.5 D may choose to have an implantable lens (known as a phakic IOL) placed inside their eye as an alternative to LASIK.
The same complications are possible for a -10.5 D myope as for any other patient undergoing LASIK surgery. However, there will be a higher chance of needing a LASIK enhancement a second, fine-tuning procedure to obtain the best possible vision. Dr. Caster
Q: I have hyperopia (farsightedness) of +6.5 D in my right eye and +7 D in my left eye. Also, I have a "lazy" left eye from childhood. Can you advise whether I'd be a suitable candidate for LASIK surgery? And does my lazy eye prevent the surgery? S.
A: I would advise against having LASIK surgery in your particular situation. The maximum amount of hyperopia that is approved for LASIK treatment by the FDA is +6 D, but many doctors choose +3 or +4 D as the maximum they treat. Some of the laser machines are a little better than others at treating the +4 to +6 range.
Depending on your age, refractive lens exchange, or clear lens replacement, may be a suitable surgical alternative.
Lazy eye, referred to medically as amblyopia, can prevent a person from being a LASIK candidate, but it depends on the degree of "laziness." Dr. Caster
Q: I have farsightedness, with +6.5 D in my left eye and +2.0 D in my right eye. The research I've done up till now says that I am not a candidate for LASIK. I want your expert opinion on that. Is there any kind of laser surgery that can treat +6.5 D and help me get rid of glasses? A.
A: A prescription of +6.5 D is beyond the range that can be corrected with LASIK. For some people in this range of farsightedness, a clear lens extraction may be a viable option. I recommend that you look into that option. Dr. Caster
Q: I have -4.25 D of astigmatism in my right eye, while my left eye is perfect. I went for a consultation, and my corneas are of very good thickness and well shaped for surgery.
However, my doctor told me that I was borderline for the procedure since my astigmatism was so high. Even if I have the surgery, my right eye will not be nearly as good as my left eye and might have to go through an additional surgery.
On the Internet I was reading that LASIK can be used to treat astigmatism up to 6.00 D, and some people report perfect results after one surgery. What is your expert opinion? A.M.
A: LASIK can treat up to six diopters of astigmatism, depending on the technology used. Dr. Caster
Q: I have worn glasses with a prescription of -7 D for the past 13 years. Would LASIK surgery be safe for me? My eye doctor has screened me for LASIK using the Allegretto wavefront-guided laser. I'm concerned that LASIK surgery may affect my professional life (I am a software engineer) and night vision. K.J.
A: Your situation is well within the range that the Allegretto technology system is used for, and with excellent results. Night vision can be adversely affected during the initial healing period (up to three months), but thereafter night vision is typically better than it was with glasses or contact lenses. Dr. Caster
Q: Can laser surgery produce a farsighted outcome? My left eye is -0.25/-1.75 and my right is +1.50/-0.25. I would like to match my left to my right, while also removing any astigmatism in both. Is this possible? E.S.
A: Yes, laser vision correction can correct nearsightedness or farsightedness, as well as astigmatism associated with either. So your eyes could be matched. Dr. Caster
Q: I am 20 years old and I have a high congenital myopia of -11 D. Am I a suitable candidate for LASIK surgery? Will I develop a cataract due to this surgery? J.
A: You may or may not be a candidate, depending on a host of other factors. A consultation is needed with your eye surgeon. Dr. Caster
Q: I have astigmatism. Can I still have LASIK surgery? T.
A: Yes, LASIK is very good at correcting astigmatism. Dr. Caster
Q: I have farsighted astigmatism in both eyes. My left eye is considerably better than my right eye; my right eye can't read very well unless the font is really large. Is this because of the astigmatism or something else?
If I were to get LASIK eye surgery, would my eyes be "balanced," i.e., would this bring my right eye up to the same level as my left? M.
A: If the right eye is healthy, correcting the farsighted astigmatism would improve the vision, presumably to the level of the other eye. Dr. Caster
Q: Can LASIK eye surgery correct astigmatism, or would eyeglasses still be needed? T.B.
A: LASIK corrects astigmatism. Most people who have LASIK have some astigmatism and they do not wear distance glasses or contact lenses afterwards. Dr. Caster
Q: I am legally blind in my left eye. Is it possible for LASIK surgery to help with getting my vision somewhat able to see out of that eye? I do wear glasses at this time and have a cataract in my right eye. S.D.
A: Legal blindness means that even with the best glasses or contacts an eye cannot see better than 20/200. Many people do not use this term properly. If, however, the eye is legally blind in this accurate sense, then LASIK cannot help. Dr. Caster
LASIK and Age Limitations
Q: I am 15 years old. Could I get LASIK eye surgery? Why is LASIK not performed in younger children? L.
A: We want to wait until the eyes stop changing before performing LASIK. Otherwise, if the eyes are still progressing into greater nearsightedness, the patient will be back in glasses. Typically, the eyes stop changing by the later teenage years. Dr. Caster
Q: I am 74 years old and nearsighted. Am I too old for LASIK? J.S.
A: You are not physically too old. As they say, you are psychologically as old as you feel. Dr. Caster
Q: I'm 45 years old. Is it worth getting LASIK? Are there long-term effects? R.
A: It is worth getting LASIK if you want to be able to function without distance glasses or contact lenses. Of course, an individual evaluation is needed. Consideration is needed regarding your upcoming presbyopia, which means loss of near vision associated with age, and which occurs whether or not you have LASIK. Dr. Caster
Q: I am 77 and in excellent heath, with just the beginning of cataracts. Assuming I can have whatever cataract treatment I need beforehand, would my age preclude me from LASIK surgery? My current lens prescription is: SPH +0.75, CYL -1.00, AXI 105, ADD +2.75; SPH +1.00, CYL -1.00, AXI 105, ADD +2.75. R.C.
A: Your age does not preclude you from LASIK, should it be needed after your cataract treatment. Dr. Caster
Q: What is the oldest age at which I could consider LASIK surgery? Also, would it be advisable if had beginning cataracts? A.W.
A: Generally, if your diabetes is stable, your glasses or contact lens prescription is stable and your eyes are healthy, then you can have laser vision correction. Dr. Caster
Q: I'm 18, and I've had glasses since I was in kindergarten. I don't mind wearing my glasses I look fine. I don't always want to, but they're needed. I've worn contacts before, but they're truly not for me. In essence, what is the exact age most eyes stop developing, because I would LOVE to have LASIK surgery. A.M.
A: For most people who have nearsighted eyes, their vision will stop worsening sometime between the ages of 16 and 22. Once the eyes stop worsening, they typically remain stable. We want to see two years of stability to feel comfortable that the growth phase is over. Dr. Caster
Q: My 3-year-old son has amblyopia and esotropia. Is he or will he be a candidate for LASIK? Also, at what age is the earliest that we are able to perform LASIK surgery if he is a candidate? A.
A: LASIK will not cure amblyopia or esotropia. If the amblyopia is severe, then LASIK is not indicated at all. The youngest age is typically around 18. Dr. Caster
Q: I plan on having LASIK surgery when I turn 18, but I'm also enlisting in the Marines. Will my improved vision after LASIK be permanent? C.
A: LASIK does not stop the eyes from undergoing naturally occurring changes in the future. Most people who are nearsighted do not undergo much change after the age of 18, but some certainly do.
That is why most doctors will want the patient to have stable vision for one to two years before having LASIK, because those people are less likely to change afterward. If your eyes do change a little in the future, then you can have another LASIK treatment if you want to. Dr. Caster
Q: Would you recommend LASIK surgery when I turn 18? I'm currently 14 and wear bifocals. The prescription for my glasses, if I'm correct, are 2.5 top and 2.75 bottom. If my number doesn't change for two years, could I undergo LASIK? J.
A: We would, of course, have to see what your eyes are like when you are 18. But that might be a good time for treatment. Dr. Caster
Q: I have only been wearing glasses for two years. I am a 27-year-old female in active duty military. Would you recommend getting PRK or LASIK surgery so soon? L.H.
A: I would recommend waiting at least another two years, to be sure that your vision has stabilized. Dr. Caster
Q: Can you perform LASIK surgery on a 6-year-old child? What are the possible complications that may result? A.M.
A: Laser vision correction is now being used in younger children on a very limited basis only for certain specific medical reasons.
In general, it is not used in people less than the later teenage years or early 20s because vision often does not stabilize until that stage in life. The other issue with younger children is cooperation, both during the treatment and recovery period. Dr. Caster
Q: I am 15 years old and my eyes have been stable at -4.25 D (left) and -4.50 D (right) for the past three years. Am I a good candidate for LASIK? K.
A: I would recommend waiting until you are 18 years old, which is the age that the FDA has set as its minimum approved age. It is not necessary to follow the FDA approved age limit, but I think it is wise to wait. Dr. Caster
Q: I am 64 years old. Am I still a candidate for LASIK surgery? I have heard that at my age I will still need glasses to read up-close. J.G.
A: Sixty-four is not too old for LASIK! (What would the Beatles have thought? They could have included a line about LASIK in their song, "When I'm 64.")
You can have both eyes adjusted for distance, and use reading glasses, or have one eye adjusted for distance and one for up-close reading. Dr. Caster
Q: Are there any risks at the age of 57 with LASIK surgery? I am nearsighted, with healthy eyes. W.M.
A: Your risks are the same as any other patient. The serious risks are exceedingly small. The more common risks include the need for a LASIK enhancement, temporary dryness and temporary increase in night halos. Dr. Caster
Q: I am interested in getting LASIK; however, the prescription in my left eye has yet to stabilize. It has been changing by 0.25 D every year for five years now. First, is it possible that my prescription in that eye will never stabilize? Second, I have heard/read that some eye surgeons are willing to do the procedure if your prescription has only been slightly changing. Is this true and, if so, how likely is the procedure to be successful? A.D.M.
A: LASIK will not stop the eyes from changing. So if your eyes change in the future, after your treatment, you will become a little nearsighted again. This can, of course, be corrected with another LASIK treatment. Typically, the eyes do stop changing, most commonly in the teenage years or early twenties. Dr. Caster
LASIK and Eye Conditions, Allergies and Other Health Conditions
Q: I was diagnosed with dry eye and minor blepharitis and switched from contacts to glasses. Is it possible to get LASIK surgery under these conditions with positive results? M.P.
A: Yes. Dry eye and minor blepharitis are very common in the general population, and people with these conditions can have LASIK successfully. Very severe dry eye or severe blepharitis requires treatment of the condition before laser treatment and might prevent the laser treatments if the condition is too severe. Dr. Caster
Q: Is a COPD patient at high risk during laser eye surgery? C.R.
A: You must be able to lie on your back for five minutes in order to have laser eye treatment. Dr. Caster
Q: I was diagnosed with retinitis pigmentosa when I was in the 4th grade. I am now 22 years old. Will PRK or LASIK surgery correct my vision in the same sense contacts or glasses do? With contacts my vision is able to get to 20/ 20 in my left eye and 20/15 in my right. I understand the procedure will not cure my disease, but can I be treated? D.O.
A: The treatment corrects your vision in the same sense that glasses or contacts do. Dr. Caster
Q: I tested positive on the PPD test [tuberculosis skin test]. I don't have TB. I am currently taking INH. Am I a good candidate for LASIK? B.S.
A: INH will not affect the LASIK treatment. Dr. Caster
Q: I have von Willebrand disease, with an associated prolonged APTT (clotting time). When having dental surgery I must have DDAVP to normalize my bleeding risk. Would this be the same for LASIK? Is a bleeding disorder a contraindication for LASIK? S.
A: For people with bleeding disorders such as yours, I recommend the PRK version of laser vision correction. When this variation is used, there is no risk of bleeding. Dr. Caster
Q: This one may be out of left field. Soon after I was born, a tumor grew and attached itself to my right tear duct. When it was removed, the tear duct came with it; therefore, my right eye is chronically dry.
I am a few days short of turning 22, and it has yet to limit me in any way except not being able to wear contacts and enter into the military. Do you believe I could be a candidate for the procedure?
I've been dealing with this for my entire life, so it being dry doesn't faze me one bit. I just dream of one day waking up and not have to grab my glasses, because I almost literally do not know what that's like. A.J.
A: I do not think that laser vision correction is a good option for you. Because of your extreme dryness, there could be difficulty with healing. Dr. Caster
Q: My son was diagnosed with amblyopia, or "lazy eye," at age 7. At no time has he dealt with strabismus (crossed eyes). He patched the affected eye with some improvement, but his vision is still far less than his better eye.
We are investigating LASIK options for him. Is it possible to have a general idea of how effective the outcome of the surgery will be prior to committing to it? K.M.
A: LASIK can correct the amblyopic eye to the same degree that glasses or contacts can correct the vision. Dr. Caster
Q: I have a lazy eye, which I've learned to called amblyopia. I am not able to see straight ahead, but I can see out of my periphery. Do you think that LASIK surgery would help my eye stop wandering? How do I go about finding the right eye doctor/surgeon? J.D.
A: LASIK will not stop your eye from wandering. It does not cure amblyopia. Dr. Caster
Q: I was born with crossed eyes, and had corrective surgery when I was 18 months old.
I've had to wear glasses all my life and I cannot see very well past four to five feet in front of me, besides shapes and blurs. I cannot wear contacts, mainly because I was told I am very sensitive to light, so I have had to wear tinted glasses.
I was thinking of getting LASIK surgery, but not sure I could due to my corrective surgery when I was younger and the severe sensitivity to light i have now. Is it still possible I could have the surgery and it would help my vision and the sensitivity to light? I.M.
A: LASIK would not help your sensitivity to light, but could probably help your vision. An examination by a LASIK specialist is needed. Dr. Caster
Q: I have a lazy eye, and my right eye drifts inwards a bit when I don't wear contact lenses or glasses. Would having LASIK eye surgery produce the same results as wearing glasses or contacts, i.e., no drifting of the right eye occurring? K.M.
A: The eye alignment after LASIK would be similar to the alignment with contacts. Glasses sometimes have prism built into them, which can change the eye alignment in a way that contacts or LASIK do not. Dr. Caster
Q: I've been told I have a scar on my retina. Can LASIK fix the problem with my vision in that eye? I wear glasses, but only need them for the one eye. Would I still need to wear glasses? L.H.
A: LASIK will not repair the scar in the retina, but it can eliminate the need for glasses. I would only recommend LASIK if both eyes with glasses are capable of seeing quite well. Dr. Caster
Q: I have worn contact lenses for years. About two years ago I was diagnosed with blepharitis. Is it ever possible to have LASIK surgery with this condition? Is there a permanent cure for blepharitis? S.M.
A: Blepharitis is not a serious condition. It is sort of like dandruff, which can be an annoyance but is not particularly harmful. There is no cure; it comes and goes over time. But you can certainly still have LASIK surgery. Dr. Caster
Q: I have blepharitis which is completely controlled by daily warm eye compresses. I am 68 years of age. Could I be a candidate for LASIK surgery? A.W.
A: If your blepharitis is under good control, and you are 68 years young, you are a probably a good candidate. Dr. Caster
Q: I've had several cosmetic eye procedures. I was told I have dry eyes, and scar tissue as a result of the dryness. My vision hasn't been worsened by this. Can I still have LASIK surgery? My wish is to not ever wear glasses again. A.E.
A: People with dry eyes can have laser vision correction. Sometimes, the non-flap version is preferable. If dryness is truly severe, no treatment is advised. However, the dryness is often better after laser vision correction than it was with contact lenses, which accentuate dryness. Dr. Caster
Q: If there is a history of glaucoma (mother/aunt/uncle) in my family, is it better for me to have PRK over LASIK surgery, in case I develop glaucoma myself as I get older? M.
A: Neither LASIK nor PRK will impact your development of glaucoma, nor will it influence the treatment of glaucoma. So choose whichever you prefer LASIK or PRK based on other factors. Dr. Caster
Q: I have type 1 diabetes, which is managed with an insulin pump. I know diabetics typically are not candidates for LASIK because of slower healing, but I tend to heal a lot faster than normal, at least with piercings and tattoos. Could it still be possible for me to get LASIK done? H.
A: Many LASIK surgeons will not treat patients with type 1 diabetes. Many others, however, do feel comfortable if the diabetes is well controlled and if there are no significant complications from the diabetes. Dr. Caster
Q: I have coloboma in both eyes. The left eye is more severe; most of my vision is out of the right eye. Currently I have about 20/40 vision. I wear glasses but am able to drive, etc. Would LASIK be an option for me to correct the level of sight I have in the right eye? I have been told not to pursue it from some people, but I want to improve my vision as much as possible and make it easier on me when I am renewing my drivers license. M.K.
A: Coloboma can present a problem for the eye trackers on the lasers. I would want to test your eye on the laser tracker to make sure that the tracker was performing normally before recommending the procedure for you. Dr. Caster
Q: I have several eye allergies (pollen, dust, animal dander, etc) and very easily irritated eyes. I cannot wear my contact lenses longer than a few hours because I get burning and red, bloodshot eyes.
When tested during my LASIK evaluation, my eyes were determined to have only "mild" dryness. Dry eyes can be a possible side effect of LASIK, and I wonder if this would exacerbate my eye irritation.
I would rather walk around with blurry vision than have burning/dry/painful eyes forever so am I still a candidate for LASIK with "mild" dry eyes and multiple allergies that cause eye irritation? T.
A: Eye allergies and eye dryness are different things, though they both can cause irritation. LASIK can sometimes make dry eyes more dry, but if it occurs, typically this is only during the first three months of healing.
Also, many people say that their eyes are much less dry-feeling after LASIK because now they do not use their contacts, which aggravated the dryness feeling. So mild dryness is one of the main reasons many people have LASIK, because the mild dryness makes contact lens use difficult and they are very happy after LASIK.
Try omega-3 fish oil pills for your dryness three pills every morning. It works wonders for dry eyes. Dr. Caster
Q: Is LASIK applicable to albinos? C.A.
A: LASIK can be given to people with albinism of the eyes, to correct the vision as well as glasses or contact lenses can. Dr. Caster
Q: I am thinking about having LASIK but I suffer from migraines. I was told from one doctor that I have to be off my triptans (a kind of medication) for three months because they can affect the shape of the cornea; another doctor said they don't. Who is right? A.
A: Your medication will not affect your lasik treatment. Dr. Caster
LASIK and Presbyopia
Q: I am nearsighted have been since adolescence. I'm 48 years old and now have bifocals, which really hinder me in my work as a maintenance technician. I can never seem to get my head in the right position to see things up close in electrical panels or engine compartments of vehicles, etc. Is there any way to correct my closeup vision? It's really tough to do my job sometimes. M.K.
A: You can correct your distance vision in both eyes, you can correct your near vision in both eyes, or you can (after appropriate testing to determine your suitability) correct one eye for distance and one eye for near. Dr. Caster
Q: I had LASIK three weeks ago and am very pleased with my far vision. However, I am having to use two pairs of glasses: one to see in the middle distance and one for reading. I was offered monovision, and now I regret not choosing it. I am 58. Is it still possible to have monovision surgery for one eye? R.S.
A: Yes, you can have one eye adjusted for midrange or near, as you desire. Dr. Caster
Q: About three months ago I had LASIK surgery that corrected both eyes for distance. I am over 40. Prior to the surgery my near vision was not that bad. Since the surgery I need reading glasses to even read my phone. Is it possible to have an enhancement to create monovision since I have already had the other? T.N.
A: Yes. I feel that this should have been carefully explained to you, and hopefully demonstrated, prior to your first treatment. Make sure any proposed change is carefully demonstrated with glasses before treatment. Dr. Caster
Q: I had LASIK surgery about 13 years ago, and it worked great to correct my nearsightedness. Now I am 47 and need reading glasses. Can I have another LASIK surgery to fix that? J.
A: Yes, you can have a LASIK treatment to fix your near vision. Dr. Caster
Q: I had LASIK about 20 years ago. I am now 64 and wear a contact lens in my right eye for reading. Distance vision in my left eye is not good. Of course I cannot wear a contact lens in that eye because of LASIK-induced flattening. The left eye has astigmatism. Can I get LASIK again? I have no cataract yet in the left eye. S.H.
A: You can most probably have LASIK in both eyes, adjusting one for near and one for far. Dr. Caster
Q: I have 20/20 distance vision but need reading glasses to for up-close tasks. I was told if I get LASIK to correct my near vision, I will have to wear glasses to see far because the corrective surgery will affect my distance vision. Is that true? D.F.
A: That is correct, if you adjust both eyes for reading. However, many people choose blended monovision, in which one eye is adjusted for near vision and one for far (either using contact lenses or laser correction).
This seems strange to many when they first hear about it, but it works very well for a significant portion of the reading glass population. A simple test by your LASIK doctor can determine if this would be right for you. Dr. Caster
Q: I am a 45-year-old woman and underwent LASIK last week to correct my vision (-4.75 D in both eyes). I was able to read and do computer work without glasses before the operation. Now, I have to use +1.50 D glasses for reading and computer work.
I don't want to wear reading glasses. Is there any remedy available, or can I get LASIK again to correct my near vision? H.M.
A: It is too soon to know what your reading vision will be. The near vision after LASIK should end up to be similar to the near vision with your distance glasses on, assuming both eyes were corrected for distance with LASIK. If you are interested in monovision blended vision, you can have one eye adjusted for near and one for far. Dr. Caster
Q: I'm a 57-year-old male in very good health and now wearing -9.00 D (Acuvue Oasis) contact lenses in both eyes. My vision has been very stable for years. I have very mild astigmatism in one eye but not enough to require a contact lens for astigmatism.
I'm considering LASIK surgery, but am concerned that if my eyesight should worsen as I get older I may not be able to have the surgery performed. If my eyesight should worsen, is it still possible to have LASIK performed with the intent to: 1) reduce the power magnification needed of my contact lenses; and 2) to see better when not wearing contact lenses? M.
A: Several factors, such as your corneal thickness, are important. If your corneas are of normal or greater thickness, you should be able to get your eyes corrected with LASIK and not need contact lenses or distance glasses. You will need reading glasses, unless you choose the monovision LASIK option. Dr. Caster
Q: I am 51 years old and have been wearing glasses since I was 14 and contacts since 18. I almost exclusively wear contacts. One eye is at -4.50 D for near and one is -3.25 for distance. Both eyes are BC 8.3 and DIA 14.0. My glasses are just for distance, no bifocals.
My problem is with contacts; I can see pretty well but I don't think it's as clear as it should be either near or far. With my glasses, when I want to read fine print I take off the glasses and can read better than with the contacts, but I have to hold it four to six inches from my eyes.
My doctor says my eyes are very steep. Can corrective surgery make my vision clearer than with contacts? I have no trouble adjusting to both eyes being corrected differently. S.B.
A: Correcting one eye for near and one eye for far is called monovision, or blended vision. Monovision is never as good for near or far as having both eyes adjusted exactly for near or far, as bifocal glasses do. But monovision is great in that you don't have to deal with bifocal glasses. So you could have LASIK treatment to create monovision, but it will probably be similar to your contacts. Oftentimes we can make vision better than with the contacts, but we never want to promise that. Dr. Caster
Q: I had LASIK surgery seven years ago to correct short-sightedness (myopia). Is there an equivalent to correct long-sightedness and do I need to wait until my eyes have been "stable," i.e., my long-sightedness has remained the same for a year, before going ahead with the surgery? A.H.
A: The farsightedness of middle age will continue to worsen as you age, up until age 60 or so. But if you are now using reading glasses you may benefit from monovision laser treatment. You need to be tested to see whether it is appropriate for you. Dr. Caster
LASIK After Other Eye Procedures, Including Laser Eye Surgery, Cataract Surgery and Corneal Transplant
Q: I had LASIK surgery approximately 15 years ago. My vision has deteriorated to the point of needing glasses to see at a distance, and my reading glasses have gone from 1.5 to 2.5 diopters. Can I have this corrected by another LASIK treatment? J.C.
A: Lasik should be able to correct your distance vision. Your near vision can be aided by monovision LASIK, if you so choose. Dr. Caster
Q: I had LASIK and then 10 years later I had bilateral cataract surgery. Can I now have LASIK again and would it correct my vision? J.M.
A: Yes, you can have LASIK again after cataract surgery to correct your vision. Dr. Caster
Q: I had LASIK surgery about 10 years ago,which was a wonderful experience. My question is, can I have an enhancement now? After all that time? Would it be safe? My vision seems to be not as good as it once was. B.S.
A: You can have LASIK again. Re-treatments like this, even 10 or 15 years later, are performed commonly. Dr. Caster
A: It is certainly possible to have additional "enhancement" laser eye surgery a second, or if needed, a third time. Dr. Caster
Q: I had RK (radial kerotomy) surgery in 1992. It was very successful, however, in the past year or so I have noticed that my distance vision is poorer in the mornings when I wake. And if I lay down during the day, my vision is poorer when I get up.
Is this a result of RK? Is there anything I can do about it? Can you have LASIK to correct this? D.W.
A: RK, or LASIK for that matter, will not stop the eyes from changing over time. So it is possible that your eyes have changed a little since your original surgery. Fortunately, this can usually be corrected with a LASIK treatment, or with glasses or contacts lenses. Dr. Caster
Q: I had RK in 1993, two surgeries on my right eye and one on the left. In 2004, I had LASIK and it was fine for awhile but my vision has drifted some. Is it safe for me to have another procedure? M.K.
A: The answer is yes, it is probably safe. However, I would recommend that any further treatments be performed on the surface of the eye using PRK laser eye surgery. Your vision will probably continue to drift as a result of the RK treatment. Dr. Caster
Q: I had RK surgery in 1995 and it worked great. As I got older, I needed glasses for reading and have had to revert back to glasses. I have heard that I cannot have any more eye surgeries to correct my eye problems now. Is this true? Can I have eye surgery and correct my vision so I do not have to have glasses? If so, what type of eye surgery am I looking for? B.H.
A: What you have heard is completely wrong. Laser vision correction can be used for people who have had RK. You can choose to have both eyes corrected for distance. If you are over 45, you will need up-close reading glasses. If you are over 45 you may choose to have blended monovision, in which one eye is adjusted for distance and the other for up-close reading. This is based on your desires and testing at the doctor's office. Dr. Caster
Q: I had RK about 25 years ago, but now my vision is starting to blur distance, close up and computer work). Could I be a candidate for LASIK correction now? C.G.
A: Yes. People who had RK in the past can typically have laser vision correction if their eyes have changed over the years. Dr. Caster
Q: If my vision changes after LASIK surgery, can the procedure be performed again? Basically, how many times can surgery be performed if vision keeps changing? J.R.
A: LASIK surgery can almost always be performed again if your eyes change in the future. There is really no limit if there is enough thickness to the cornea. Dr. Caster
Q: I would like to know if you can have LASIK performed more than once. Back in 1999 I had it done and it was wonderful. But about three years later my eyes went bad again. I was thinking about doing it again, but will the results last longer than three years? I am 60 years of age. B.R.
A: Laser vision correction can typically be performed more than once, if needed. Of course, laser vision correction does not stop your eyes from naturally occurring changes such as presbyopia. Dr. Caster
Q: I had LASIK correction approximately 13 years ago. Although my distance vision is still good, my near vision is rapidly getting worse. I wear reading glasses. Can I have LASIK again to try to improve my near vision? I'm 59 years old. J.E.
A: Monovision blended vision works well for many people, and this can be achieved with contact lenses or with LASIK. Dr. Caster
Q: What are the increased risks of having LASIK performed a third time? My mother has had LASIK twice and now needs to go again for a third time. C.C.
A: The risks from a third procedure are no greater, or less, than the risks from the second procedure.
These include infection, epithelial ingrowth (which would require an additional but minor treatment), and problems with the flap. Overall, the chances of a problem are quite low and can be usually easily treated. Dr. Caster
Q: Can you have LASIK surgery for vision correction after having cataract surgery? B.H.
A: Yes, LASIK is often performed after cataract surgery. Dr. Caster
Q: I had bilateral eye surgery when I was 13 years old. Can I still get LASIK? L.
A: Well, it depends on what type of surgery you had. Most likely, you had surgery to straighten your eyes to correct a condition called strabismus (crossed eyes). If so, the answer is yes! Dr. Caster
Q: My son had laser surgery on his eyes when he was one month old for retinopathy due to prematurity. Now he has vision that can only be corrected to 20/40 with glasses and he wants to go into law enforcement. Is he a candidate for LASIK eye surgery? C.K.
A: I would advise against laser eye surgery in this situation. Also, typically with vision corrected to, at best, 20/40 with glasses, he would not qualify for law enforcement even if he had laser eye treatment. Dr. Caster
Q: I had LASIK done on one eye about 12 years ago. I think it's reverting back to double vision. Can this be corrected again? M.J.
A: Most likely, the answer is yes. Dr. Caster
Q: I had corneal replacement surgery more than 10 years ago. Is it possible to get LASIK to improve my vision? K.
A: Yes, LASIK can be performed after corneal transplant if needed. Dr. Caster
Laser Eye Surgery and Pregnancy
Q: I am a 30-year-old female. I had LASIK five years ago and had no trouble until about one year ago, when I had a 50 percent return to baseline vision. I am eligible for the touch-up, but plan to get pregnant this year. Should I wait until after my pregnancy? How will that affect my eligibility for the touch-up? M.
A: In some rare cases, vision can change a little, usually temporarily, during pregnancy. It does not happen very often. In your case, it sounds like your vision may still be changing, so I would recommend waiting for a while to ensure stability before undergoing a touch-up. Dr. Caster
Q: I am about to have LASIK, but I am also going to get pregnant soon. Will the post-operative medicines have any effect on my pregnancy, and are they safe for my baby? Also, will getting pregnant soon after the procedure affect the results? M.
A: The post-op medicines are usually only taken for a week. They are eye drops, and very little gets into your system. However, I always advise women to refrain from treatment if they are currently pregnant. The pregnancy in very rare cases can change the measurements of the eye, though usually only temporarily and typically by only a very small amount. Dr. Caster
Q: I just found out I'm four weeks pregnant and have PRK scheduled for next week. Is it safe for my baby to continue with the surgery? All pre-op is completed. T.S.
A: I would wait until after the baby is born and after you have stopped nursing. Although all the drops and pills used are most likely safe for the baby, it is always better to be cautious and avoid medications that can be avoided in this case, by postponing your treatment. Dr. Caster
Q: I've heard that it's better to have vision correction surgery (LASIK, etc.) after pregnancy because your eyeglass prescription may change. Since I'm planning to become pregnant soon (maybe in six months' time), I'd like to know if it's better to wait until having the baby or if there is no difference at all? Z.E.
A: It is possible for the hormones associated with pregnancy and breast-feeding to change your glasses prescription. Most likely, however, this would be on a temporary basis, because the hormones are temporary.
I have been performing vision correction surgery for a long time, and I cannot remember even a single patient whose prescription changed a significant amount on a permanent basis as a result of pregnancy.
So my advice is: Do not have LASIK surgery if you are pregnant or breast-feeding. But it is okay to have the procedure now, even if you plan to be pregnant in the future. Dr. Caster
Q: Is it true that a woman must wait until she has finished having kids and nursing before getting LASIK surgery? G.W.
A: This is a common misperception. A woman does not have to wait until after having children.
This misperception occurs because of the following: there is a very small percentage of women who will have their prescription change a little bit, usually temporarily, while pregnant or breast-feeding. After the pregnancy and breast-feeding are over, the prescription almost all the time returns to where it was before the pregnancy.
So it is advisable not to have laser vision correction if you are pregnant or breast-feeding, but it is fine before or afterwards. Dr. Caster
Q: I'm 29 years old and have a prescription of -1.75 D in both eyes, plus slight astigmatism. I've been wearing glasses for 12 years and I'm now considering having LASIK surgery. I have no kids yet, but hopefully I will in years to come. What negative effects could I have on my eyes if I was to give birth vaginally? I've heard that the pressure of a natural birth can alter the results of my eye surgery if I get it done before becoming pregnant. Is this true? Should I wait and have my kids and then have LASIK surgery? L.
A: You have been given some misinformation. Labor does not affect the results of LASIK. What can cause an effect, which is almost always temporary and small, is a minor change in your vision due to the hormones of pregnancy. These changes are uncommon and typically temporary, so they should not play any factor in your timing to have LASIK, except that you should avoid having LASIK when you are pregnant or nursing. Dr. Caster
LASIK and Higher Order Aberrations
Q: I have nearsightedness (4.5 and 5.5 D) and astigmatism and have been told that I am a good candidate for all-laser LASIK. I currently see big starbursts around light sources at night while wearing glasses, such as oncoming headlights while driving.
Does the fact that I already have this issue prior to getting LASIK mean that it is more likely that I am going to experience worse or longer lasting starbursts after LASIK?
The clinic that qualified me for LASIK is telling me that none of their patients ever have starbursts for more than 90 days after the procedure since it is all about correct laser calibration and technique, but then I read so many stories about people who have this problem for years or forever. A.
A: The newer technologies will in most cases not make the pre-existing starbursts worse, but they also are unlikely to make them better than they are with your glasses. So you will probably continue to have starbursts after LASIK, most likely similar to how they are now with your glasses.
During the first 90 days they may be worse than you are used to, but they will then most likely revert to your current level of starbursts. Dr. Caster
Q: When I was 17 years old I was hit in the eye with a paintball, which caused scarring to my retina. I currently have some "black spots" where i see nothing, but this doesn't bother me as much as the blurry vision I experience.
Is it possible that LASIK could help smooth the affected areas of my eye so I can see clearly again through my damaged eye? M.D.
A: Unfortunately, LASIK surgery is not able to adjust for scarring problems with the retina. Dr. Caster
Q: Does requiring prism in my glasses make me a bad candidate for LASIK? I'd like to have laser eye correction so I don't have to wear prescription sunglasses. T.
A: LASIK will not correct the need for prism in glasses. If your eyes are not aligned properly and you need prism, strabismus surgery can eliminate the problem. Dr. Caster
LASIK Exam and Preparing for LASIK
Q: Doctor, is it true that one should stop wearing contact lenses at least a year before LASIK surgery? L.B.
A: No. For soft lenses I ask my patients to stay out of the lenses for five days. For gas permeable contact wearers, the time frame is longer: I recommend about two months out of the lenses. However, you can shift into soft lenses during this time and stay out of them for the last five days. Dr. Caster
Q: I had an eye exam to see if I was a good candidate for LASIK, which I am. My eye doctor is charging me $4,000 for custom LASIK since I have a few abnormalities in my left eye but I want to shop around. If I decide to go to another LASIK surgeon, can they use my results from the other doctor or do they have to do another exam? A.M.
A: Each doctor will do his or her own exam. The treatment is not as simple as pointing and shooting the laser. There are a lot of choices that the doctor must make. And the quality of the measurements will affect the quality of your results. So I would not make my decision based on price. Dr. Caster
Q: I have been using contact lenses for the past six years. I want to get LASIK, and my sight has stabilized. So how long before the LASIK procedure should I stop wearing contacts? A.K.
A: It depends on what type of contact lens you are using. For regular soft lenses, three to seven days is recommended (different doctors choose different guidelines). For gas-permeable lenses, usually two months is needed. Dr. Caster
Q: I'm getting LASIK surgery but I'm taking birth control pills called Ortho Tri-Cyclen. Do the pills affect healing after surgery? J.
A: Birth control pills do not affect LASIK healing in any way. Dr. Caster
During the LASIK Procedure
Q: Can laser eye surgery be performed without putting the patient to sleep? C.R.
A: Laser eye surgery is always performed with the patient awake. The treatment takes about five minutes and is virtually painless, so there is no need to put anyone to sleep. Dr. Caster
Q: Can you have LASIK eye surgery under sedation? I have a very big fear of anything going near my eyes and have never even been able to put contact lenses in. E.F.
A: Fear of things near the eyes and difficulty with putting in contact lenses are very common. In fact, this is one of the most common reasons people undergo LASIK because they cannot wear contact lenses and do not want to wear eyeglasses.
Most patients are sedated when they have LASIK treatment. Sedative medications will not put you to sleep, but they will help eliminiate anxiety and make you will feel much calmer and at ease. Sedation makes the LASIK process pretty easy for the patient, even for those who have this common fear. Dr. Caster
Q: Does the patient have to be awake during LASIK surgery? B.B.
A: Yes. But your eye doctor may give you medication beforehand to help you relax, which makes the whole process quite easy. Dr. Caster
Q: I want to get LASIK but I am scared to get it because I know that your eyes are open the entire time. Are you put to sleep before the operation or are you awake for the whole thing? B.
A: LASIK treatment is very quick, lasting less than five minutes. You are awake, but most doctors give a medication relaxer to decrease patient anxiety. It is scary, because we are treating your eyes, but the treatment is very quick and very easy on the patient. Dr. Caster
Length of Downtime After Surgery
Q: How soon after LASIK surgery is it safe to travel by airplane? Does the air pressure in a plane mean you have to wait a certain amount of time after the surgery? J.F.
A: The air pressure in the plane does not affect the eye after LASIK. You can fly the next day. Dr. Caster
Q: I am 23 years old and want to get LASIK. I am currently working in the hematology department of a hospital lab, which involves a lot of work looking through a microscope. How soon after the surgery would I be allowed to look in a microscope? Also, if I were to get pregnant later in life (say in two years), would this affect my LASIK results? M.
A: Most people can go back to work the next day after LASIK. Pregnancy can sometimes cause a small change in your vision, which is typically temporary. Dr. Caster
LASIK Risks and Complications
Q: My son, aged 30, wants to have this operation. He has, I understand, not very bad eyesight (he wears contacts). I am completely against the operation: If you cannot see, there is little else in life.
Could it be of some benefit if one postponed this operation for two or three years? I understand the wavefront-guided laser has been in operation only 12 months.
Also, would it be advisable to do this operation on one eye and do the other later, hopefully after better methods have been developed? Also, please advise as to who is the best surgeon to do this. F.I.
A: I am not aware of a single case where someone has lost their eyesight after LASIK, though with the millions of cases that have been performed, I would guess that it has happened. So the chance of blindness is very, very, very unlikely.
Wavefront treatment has been available for around 10 years, with many millions of treatments performed.
You will have to determine who you wish to perform the treatment. Dr. Caster
Q: Does LASIK have any long-term complications? E.A.E.
A: Generally, the only significant long-term complication of LASIK is a change in refraction. That is, some people will become nearsighted, farsighted, or astigmatic to a small degree some years after treatment.
LASIK does not stop the eyes from changing. But if there is a change in vision, the degree of nearsightedness, farsightedness or astigmatism will be much less than the original amount, and can typically be corrected with an "enhancement" LASIK treatment. Dr. Caster
Q: I am seriously considering having laser eye surgery done but I am very nervous of the outcome. Are there any cases where a patient went blind by having this procedure done? S.B.
A: I am not aware of any cases where a patient has gone blind from LASIK. If it has occurred, it would obviously be an extremely rare event, and most probably would occur from a severe eye infection that was not properly treated. Dr. Caster
PRK and RK Eye Surgery
Q: How safe is PRK surgery after LASIK? I have had three unsuccessful LASIK procedures and now my doctor is suggesting PRK. P.
A: PRK is often performed as an enhancement to LASIK treatment, especially after several flap-lift treatments that have not resulted in total correction of vision. There are no guarantees of total perfection, but the procedure is very safe and usually gets the job done. The healing process, however, is slower than with LASIK. Dr. Caster
Q: Am I correct to assume that the major drawback of PRK is the longer recuperation after surgery? I've noticed you can never do wavefront PRK now. Healing time aside, isn't PRK a better solution? I don't mind having a longer healing period if it means best results in the end, i.e., no risk of flap complications. E.
A: The results from PRK and LASIK are the same, except for specific situations that can generally be determined ahead of time. You can certainly perform wavefront with PRK. The main difference is the significantly longer healing cycle with PRK. Dr. Caster
Q: I had RK back in the early 90s with great success. Unfortunately, now I am experiencing vision fluctuations. My vision is worse in the mornings and gets better later in day. My question is whether there is any chance that my vision will stabilize, or is this how it will be for the rest of my life? Also, is there anything on the horizon for new treatments for post-RK troubles? D.
A: There are treatments in the works, known as corneal cross-linking, that should help people with fluctuations. Dr. Caster
Which Laser Eye Surgery Is Best for Me?
Q: I'm concerned about the effects of altitude (14,000 - 23,000 feet) on eyes corrected with LASIK vs. IntraLase SBK vs. PRK. If it is relevant, my prescription is -8.5, my eyes produce more protein deposits than "normal" (per my eye doctor) and tend to be on the dry side. Soft contacts don't fit my eyes well, and they come out frequently enough that I've decided corrective surgery is necesary for safety during my adventures. K.
A: The lower pressure experienced at high altitudes (I assume you are a mountaineer) does not affect LASIK, PRK or any variations, including IntraLase SBK. At higher altitudes, the air is drier, and of course contact lenses become very difficult. Some people with drier eyes can do better with PRK vs. LASIK or IntraLase SBK, but this is typically during the first three-to-six-month period, and then dryness tends to return to the baseline dryness level experienced with glasses prior to the treatment. Dr. Caster
Q: My eyeglass prescription is around -5.0 D. My cornea thickness is around 550nm, I have flat corneas (K reading of 42) and my pupil diameter is 4.7mm. What type of procedure do you think would be a good option for me: thin-flap LASIK, SBK, phakic IOLs (implantable lenses), refractive lens exchange (RLE) or PRK?
I am worried about halos and dry eyes with thin-flap LASIK due to my flat corneas and retinal issues if I have IOL surgery or RLE. Does thin-flap LASIK reduce the risk for dry eye and halos and poor night vision? I am 42, have moderate dry eyes, but my eyes are otherwise healthy. Any procedures you would lean towards with my eyes? E.
A: PRK might be slightly better for people who have extremely dry eyes prior to treatment. LASIK is appropriate for most people with mild dry eyes. SBK is a form of PRK and is not very commonly performed in my opinion it has no advantages. At your age I would not recommend RLE, and for a -5.00 D I would not recommend phakic IOL. Dr. Caster
Q: The Navy will pay for my LASIK or PRK surgery. I want to be a pilot, and someone told me LASIK disqualifies you for flying. My eyes are approved for both LASIK and PRK, and I was wondering which one would be better for me becoming a pilot. I am 19, my prescription lens glasses haven't changed since I was 16. I am an active duty corpsman, aka combat medic. B.A.
A: You will get the same result from LASIK or PRK. My understanding is that the military is now happy with both LASIK and PRK, but each branch sets its own policy and you should check with the Navy to be 100 percent certain. Dr. Caster
Q: I was a +6 and had LASIK nine years ago. I was left with ghosting, and my doctor said it was caused by dry eye.
I found out two years later that I had a low spot on my cornea. I am now wearing a hard contact lens to flatten my cornea. Could LASIK fix this low spot? W.M.
A: With the current widely used technology, the answer is no. However, there is a newer technology called "topo-" or "topography-guided" that is very promising for your problem.
There are several variations of this technology, so I would wait to see which variation proves to be the best. Dr. Caster
Q: My sight is great after LASIK. My question is, when swimming underwater, my vision is as bad as it was before surgery, even four years later. Is this normal? T.H.
A: Your vision underwater is actually better than before, but only by a little. The human eye is designed to see well in air, not underwater. The optics for an underwater eye are completely different than for an "above the water" eye. A few rare fish who need to see in both environments actually have their eyes divided in two: an upper part to see in the air, and a lower part to see underwater. Dr. Caster
Q: I would like to ask if there are any existing tests or procedures that can be done to examine if laser surgery has been conducted on an individual. In other words, is it possible to find out if someone has had laser surgery if there are no official paper records? B.
A: There are tests that will frequently, but not always, identify a person who has had laser vision correction. If the correction was very small, the tests may not show the treatment. Dr. Caster
[Page updated December 2013]
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