Ask the Eye Surgeon Q&A
Do you have a question about LASIK?
Our panel of LASIK surgeons answered the following questions, so please check here to see if your question about LASIK has already been asked and answered.
To find the questions and answers that will be most helpful to you, please click on one of these subjects:
- Corneal and Pupil Concerns
- Custom LASIK (Wavefront)
- Deciding Which Procedure To Have
- Dry Eyes
- Monovision for Presbyopia
- New Technology
- Risks To Consider
- During LASIK
- After LASIK: Enhancement Surgery
- After LASIK: Vision Problems
- After LASIK: Your Activities and Lifestyle
- Miscellaneous Concerns (Cataracts, Lazy Eye, Glaucoma, Etc.)
Q: Is LASIK eye surgery safe for teens?
A: LASIK is safe for teens, but it is not recommended for most teenagers. It is best to have LASIK only when you have stopped growing and your eyes have stopped changing, which is frequently in the very late teenage years or during your twenties. If you have LASIK before your eyes stop changing, you will need to come back and have further LASIK after your eyes stop changing. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: At what age do you have to be to get custom LASIK?
A: You can have custom LASIK at the same age that you can have conventional LASIK. We like to wait until your eyes stop changing, which is usually after 18 years of age. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: I'm 19 years old, and I have been wearing contact lenses since I was 11. Right now my left eye is 5.25 and right eye is 5.75. I would really like to get laser eye surgery, but would you recommend I wait a few more years because my eyesight might still be changing? Any information is helpful.
A: Your eyes may or may not be changing. If your prescription has been changing, then I would wait. If it has been constant for two years, then you have probably stopped changing. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: Let's say I lived in Michigan and my prescription was -2 and -2.25. Now let's say I was 14 years old and would have to pay for this myself. How much would you figure I'd have to pay for LASIK eye surgery in Michigan with such a low prescription?
- Have questions about dry eye? Submit them to our dry eye expert or find answers to previously submitted questions
- Learn about iLASIK advanced laser vision correction
- This useful, one-stop guide takes you through the LASIK experience before, during and after surgery
- Get relief from dry and irritated eyes with Tears Again Hydrate omega-3 gels
A: The price of LASIK surgery varies at each center. The price usually is dependent on the type of technology used, not on the prescription. LASIK is not FDA-approved for patients under 18, because their eyes typically have not stabilized yet and may continue to change with age. Jon Dishler, MD, Dishler Laser Institute, Denver, Colo.
Corneal and Pupil Concerns
Q: I just went to the doctor's office, and they told me that since my corneal thicknesses are 490 and 486 microns, I would need to do PRK and not LASIK. He said LASIK is 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. There is no one accepted answer regarding this. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: I checked into LASIK surgery, and my doctor said my cornea was too steep, so I was not a good candidate. He said there would be new types of surgery coming out.
I am only a little nearsighted but have developed a terrible glare problem with light. I am fighting these contacts all the time, but they're all I can seem to wear. I also have a couple of floaters in my right eye. Is there any hope of fixing my eyes?
A: First, floaters are due to changes in the vitreous jelly, in the back part of the eye. LASIK will not change this: You will still have floaters after LASIK surgery.
As far as your corneal steepness goes, it is true that steeper corneas present a slightly higher risk of flap complications (excessively thin or buttonholed flaps) when using a traditional blade-based microkeratome.
Laser-created flaps are very useful at essentially eliminating the added risk of having a steep cornea. They will create a precise flap, independent of preoperative corneal curvature.
An alternative to LASIK using the femtosecond laser to make the flap would be PRK, a laser procedure that does not involve the creation of a flap.
The disadvantage of PRK is primarily a slower recovery of vision. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: My pupil size is 7.28mm in one eye and 7.78mm in the other. My prescription is -2.50 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 a large pupil and large nearsightedness, which you do not have. We treat people like you commonly, with the understanding 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, Beverly Hills, Calif.
Q: I will be having my vision corrected with PRK soon. My optometrist told me I am a good candidate for the surgery, with one exception: I have 8.5mm pupils. He measured my pupils with a type of ruler under lower than normal light. He believes that the surgeon will turn me away because of my abnormally large pupils. What is the average ablation zone for the laser platform for PRK? Does having 8.5mm pupils, under lower than normal light, automatically disqualify me? Does the ablation zone even matter? Will wavefront be the cure-all for people with larger pupils?
A: Most recent studies show that pupil size does not correlate with risk of night side effects. Amount of prescription (in diopters), laser treatment zone diameter, and type of treatment (traditional or wavefront) does matter. I would recommend a large (9mm) treatment zone if corneal thickness allows. All the lasers I use will go that large. Wavefront reduces, but does not eliminate, the risk of night vision side effects. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: I had my eyes examined, and the doctor advises me to go with PRK. He said my vision is not all that bad, and when my eyes were dilated they were at -1.25 D. Also, when I had a map done of my eye, he said my corneal thicknesses were at 486 and 494. I hope you understand what I just wrote, and my question is, would you also do the PRK, or would you do LASIK?
A: In patients with thin corneas, I prefer to do LASIK with a laser-created flap. PRK is my second choice. Nothing wrong with PRK if a laser for creating the flap is not available. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: How much does LASIK cost?
A: The procedure costs between $1,000 and $6,000, depending on where you go and exactly what technique is used. I highly recommend that you avoid the low-cost places. Your vision is not a place to cut corners in order to save money. The higher-priced places typically are much more careful and thorough. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Custom LASIK (Wavefront)
Q: At my first consultation I was told that I have 8mm pupils and that they would have to use a custom laser, which would also double the price. Is this custom laser an actual tool for me, or is it just their marketing department trying to get more money out of me?
A: There is disagreement about the effect of larger pupils on night vision after LASIK. Some research suggests that people with larger pupils are more likely to experience night vision issues after LASIK. But other research shows that there is no increase in night vision issues. Custom wavefront definitely produces better night vision on average. For those with a very small correction and possibly those with small pupils, the wavefront custom software may not make much of a difference. But for most people, the custom software will allow for improved night vision. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: I've had the tests and qualified for the LASIK procedure. The doctor said I am an excellent candidate for both the traditional and the custom procedure. The custom is about $1,000 more. Is it worth the extra money? From what I got out of him, he said that neither custom nor traditional can cure night vision problems or halos, and traditional can make it worse, while with custom, it will stay as it is currently. I appreciate any advice you can give me.
A: We usually will advise custom if your level of aberrations is above 0.30. At this level of higher-order aberrations, patients become more symptomatic. If less than 0.30, you will likely not notice much difference. Ask your doctor to show you the amount of aberrations then it will be easier to decide. Vandi Rimer, OD, Dishler Laser Institute, Denver, Colo.
Q: The only advantage I've heard that custom LASIK has over basic LASIK is night vision. I've read that night vision is good immediately after surgery for many custom LASIK patients, but six months out from surgery, basic LASIK patients have the same night vision as custom LASIK patients. So why would I consider the extra expense of custom LASIK when I can just wait for the six months of healing for the same result?
A: Custom LASIK not only addresses the halos and night vision that have been a problem in the past, but also attempts to give patients better vision than they would have with conventional LASIK. It actually takes a fingerprint-like examination of the eye and corrects each eye differently based on the particular eye's own fingerprint. With conventional LASIK, everyone who has the same prescription (e.g., -3.00) gets the same treatment. Steven Nielsen, MD, The Nielsen Eye Center, Quincy, Mass.
Deciding Which Procedure to Have
Q: I was examined for LASIK by a local surgeon and was told I was a good candidate, but I still have questions about its safety. I'm active, swim a lot, hike a lot, and tend to get smacked in the face, not a lot, but sometimes. I'm forever getting hit with a branch, or a plant blows up and spews pollen into my eyes, which stings a lot, by the way. Bugs fly into my eyes, and I'm capable, but clumsy at times.
Does the flap created by the IntraLase laser ever really heal completely? If I go swimming and play on the beach, possibly getting sand in my eyes, or salt water in my eyes, or jetskiing at high speed, will the wind or water reopen the flap? I'd prefer better vision, but not at the risk of the flap opening while doing something strenuous. I often open my eyes without goggles while swimming underwater.
If the flap heals enough to stand that kind of strenuous activity, how long does it take to heal? There is a tropical vacation looming, with opportunities for surfing, scuba diving, horseback riding, hiking, snorkeling and helicopter rides. I would want assurance that surgery wouldn't affect my ability to participate. Are there other vision correction choices for me? I'm mildly nearsighted, around -3 diopters or less, in my 20s with a mild astigmatism. When retreatment was mentioned, they described "reopening the flap" as if it was an open door that didn't seal shut and heal completely.
A: LASIK is a very safe procedure, even for people who lead an active lifestyle. In fact, the army is routinely performing LASIK on personnel who are certainly exposed to many of the possible problems that you describe.
That said, PRK (photorefractive keratectomy) is an excellent alternative. PRK is performed without creating a corneal flap. It is what is referred to as "surface ablation." The major problem with PRK is that the healing period is not as quick as with LASIK. It takes about 36 hours for the cornea to heal, and during that time, vision may be blurred and there is a foreign body sensation.
Some surgeons prefer PRK to LASIK because it alleviates any possible complications from flap formation. For low degrees of myopia, which you seem to have, PRK is definitely an excellent choice and one you should discuss with your surgeon. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
Q: I feel that I would be a good candidate for custom LASIK since I have extreme nearsightedness coupled with astigmatism. However, I am also 45 and now I'm losing my near vision as well. Is there any way to address all of these problems?
A: monovision. Marc Emory Bosem, MD, CorrectVision Laser Institute, Weston, Fla.
Read more Q&As about monovision.
Q: I have been considering LASIK surgery or the phakic IOL. I have myopia with -10.25 in the left eye and -8.00 in the right. I had one doctor suggest phakic IOL. A second doctor suggest LASIK; although I would not have enough cornea left for an enhancement, he felt I was a good candidate if I could deal with a little regression in the left eye somewhat of a monovision. A third surgeon said I did not have enough endothelial cell count in the right eye and was pushing the limit for LASIK and would not do either. I am very confused. Can you help? What would be the possible complications with my high myopia?
A: Only with a detailed knowledge of your corneal shape, corneal thickness, anterior chamber depth, endothelial cell count, pupil size and other factors can I begin to make a specific recommendation. I can say that if you do have LASIK, you should seriously consider having it done with IntraLase to create the flap. The IntraLase laser can very precisely create a very thin flap this will leave as much cornea underneath the flap as possible. This would maximize the chance that you would be able to have a retreatment if necessary. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: I recently visited two LASIK clinics (traditional LASIK and IntraLase LASIK). I qualified for both types of procedures, but I am trying to decide which way to go. The "traditional" clinic does not perform IntraLase. They mentioned that because it is a new technology, very little is known about it. They also stated that the recovery time is longer and I am more likely to see halos or have trouble with night vision. The IntraLase clinic told me how much safer the procedure is and how it better suits the wavefront LASIK because it creates an even flap. In your professional opinion, which would you recommend and why?
Also, the IntraLase clinic does not offer free lifetime adjustments. They offer only one year of adjustments. My regular ophthalmologist told me that it is very rare they would, or even could, go back in to make adjustments. Should this be a consideration?
A: I use both IntraLase and microkeratomes. IntraLase is not new, and much is known about it. The traditional clinic is trying to sell you what they have and dissuade you from going elsewhere. They are giving you misinformation, and this is worrisome when it comes to a surgical practitioner. Halos and glare are no different in microkeratome versus IntraLase, so that is even more misinformation.
Does the IntraLase clinic also offer microkeratome-based surgery? Are there compelling reasons to go with IntraLase (thin cornea, steep or flat cornea, etc.)? For uncomplicated patients, I offer both technologies, but for special cases, I insist on using IntraLase. IntraLase is safer, even for routine cases, but the difference in safety is fairly small.
Your regular ophthalmologist is also misinforming you: Adjustments are done in 5 percent to 10 percent of cases, and unless the cornea is very thin, they are easily done. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: I'm considering LASIK but believe that I may have a slight "dry eye" problem in my left eye only. I wear eyeglasses because contacts never seem to work; my left eye feels blurry and irritated, like the lens is wrinkling or sticking all the time; rewetting drops don't help. I've not been diagnosed with dry eye and have never had any testing for it. I've been told that even if I have a slight dryness problem in my left eye, it should go away two or three weeks after LASIK, to where it was pre-surgery. Can LASIK cause permanent dry eye? If it's just temporary, how long will it last?
A: LASIK can worsen a dry eye problem, which may last several months. The effective way to counteract this problem or to blunt its severity is to use Restasis medicated eye drops twice a day, beginning about a month prior to surgery. If your symptoms abate, you will more than likely do well. Talk to your ophthalmologist about your problem, and be sure to get properly diagnosed. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
Q: Are there any pre-LASIK tests that could determine if I may experience dry eye side effects? I've had trouble finding contacts that don't dry my eyes out, and I wonder if this puts me in an at-risk category.
A: There are no tests that can absolutely tell us if a person will have dry eye after LASIK, but we can get some indication of who is more likely to experience this problem. The most important information has to do with the degree of dry eye before LASIK: Those with severe dry eye who cannot wear contacts and who have dry eye with their glasses are at the highest risk, and should consider PRK or LASEK, which do not increase dry eye. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: My age is 54, and I've used contact lenses for 20 years. My vision is -5.00 diopters. There is some difficulty in using contact lenses due to some dryness in the cornea. I want to treat myopia with LASIK. What is your advice?
A: You need to see a laser vision correction specialist to determine if you are a good candidate. Everything that you have mentioned so far indicates that you are a suitable candidate. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Monovision for Presbyopia
Q: I'm a 51-year-old male with previous RK who is now experiencing farsightedness. Can LASIK be used to correct vision in this case?
Q: What are your thoughts on using LASIK with a monovision outcome in order to correct both nearsightedness and farsightedness?
A: I believe monovision can be a good choice. However, it is important to do a monovision trial, where you are fit with a contact lens to simulate the monovision and determine how you adjust and/or adapt to it, prior to having the surgery. There is a compromise at distance and near when you choose monovision. One eye is clear, and the other eye is blurry at all times. If you can learn to ignore the blurry image and pay attention to only the sharp image, you will be a good candidate. You must realize that the vision will be about 20/25 at distance and 20/30 at near with this technique. We usually advise to get the most optimal vision at distance and near by having both eyes corrected for distance and use reading glasses for near work.
I would advise the contact lens monovision trial for about a month, then see how you adapt and make your choice at that time.
Remember, this is a permanent procedure, and not everyone can have an enhancement if you change your mind and decide against monovision once you have already had the surgery. Choose wisely. Vandi Rimer, OD, Dishler Laser Institute, Denver, Colo.
[Read more about monovision with contact lenses.]
Q: I was wondering about monovision. I am having only one eye done and I'm wondering how common this is. How long usually does it take to get used to this? My eyes are very bad to see from a distance, and I'm worried that I will never get used to something of this nature. Can you give me some history on this procedure?
A: Monovision is very successful. Almost everyone can adapt to it with very little effort. It has been used by people wearing contact lenses for many years, well before LASIK. If you have any reservations, ask your surgeon to simulate monovision with contact lenses for you. This is a very effective demonstration of how well the procedure can work. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
[Read more about monovision with contact lenses.]
Q: Ten years ago (I am now 53), I started needing reading glasses. I do understand that this is normal at this age. I can get by without them, but I do have a little trouble with fine print. Sometimes my arms just don't seem long enough. My vision used to be great even at close range, but alas, no longer. I feel that the use of reading glasses makes me look and feel older than I really am. Is there any way to correct this problem either with surgery or with eye exercises?
A: You have presbyopia, which everyone gets in their mid-40s. Eye exercises do not help. Monovision with contact lenses or surgery (LASIK or CK) is the solution for many people. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: If you do monovision correction and make one eye 20/20 for distance and the other 20/60 or something for reading, what happens to midrange vision? For example, three to ten feet away, reading someone's name tag or looking at books on a shelf in a bookstore?
A: It depends on exactly how much residual myopia the patient's near eye is left with, how much presbyopia they have, how small the print is that they are looking at and how well their brain adapts to monovision. In any case, the midrange vision would be better with monovision than without it. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: Is there much difference between the mechanical microkeratome and the new laser machines when creating the flap?
A: Yes. The difference is greater for some patients than others. Some patients present a higher than average risk of flap complications when a mechanical microkeratome is used. These situations include patients with very flat or very steeply curved corneas, patients with high astigmatism and patients with thin corneas.
In all patients, I have seen a reduced risk of dry eye postop with the laser (IntraLase and others) than with mechanical keratomes. I, along with other surgeons, also have seen a slight improvement in visual outcomes when using the laser.
In my opinion, the only downside to the IntraLase is the increased cost of the procedure to the patient. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Risks To Consider
Q: I suffered a traumatic injury to one eye when I was 7 (now I'm 45), resulting in blindness in that eye. I am myopic with a slight degree of astigmatism in the other eye; correction is with a gas permeable contact lens. Your website's self-evaluation indicates that I could be a candidate for LASIK or a LASIK-type procedure. Understandably, having only one eye to play with, I am very interested in risk. What do you think?
A: LASIK is a highly successful procedure; however, like all surgery, it is not without the potential for complications. As a general rule, I try to dissuade patients with only one eye from having LASIK. If the patient has good motivation and understands the potential for problems, and there are absolutely no contraindications, then LASIK is an option. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
Q: I've been wearing glasses. It has been fine for eight years, but recently I'm having some type of skin problem. I can no longer wear glasses because my glasses irritate my nose and the sides of my face, leaving some ugly marks on my nose and the sides of my face. I have not tried contacts or laser surgery. I'm afraid of having contacts getting stuck behind my eyelids and having to go though surgery to get them out, as well as having to take them off and on to clean them. I heard that laser surgery is not perfect and has some side effects, such as people can't drive at night and people getting eye infections. I'm wondering: what are my other choices, or which choice is good for me?!
A: To determine what procedure would be best for you would require a comprehensive eye examination. Most patients do best with LASIK, but there are other procedures available as well. Even with LASIK, there are different types of techniques and lasers available.
The risk of night vision problems generally is low, and depends on your starting prescription, the laser being used and the type of LASIK being done (traditional or wavefront-guided). For years, people thought pupil size was critical in predicting risk of night side effects, but several recent large studies show this is actually not the case. Usually, the risk is less than 5 percent. The risk of getting an infection with LASIK is extremely small (perhaps one in 10,000 cases or less) and is on a par with the risk of getting an infection by wearing contact lenses. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: Is double vision a possible complication following LASIK surgery? If so, can it be corrected?
A: Yes, rarely that can occur. It depends on what the cause is. Sometimes it can be corrected, sometimes not. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: Through a diligent review of all available materials on LASIK, I have found some conflicting information regarding autoimmune diseases and eligibility for the procedure. I am 41 and nearsighted (-5 and -7), with no signs of presbyopia. Five years ago, I was diagnosed with "possible systemic lupus." I have had three elective surgical procedures without any healing problems, and I have not experienced any lupus "flares" since this diagnosis. Every six months I'm evaluated by my rheumatologist, who continues to tell me that I am very healthy despite having some of the symptoms for lupus. My sister (with the same symptoms for "possible lupus" from the same original rheumatologist) had bilateral LASIK nine months ago without any complications or healing problems.
I would like to know if I would be a candidate for LASIK. And if I am not a candidate, then please elaborate on this. Currently, I am completely dependent on my glasses and would be extremely happy with 20/40 or 20/60 vision results.
A: I perform surgery on lupus patients if they are not actively flaring up. In the early days of PRK there was thinking that autoimmune patients might have a higher risk of inflammation in the cornea postop, which could lead to complications. This stigma "stuck" with LASIK and, in my opinion, is unwarranted. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: I had RK surgery 20 years ago and I'm now farsighted in both eyes (+2.5). Can PRK give me 20/20 again? I was told I'm not a good candidate for LASIK my RK cuts are too deep.
A: PRK or LASIK after RK is a more difficult procedure, but one can achieve 20/20. Marc Emory Bosem, MD, CorrectVision Laser Institute, Weston, Fla.
Q: I had a bad blade RK in 1987 with an allergic reaction to gentamycin. The result was +7.00 diopters with 4.00 cylinder. I had a "purse string" redo and follow-ups. Can wavefront with PRK work, to just burn it down to good shape?
A: Your vision probably could be substantially improved through PRK, with or without wavefront. However, a complete correction is unlikely. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: Are you put to sleep for the wavefront surgery? How long does the procedure last?
A: You are awake, but you can be mildly sedated with Valium if you desire. Your eye is numbed with eye drops there are no needles. Your eyelids are held open with an instrument, so all you need to do as a patient is relax and stare at a small light. The actual laser time is anywhere from 10 seconds to two minutes, depending on your prescription and on the laser being used.
Most patients find the entire experience quite simple, and easier than a dental cleaning. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
[Read more about the LASIK procedure.]
Q: Is it possible for me to be sedated during the surgery? I can't even put contacts in, and I don't think I'll be able to sit still long enough to have the procedure done.
A: Some doctors use low-dose Valium, but you have to be awake. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
After LASIK: Enhancement Surgery
Q: I'm thinking about LASIK. If I do it and need more than one procedure (my contact lens prescription is -5.25 and -5.75), which I understand is possible, how long do I have to wait between procedures?
A: Most doctors recommend waiting at least three months after LASIK before having an enhancement. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: I had LASIK surgery exactly one week ago. The next day, my vision was 20/20 but pretty blurry. It's still blurry and doesn't seem any different than the day after surgery. I called today, and the doctor's assistant told me to cut back on the artificial tears and that when I end the medicinal drops today I may see improvements. Is this normal? Everyone I've talked to seems to see clearly within a day or two, not a week or more.
A: Hopefully you will continue to improve. If your vision is not satisfactory two or three months out, you may need to have an enhancement surgery. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
[Read more about LASIK results.]
Q: I am seven weeks post-op. Is it too early for an enhancement in one eye?
A: You should wait at least three months before having an enhancement. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
After LASIK: Vision Problems
Q: After my son had LASIK on his eyes, now the doctor says he has haze, so my son has to do it again. What does that mean?
A: Haze is usually the result of a surface treatment or PRK. Haze after LASIK may be swelling, which is treated medically. I do not know what procedure your son had, so you need to discuss the details with your doctor. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
Q: My 19-year-old daughter had LASIK surgery. It has been four days, and she says she still can't see very well: Things are still blurry, and she can't see at a distance. Is this normal healing, or should we be concerned? We can't get any answers from the doctor's office she went to. They say everyone heals differently, and they will know more on her first week checkup. This is my baby girl, and I am nervous about this whole thing.
A: Her doctor should be much more helpful to you and should explain what is going on. Call and demand that the doctor explain how your daughter is doing. Otherwise, obtain a second opinion with another doctor. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: I had LASIK surgery in 2000 and have had night vision problems like starbursts. I would like to know if I can now have the new custom LASIK done to help me.
A: Custom LASIK can sometimes treat night vision problems, and sometimes they can be helped with drops that constrict your pupil. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
Q: I have had LASIK surgery twice. (I was over-corrected the first time.) I am completely happy with my vision this time; however, my eyes are extremely light sensitive now. I can hardly keep them open while driving. I can barely look at the TV or even the computer screen. Everything seems sooo bright. Will this be temporary? Please say yes. I am going to talk to my eye doctor about it. I mentioned it at my last appointment, but he didn't really address it.
A: Nearly always it is temporary. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: Two weeks ago I had PRK surgery. I now have double or perhaps even triple vision. For example, when driving with my spouse I now see two or three green lights instead of one. Reading is the same. My surgeon says this is temporary and should clear up in a few weeks. I can't find any information on the websites about this problem. Do you feel that this is temporary?
A: It should heal soon. Marc Emory Bosem, MD, CorrectVision Laser Institute, Weston, Fla.
Q: After surgery, should one still need to use glasses, how soon after LASIK can one use contact lenses?
A: If you need glasses, then you have not achieved a full treatment correction. Glasses could be used at any time. Contacts should be avoided for at least six months. You might benefit from an enhancement surgery. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
After LASIK: Your Activities and Lifestyle
Q: Can I box after the LASIK procedure is done and healing is complete?
A: I would not recommend boxing, ever, after LASIK. If you want to box, you should have PRK or LASEK instead. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: After consultation, my doctor told me I'm a great candidate for both PRK and LASIK. I am having trouble deciding which procedure to go with, and my doctor will not make a recommendation on either one. I'm very active in individual sports (non-contact) and am leaning toward the LASIK procedure. In terms of physical activity with sports, is one or the other a "safer" procedure to have?
A: PRK is safer, only due to the fact that if you get poked in the eye with a sharp object (for example, a finger), the flap may become misaligned. But with PRK there is no flap. Otherwise, both procedures are a good choice. However, PRK has a slower recovery process than LASIK. Vandi Rimer, OD, Dishler Laser Institute, Denver, Colo.
Q: I recently had LASIK surgery performed on both eyes due to severe farsightedness and astigmatism. I am traveling via air to Europe next week. Since my surgery was only three weeks ago, is there any need to worry about pressure on my eyes due to the altitude?
A: No. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
Q: I'm 22 and will be going to law school next year. Since I will have to do huge amounts of reading, should I wait to get LASIK until after law school? I'm a good candidate otherwise (4.25 D, no astigmatism). I've just heard that after LASIK it might be more difficult to read large amounts.
A: You should have no problems; it will not affect your reading vision. Steven Nielsen, MD, The Nielsen Eye Center, Quincy, Mass.
Miscellaneous Concerns (Cataracts, Lazy Eye, Glaucoma, Etc.)
Q: How does one request a second opinion? Should I ask my current doctor, or select someone and let my current doctor know that I am seeking a second opinion?
A: Either way is acceptable whatever you feel more comfortable with. It is common for people to get second opinions, so you and your doctor should not feel uncomfortable about it. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: I am 30 years old and would like to have LASIK vision surgery. I don't know which laser to choose: the Bausch + Lomb 217Z Zyoptix or the Schwind-Corwave/ORK-Cam LASIK. Please advise me if there is any other better alternative to the above.
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, Caster Eye Center, Beverly Hills, Calif.
Q: I just wanted to know the estimated number of people who had 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. In 2008 and 2009, the number decreased to around 1 million per year largely as a result of the recession. This still makes LASIK by far the most popular elective surgery in the United States. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: Can LASIK surgery lead to glaucoma? I am now 52 years old. I had LASIK surgery two years ago and a follow-up surgery a year ago. My left eye was corrected for distance and my right eye for reading. I was just diagnosed with open angle glaucoma. My left eye is very bad. My right eye shows evidence of glaucoma but not to the extreme of the left. Could a complication from the LASIK surgery have lead to glaucoma-like symptoms?
A: No, LASIK cannot cause glaucoma. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: If you are developing cataracts, would LASIK surgery be appropriate, or does cataract surgery end up doing what LASIK would accomplish?
A: LASIK surgery would not be appropriate if you are developing cataracts. There are new intraocular lenses that can accomplish the same goal as LASIK and give vision at near and distance without glasses. Sometimes LASIK is used after cataract surgery to "fine tune" the vision. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
Q: If I were to have LASIK now, and I develop cataracts later in life, would I be able to have the cataracts removed, or would there not be enough cornea left?
A: Yes, it is possible. Cataracts are in a different part of the eye. Marc Emory Bosem, MD, CorrectVision Laser Institute, Weston, Fla.
Q: I have been told that I am a good candidate for LASIK. I was hoping to have the procedure done before I become pregnant later this year. Is there any reason to wait until after the pregnancy (it would be my last), as I have heard that in women who are pregnant the eyes may be undergoing changes. I would not get the procedure done during pregnancy but was wondering whether changes to the eye during pregnancy could affect the results of my surgery if I get it done before becoming pregnant?
A: If you are definitely going to get pregnant soon, I would suggest waiting for your pregnancy to be completed. There are changes to the eye that occur quite naturally during pregnancy that could change the results of your LASIK procedure if you were to have it now. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
Q: Why is the very beginning of cataracts a contraindication for LASIK? Is it because the lens would ultimately have to be removed and therefore it is not very practical? Or does it affect the procedure of lens removal/replacement?
A: Corneal refractive surgery, or LASIK, is contraindicated in patients who are developing cataracts because of the changing refraction created by the cataracts. More importantly, removal of the cataract might very well solve the refractive problem and negate the need for LASIK. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
Q: Hello, I have diabetes and I'm considering LASIK. I do not take insulin, and I control my diabetes through diet and exercise. My blood sugar is consistently around 126-130, and the last time my A1C was checked, it was at 6.4. Could I be a good candidate for LASIK?
A: There is no hard and fast rule about LASIK in patients with diabetes. As long as you are not using any medication to control your blood sugar and you have no ocular changes, there is no reason not to have LASIK. Bernard Milstein, MD, The Eye Clinic of Texas, Galveston, Tex.
Q: I have pterygia in both eye. They are not very big and cause me no discomfort at all. They also do not obscure my vision. Are pterygia a problem for laser eye surgery? Would they have to be removed prior to the procedure?
A: No, if they are small and not causing any trouble, they do not present any problems with LASIK. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: I am about to have LASIK soon, but I have a cold. Is it safe to have LASIK done when I have a cold?
A: Yes. Gary Kawesch, MD, Laser Eye Center of Silicon Valley, San Jose, Calif.
Q: I am considering LASIK surgery and I'm looking for some independent advice. A friend of mine who had LASIK can no longer take Advil or ibuprofen without getting puffy all around his eyes. He takes Tylenol without any problems, and his eyes have been great except for this one reaction.
I have also read on the Internet that certain anti-depressants can increase the dry eye effect and accentuate dry eye problems that can result from LASIK. I have taken anti-depressants in the past with positive results. It is possible that I will take them again in the future, so I am a bit worried about this. I also take Propecia for hair loss.
Can you please tell me your opinion on these three meds (Advil, anti-depressants, and Propecia) with respect to LASIK?
A: The problems that your friend is having sound like they are independent of LASIK surgery. Sometimes patients develop allergies to certain medications over time.
It is true that certain anti-depressants make a patient more prone to have dry eyes early in the recovery period, but there are certainly therapies that can be done to relieve the symptoms.
We routinely do LASIK on patients taking all of these meds and have not seen a significant correlation with added risks or longer recovery. Jon Dishler, MD, Dishler Laser Institute, Denver, Colo.
Q: I am considering having LASIK as a graduation present to myself this year. I currently have a prescription of -4.25 and -3.75, and it has been stable for one year. I have some health issues, including severe allergies (I'm off prescription medication), and I have hypothyroidism, which is in the process of being regulated. I also take birth control pills. I am willing to go off of allergy medication and the birth control pills if you believe it would give me a better result for my eyes to adjust to their "normal" state. Also, do you feel I should have my Synthroid at a regulated dose before surgery? I also was hoping that LASIK could help my dry eye (which might be from prescription meds), my inability to wear contacts and my poor night vision. Any suggestions? I am willing to pay extra for the custom procedure. Thank you for any advice!
A: Custom LASIK is great. Get the dry eye medically treated first. Birth control pills or Synthroid are OK to take. Marc Emory Bosem, MD, CorrectVision Laser Institute, Weston, Fla.
Q: My whole family has retinitis pigmentosa: mom, uncles, both my children and myself. Will LASIK help us? Please say it will. I will be the guinea pig.
A: LASIK will have no effect on retinitis pigmentosa (RP). Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
Q: I have a lazy eye. Is LASIK surgery possible on people with lazy eye?
A: It depends on the degree of amblyopia. You will need to be examined by a LASIK specialist. Andrew Caster, MD, Caster Eye Center, Beverly Hills, Calif.
Q: Is LASIK surgery an option for correcting amblyopia (lazy eye)? If not, is there a surgery available?
A: It is an option, but the eye will only see to its best potential, which may be less than 20/20. Marc Michelson, MD, Michelson Laser Vision, Inc., Birmingham, Ala.
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[Page updated April 2010]
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