Q: Have you hear of The Lasik Vision Institute? I am thinking of having lasik surgery there.. I live in San Diego. A: Do your homework. Look for bad reports. Andrew Caster, MD

Q: I am a periodontist and obviously depend on my vision for work. I have been approved for lasik surgery and the custom vue was not rec. due to the correction differences between the two analyses. I would be corrected from -4.37 with custom vue and -5.05 with the other evaluation. My corrected vision is 20/15 at the -5.05. Which is best? Also, I do develop keloids with some abrasions. Is this a big risk for me? A: Keloids are not a problem for Lasik. I would not do the custom vue due to the divergence in measurements. Andrew Caster, MD

Q: I have decided to have a lasik as my vision is v.high ie -10.Is is safe to go for surgery? what is epilasik? which is beter. I have used glasses for 11years, hard lens for 8 years and soft lens for 8years.Is it painful?and how many days rest is required b'coz iam a teacher. A: Lasik can be performed on patients who are -10. Andrew Caster, MD

Q: I've been told that my corneal tissue is very thin. Would this rule me out as a candidate? I was told that the new laser procedures would not work on me but that PRK might be the only option for me. I am nearsighted as well as have significant astimagtism. Will PRK really do me any good? What is the estimated percentage that I might have better vision? A: PRK produces results that are almost as accurate as Lasik. Andrew Caster, MD

Q: I am looking for either CRT or Ortho K doctor in south California Irvine, laguna hills, Aliso Viejo, Mission Veijo, Newport Beach A: I do not have anyone to recommend. Andrew Caster, MD

Q: The Dr. that may do my Lasik uuses the nidek ec5000 and a Visek lasers. Im told I have plenty of "meat" to use. I have a slight astigmutism and prescription is about 2.25 diopters. Which of these 2 lasers would recommend? They say Im to use the Nidek ec5000. What would be, in your opinion, the reason they have special of $750 an eye. My biggest cocern is I do a lot of night driving for my company. Im trying to "get rid" of the glasses, period. I do understand that reading glasses will be a fact of life sooner or later. Are there any machines that are not recommended? Thanks for your help, Mike A: It is cheaper for them to use the Nidek. I would be more concerned about the result than the price. Andrew Caster, MD

Q: When you mention that steeper corneas present a higher risk of flap complications. At what level/measurment do you consider someone to have a steep cornea? A: Some doctors experience difficulties for K readings over 45. Personally, I have not experienced this problem. Andrew Caster, MD

Q: I have a very hard decision to make. My myophia is -9.75. My cornea is 488 and 479 in another. I was told that it is not enough cornea to do the lasik. A couple of doctors said I could do the PRK and one doctor said that I can't do any of the laser procedures, because they do PRK up to -5.00...( if it is more that -5.00 it is a higher risk for complications) one of the doctors said they do PRK up to -12.00. I am planning to go to a couple of more doctors (I am in San Diego), but I really want to see better and my only hope was that laser procedure. Could you please let me know what you think? Have you done PRK for people like me? Thank you so much A: I have done PRK on people like you. The other option is the new Verisyse phakic implant. Andrew Caster, MD

Q: I had Lasik performed in 2001 with a custom laser. Up until that point, my vision was worsening at least every 2-3 years, and i would have to update my prescription. Now my vision is worsening again, to the point that i have to wear glasses. It happened within a matter of a few months. My question is, I know I will have to get an enhancement, but i am nervous about it now. Are there any studies that show the safety of enhancements and the how often they may be performed? I assume i would have to keep getting enhancements every few years. How safe is that? A: As long as there is adequate thickness, you can have repeated enhancements. However, I do not think that it is wise to have any enhacement until your eyes stabilize, which happens in most people by the eary to mid twenties. Andrew Caster, MD

Q: Dr. Caster, I had custom cornea performed 7 months ago on both eyes. Was approximately 20/40 in both eyes with no astygmatism. My left eye is perfect. 20/20 and no complications. The right eye healed to 20/35 and had a slightly ghosted image (slightly lower and to the left of the primary). No nightime issues with the original surgery on the right eye as well. After vision stabilized at 6 months, the surgeon indicated that the right eye had a sligh astygmtism (as a result of the healing process) and it could ve very easily corrected by a "slight" enhancement. I had the enhancement to my right eye done just over 1 month ago. I contact was placed on my eye the day of surgery and at a week (after the contact was removed) I was seeing 20/70. I saw the doctor last week and my vision is 20/20...BUT I have some issues. 1. In high contrast situations...i.e. the banner on the bottom of CNN, or black text on a white sign in the distance...I see a complete second image below the first. I can CLEARLY read both. 2. At night, I see 2+ traffic lights and very streaky tail lights. The double image seems to be the worst on computer monitors and when the room is dark and I am looking at a source of light (TV, sign, etc). Its great that my right eye is 20/20, but the double image is a SIGNIFICANT concern. I asked the surgeon id this will go away and he indicated that he "Hopes so". That concerns me greatly. In your opinion, will this most likely go away as my eye continues to heal or was the enhancement done incorrectly? I thought the custom cornea was supposed to make this less subject to error???? You thoughts and experience would be greatly appeciated. I really don't want to have to do "another" enhancement...especially at $750 each time. Thank you in advance. A: The ghosting will probably get better on its own, but it may require another enhancement. I would wait 5 months more. Andrew Caster, MD