Q: I got an eye exam and the doctor said that I needed glasses but I hate glasses and I told my parents I will never wear glasses and I won't. Is there anyway I can get contacts without wearing glasses first? A: Contact lens wearers should always have glasses as a backup. Also, you need to be old enough and have a certain level of maturity to handle contacts, because if not handled properly, serious (vision threatening) infections can occur. Andrew Caster, MD www.CasterVision.com

Q: Several years ago I had cataract surgery on my right eye. However, with my astigmatism, I still need glasses for reading, driving, computer. I used to wear mono contact lenses. My left eye was my reading eye. I need to have my left eye cataract removed now. My doctor suggested I get lasik in the right eye to correct my vision there and get the bifocal intraocular lense in the left eye. If I do this, which should I get done first? I love to read, and don't want to be unable to do this between the surgeries. There would also be the problem/expense of new glasses between the surgeries. Currently, I still wear my old near sighted contact lense in my left eye and wear progressive lenses, with both the right and left eye corrections as the left correction in the contact alone is not enough power any more. Do you know of any websites or internet bulletin boards where I could talk to people who have had the surgery (ies) so as to hear of their recommendations and experiences? Thank you A: You could treat either eye first. I usually follow the rule of treating the worse eye first, which sounds like your cataract eye. Andrew Caster, MD www.CasterVision.com

Q: Dear Dr. Caster, Does the flap completely heal after custom lasik? Do you ever have to worry that it might becomes loose? Thanks. A: Theoretically, the flap could be moved with extreme trauma. After the first few months, this would be very rare. I have heard that a car airbag dislodged one flap (it also caused other extreme damage to the eye) and I have heard of a professional hockey player who was struck in the eye with a puck and it dislodged the flap. Then the flap must be smoothed back into place. Andrew Caster, MD www.CasterVision.com

Q: Hi, I'm 21 years old and wanted to get LASIK surgery but my friends have been telling me to wait until my eyes fully mature. My vision has gotten worse every year so would it be useless to have LASIK done and have my eyes get worse the next year? A: Lasik will not stop the eyes from changing, so you want to wait until your eyes have stopped changing before you have the procedure. It usually happens by the late teens or early twenties. Andrew Caster, MD www.CasterVision.com

Q:  I am 26 years old with healthy retinas but a 487/476 corneal thickness, 5.2/ 5.8 pupil size and a -9.00 prescription. I realize that this does not make me an ideal candidate for LASIK but I have gotten several different opinions on which surgery would be the best for me. Almost all surgeons recommended Wavefront (one doctor told me that with my prescription it may not make a difference). I have also had disagreement on the procedure with some saying I could do LASIK because Wavefront saves corneal tissue. Other doctors have recommended LASEK or PRK. Which would be the best for me? Also, research I have done indicated that PRK is best for mild/moderate myopia only. Is this a consideration as well? Thank you in advance for your help. A: For most laser systems, wavefront uses more tissue; that may be different with the Bausch and Lomb system. There is disagreement about the minimum tissue that must be left with a PRK technique. You may or may not have enough tissue. I would not recommend Lasik with your measurements. The more correction that is required, the greater the variability and hence the higher the enhancement rate and side effect rate. Andrew Caster, MD www.CasterVision.com

Q:  I have an 8 year old daughter that has astigmatism in her right eye more than the left eye. When I took her to the eye doctor this year, he said it got worse from last year. Her eye vision is 70/35. They prescribe glasses but then the doctor tells me they put only half the prescription because she is too small for the whole prescription. Can you please help me and give me advice or somewhere I can take her. She has full medical, and we live in the Indio, CA area. My fear is my daughter is getting worse fast and she tells me, why can't I see right. I don't know how to explain to her, shes so little. A: I would recommend that you find a pediatric ophthalmologist. There certainly is one somewhere in the Coachella valley where you live. Andrew Caster, MD www.CasterVision.com

Q: I'm 25 and thinking about having Lasik. My prescription was stable for a year until this past November, when it worsened in each eye by only .25. I also work in front of a computer screen all day. Am I still a good candidate? Will my vision deteriate after lasik due to computer work? A: 0.25 change is considered minimal and would not prevent you from having Lasik. We do not know what causes the eye to become more nearsighted. Some people who work a lot at computers do become a little more nearsighted, but the vast majority do not. Andrew Caster, MD www.CasterVision.com

Q: Hi, I have myopia -9.0 in left and -8 in right, I'm 27 after 3 years now my left eye increased from -8 to -9 and also my doctor says I have a dry eye. I'm a computer professional, working about 9-10 hrs in computer per day. Can I go for lasik. Is it safe to work in computers after lasik, how long should I wait before I can start working. (My dad has Cataracts, Glaucoma) I do my eye tests regularly every year and I have only myopia. Can you suggest whether lasik is safe for me and is it safe since I'm a computer professional and need to work at least 9 hrs with computer after lasik. Kaandy A: There is nothing you have said that indicates that you cannot have lasik. You may choose to wait another year to see if your eyes have stopped changing. Most people go back to work the next day after lasik, but I would work only a few hours during the first few days; you want to be careful that your eyes stay moist. Andrew Caster, MD www.CasterVision.com

Q: Dear Dr. Caster, I would like to ask one question about the vision surgery: the surgeon I have asked has told me to wear eyeglasses for one month before doing the corneal measurement (since I am wearing contact lens (soft) all day long. Does the contact lens modify the thickness of the cornea? Thank you in advance and best regards, Dan A: The contact lens can cause minor changes, temporarily, in the thickness and in the curvature of the cornea. Andrew Caster, MD www.CasterVision.com

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