Q:  I had lasik surgery 4 years ago, I'm 49 now. I had my left eye done for distance and the right for reading. The reading eye is now becoming less functional. Can I have it re done for reading again or can it be re done for distance, and I'll just get reading glasses or a contact lense. Melody A: It can probably be adjusted either way: for better distance, or better reading vision. It is your choice. Andrew Caster, MD www.CasterVision.com

Q: I have lasik in my right eye( -3.25 _ -1.25 _ 20) on 3/12/2006 and after that i did have astigmatism = 0.7 so I did enhancement on 4/15/2006. I think it is ok but I still find that as I try to read text it is still not clear and difficult. Is this normal and how do I know that there is nothing wrong this time or that I may have irregular astigmatism or any thing else? A: I like to wait three months before reaching any decisions. The eye is changing as it heals, and it really teakes at least three months before things are usually reasonably stable. Andrew Caster, MD www.CasterVision.com

Q:  I went in for a consultation yesterday to see if I qualified for Lasik surgery. After a few tests were run the surgeon came into the room and told me that I didn't qualify for the surgery. He said that because my eyes are cone shaped instead of round they can't do the surgery. I asked if there were other options and he said that there weren't, and that I would have to wear contacts or glasses for the rest of my life. Can you explain what he meant when he said that my eyes were cone shaped? A: It sounds as if you may have keratoconus. This is a condition in which the tissue of the cornea is weaker than it should be. Thre is no surgery for this condition, unless it becomes severe, and laser vision correction in most cases is not performed. Andrew Caster, MD www.CasterVision.com

Q: My question is - can LASIK harm the endothelium? I have 'endothelial changes' but not Fuch's Dystrophy at the moment. My corneas are healthy. One eye doctor that I have seen (Ultralase, Tottenham Court Road, London) is of the opinion that LASIK can cause the rate of degeneration of the cells in the endothelium to accelerate and will not perform the LASIK procedure on me for that reason. This is also the opinion of Adrian Chorley, the optician at Gatwick AMD. Another eye doctor in Cambridge has advised me that there is no real risk of this happening and said he would be happy to perform the LASIK procedure, leaving me pretty confused. He also diagnosed that my eyes had 'subtle discreet anterior lesions that were not characteristic of Fuch's Dystrophy'. So what do you think? If there is a risk, are you able to give me any idea how much of a risk it is? Many thanks - my career hangs in the balance. A: Patients with Fuchs dystrophy should probably not have the surgery, because the results tend to be slightly unpredictable. Also, people with Fuchs dystrophy who had Lasik can have some additional problems with the Fuchs in the future. But Lasik does not affect the health or degeneration of the endothelium. So other minor irregularities with the endothelium are probably not a risk. Andrew Caster, MD www.CasterVision.com

Q: My Corneal Thickness is 468u. I was told that I would qualify for either CustomVue Lasik or CustomVue PRK. My choice. What do you recommend? Also which procedure would give me better results? A: It really depends on a lot of other factors. With the thinner corneas that you have, unless your prescription is low, I would lean towards PRK. Andrew Caster, MD

Q: My brother had lasik 1 year ago, but complains that his eyes get tired and vision gets blurry after reading or watching t.v. for awhile. Is this normal? A: Your brother should have a re-evaluation to see what his eye status is. Andrew Caster, MD

Q: Would I be better using the "bladeless" lasik technique if I am 62 years old and have a 9 degree of correction. My first interview with a surgeon said my cornea thickness was "average" and he had to do some calculations to see if they could do the procedure (presumably with the blade technique)? I don't have any eye problems other than myopia and small amount of astigmatism. I do, however, have high blood pressure (controlled) and take a blood thinner for Factor V. A: The bladeless technique is better for people with corneas that would be left too thin after Lasik with a flap. This depends on your precise measurements. Andrew Caster, MD

Q: Hello again Dr. Caster, I had asked you about lasik on people with a history of keyloid scarring back about a month ago. Since then I went in to 3 lasik centers in my area and 2 said that keyloid scarring has not been an issue. One center said they didn't have much experience with it but doesn't doubt that I should be fine. Their rational was that I have the benefit of knowing about my keyloid forming problem prior to lasik and with the number of people having this procedure chances are is that other people who do not know they have conditions like mine have had lasik and didn't have problems. Of course I am still concerned because after picking the center for the procedure they have sent me the consent forms. Specifically on there it asks me to disclose any of the following conditions to the surgeon. Specifically on there is - history of keyloid scarring with surgical healing.- My lasik is on May 3rd and I just want a little non financially interested intelligent persons insight on the whole deal. Also, the center I selected indicated that I have Blepheritis and want me to use zylet drops 3 times a day starting 1 week prior to surgery. What do you think? A: Keloid formation originally was felt to be a problem for lasik, but now, as the result of a lot of research, the general opinion is that it is not a problem. On your second question, many centers treat blepharitis prior to performing lasik. Andrew Caster, MD

Q:  I'm 56 years old and my close up vision is fine; I can read the newspaper, work on the computer, see a small TV next to me on the computer desk perfectly with no glasses. I need glasses for driving, seeing signs far while driving, sitting in the movie theater, watching TV across the room etc. I wore 1 contact for years for distance, which gave me mono-vision and that worked for awhile. But now I feel 'off' or crosseyed if I try to read a label in the store, sign a receipt. My eyes don't vocus well with 1 contact. So I was wondering if Lasik would work for me and if so, would having both eyes done, would it impair my close up vision. Or if I had only one eye done Lasik, would that throw me off like wearing one contact. Thanks in advance and have a good week! Sharon A: Having monovision with lasik is similar to having monovision with contacts. If you are 56 years old and have your distance vision corrected in both eyes, then you will need reading glasses. Andrew Caster, MD

Q: What does 20/60 binocular mean? Thanks. A: At 20 feet, a person with 20/60 vision can see the size 60 letters, which are three times as tall as the letters in 20/20 vision, which is considered perfect. Andrew Caster, MD