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LASIK Laser Eye Surgery Frequently Asked Questions
Provided by Dr. Andrew Caster


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What are the odds of eliminating my glasses?


Overall, 99% of patients will see well enough without glasses to pass the DMV eye test (20/40), 90% will have 20/25 or better vision without glasses, and 84% will have 20/20 or better vision without glasses. The results are even better with the Custom technology: 99% have 20/25 or better uncorrected vision, and 96% have 20/20 or better vision without glasses or contacts. The general rule is: more accurate results will be obtained in people who require less treatment.


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Does the treatment hurt?


There is only mild discomfort during a laser vision correction procedure, usually less than having your teeth cleaned. During the first few days after treatment, there is only minimal discomfort. Most patients say that everything was much easier than they expected.


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Can I lose much vision from excimer laser treatment? Will I go blind?


This is the most important concern that patients have. None of our patients have ever lost their vision from laser vision correction. Even if it were to occur, the vision could usually be restored by an additional surgical treatment.


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How long will it take to realize my final result?


Every patient heals at a different rate; however, the majority of our patients achieve legal driving vision the very next day. Your vision will continue to improve with the final visual results being realized within a week to a few months.


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When is one technique better than another?


Although Lasik is preferable for most patients, there are many situations in which "Lasik without a flap" is preferable. "Lasik without a flap", also known as Advanced Surface Treatment, Lasek, Epi-Lasik, and PRK, is better for people with very thin corneas, certain corneal diseases, or people who expect to have eye trauma, such as boxers. As specialists in this field, we offer all of these techniques, and we will advise you about which is best for your particular situation.


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Are all lasers the same?


Absolutely not! Dr. Caster uses multiple lasers, and currently has three: WaveLIght Allegretto, Visx S4, and Alcon LadarVision. We obtain the most accurate results with the WaveLight Allegretto. Unlike other lasers, all treatments with the WaveLight Allegretto are Custom treatments. Whereas the Visx and the Alcon LadarVision have enhancement rates around 10%, the enhancement rate with the WaveLight Allegretto is less than half of that - around 4%. Other cheaper lasers, or older versions of these lasers, which are commonly used by discount laser centers, are much less expensive to purchase and use, but do not produce the same level of vision. Also, the maintenance and calibration of the laser are very important in obtaining the optimal treatment result (we calibrate the laser before every treatment -- many centers only calibrate the laser between every 4 treatments, or even just once each day).


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Everyone seems to be talking about Custom treatment. What does this mean?


Custom technology is a major advance in laser vision correction. Glasses and contact lenses correct the eye for nearsightedness, farsightedness, and astigmatism. But the eye has many other imperfections, known as higher order aberrations, which cannot be corrected with glasses or contacts. Custom laser vision correction can treat these additional irregularities of the eye. The result is often vision that is better than can be obtained with glasses or contact lenses, particularly with regard to night vision.


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If I don't get a full correction, will I be able to have a repeat procedure to improve the results?


Approximately 4% of our patients return for an enhancement procedure. These patients have had a dramatic improvement in their vision, but have not achieved a full correction. "Touch-up" procedures are extremely quick and easy, and there is no additional charge if performed within 18 months of the original treatment.


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What about the long-term results? Will my eyes deteriorate in the future?


Excimer laser treatment was first performed in 1988. Lasik is a more accurate variation of ALK, which has been performed for over 25 years, and has been proven safe in long-term studies. Extensive testing has been performed around the world by many different sources and it has been conclusively determined that there are no long-term health problems to the eye from these procedures.


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Are there other procedures or technology on the horizon that I should consider?


There are always new procedures and technologies under investigation. Not everyone is a candidate for Lasik or Custom Lasik. After a thorough evaluation, we will discuss any viable alternative procedures that might be right for your unique visual needs.


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Will I be able to see anything during the procedure?


Yes. During the procedure, you will be asked to look at a light. Seconds after the procedure is completed, you will notice a dramatic improvement in your vision. Many of our patients say that this is one of the most memorable moments in their entire lives.


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What if I move during the procedure? What if there is an earthquake?


Patients worry about this a great deal, and their fear is unnecessary. Everyone moves during the procedure. The Alcon LadarVision laser has an eye tracker, which will follow your eye as it moves 4,000 times per second. Also, we can instantly stop the laser treatment whenever we want.


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What if I blink during the procedure?


The eye is held open by a device known as a retractor, which doesn’t usually hurt.


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Do I need to wear an eye patch after the procedure?


No, but you will be asked to wear protective goggles for the first six nights. Some patients may wear a protective contact lens overnight to promote healing.


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Will scars form from the procedure?


There are only extremely faint scars that cannot be seen except with a microscope.


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Will the treatment cause cataracts, or influence the treatment of cataracts?


Laser vision correction does not cause cataracts and does not affect the removal of cataracts.


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If I don't get a full correction, will I be able to wear contacts after the treatment?


Very rarely, patients do not get a full correction and will want to wear contact lenses. The general rule is: if you could wear contact lenses before the procedure, then you should be able to wear them afterwards.


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Is it better to treat both eyes at the same time, or each eye on different days?


This is entirely up to the patient, as it depends to a large degree upon your schedule and what makes you feel most comfortable. Patients having Lasik usually see very well the day after the procedure, and most choose to have both eyes treated on the same day. Patients having "Lasik without a flap" heal more slowly, so some of these patients choose to have the treatments on separate days.


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Am I a good candidate for laser vision correction?


Some people should definitely not have excimer laser surgery. These include:

- People who are very happy wearing glasses or contact lenses. They have no need for the procedure.
- People under 18 years old. Their nearsightedness is probably still increasing.
- People whose refraction is significantly changing. Refractions often continue to change through the teenage years into the early twenties. At least two years should pass without a significant change. (A significant change is one-half diopter or more.)
- People who insist upon a perfect correction. A perfect correction is possible but cannot be guaranteed.
- Women who are pregnant or who are breast-feeding. Hormonal changes will often cause temporary changes in your nearsightedness.

So, should you consider one of these procedures? First of all, only if you are not in any of the above categories. Second, you must have nearsightedness, farsightedness, or astigmatism. You may have presbyopia as well, but presbyopia cannot currently be corrected with the excimer laser, except through a technique known as monovision. Third and last, you must want to be free of your glasses or contact lenses enough that you are willing to invest the time, energy and money to understand and undergo the procedure.

Your suitability for refractive surgery, and the best technique for your individual case, can best be determined through a personal consultation. We provide an extensive Pre-Lasik Consultation to determine if you are a good candidate for refractive surgery, and to discuss the pros and cons of each technique in terms of your individual situation.


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How safe is laser treatment?


When performed by the proper surgeon, Lasik treatments are extremely safe. Like any laser or surgical procedure, these treatments are subject to complications, but the complication rate is very low. The complication rate is much lower when a doctor very experienced in Lasik, such as Dr. Caster, performs the treatment. Most complications can be corrected through eye drops or a repeat procedure.

In order to decrease the risk of complication, we at the Caster Eye Center take many steps that go far beyond the minimum standards of most laser centers. Our laser is calibrated before every single procedure to ensure the most accurate results, whereas many laser centers only calibrate the laser every six patients, or even just once per day. We monitor and control the temperature and humidity in our laser room, which improves the accuracy of our results.

One of the more important steps to avoid complication is in the rigorous testing of our patients. After the brief initial screening exam and prior to undergoing a procedure at the Caster Eye Center, we will perform a most thorough evaluation; some important measurements will be performed two or more times, and will be further repeated if necessary.

At the Caster Eye Center, we will only perform Lasik on you if we believe that we can obtain an excellent result. Approximately 30% of the patients that come to us for Lasik are advised not to have the procedure, because we believe they are less than ideal candidates.

By far the most common complication is under-response or over-response. In the case of an under-response or over-response, the vision will be dramatically better, but a small amount of focusing error still remains. Further laser treatment, known as an "enhancement" or a "touch-up", can then be used to improve the vision further by decreasing the remaining nearsightedness, farsightedness, or astigmatism. There is no additional fee for "enhancement" procedures if performed during the first 18 months after your initial treatment. Enhancements are performed on about 4% of our patients.

About 25% of excimer laser patients will experience optical aberrations during the initial healing phases, including glare, halos at night, or ghost images. In 99% of cases, this will disappear within several months. Careful attention to detail in centration and calibration of the laser, as well as measurement of pupil size, substantially lessens the incidence of optical aberrations.


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Andrew I. Caster, MD, FACS
Caster Eye Center

Office Address:

9100 Wilshire Blvd.
Suite 265 E
Beverly Hills, CA 90212
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