Tuesday, August 22, 2006

We Can See Clearly Now...

Nearly two-thirds of the BeansTalk staff can now boast 20/20 vision, courtesy of elective laser-eye surgery.

Neither of us were particularly displeased with the situation regarding our glasses and/or contact lenses – until recently. One of us had been wearing glasses since the age of 11 (and probably should've been wearing them long before that -- the result of suddenly being moved from Catholic school, where the shortest students -- and being only second to a bona-fide, genuine little person – we were always seated in the front-row of the classroom. Suddenly, in sixth grade, we moved to public school and found ourselves seated further away from the board).

The other BeansTalk staffer had been wearing a much lower prescription, having started post-university graduation. As we mentioned, glasses were never an issue and we had fun getting antique frames and having them filled to our prescription. But wearing glasses meant not being able to see a set while surfing or ocean miracles snorkeling (prescription swim goggles are too expensive and too easy to lose).

However, last fall was the downfall, so to speak. Suddenly contact lenses were always uncomfortable and within a couple of weeks, glasses (essential in this case) needed to be worn during all the waking hours.

Within months of receiving a previously uninteresting discount gift certificate at a pre-0scar suite, we started to seriously consider it.

We both went in for consultation and one of us completely embraced the idea. Obsessively, so, even. Then, as Granny used to say, Thanks (emphasis on the plural) God. We convinced our parents to give it to us as both a Mother’s Day gift and early inheritance.

Our initial Lasik experience was mercifully easy – after an hour and half of tests, a video to watch (replete with all the frightening “blindness is a possibility caveat”), forms to fill out, we were released, our pupils dilated to the point of realization that we should’ve arranged for someone to drive us to work.

We then went in on a Friday morning, into an office full of patients, each with a paper shower cap perched on their noggins, names written upside down (presumably so the surgeon would know who he was operating on, and thereby administer the correct prescription).

We were a virtual advertisement for the pluses of having Lasik. We were given – literally – eight minutes for the Xanax to take effect (translate: it didn’t have any effect at all, but we weren’t even remotely nervous; still, should we have gotten the idea this was a bit of a rush job?) .

The surgery took 1 min. 40 seconds. We have the DVD to prove it. Warning: the only disorienting thing, I knew what to expect otherwise, was the smell of burning eye matter.

Surgery done, we sat up, read the clock on the wall (which of course, we couldn't a few minutes earlier), read the eye chart, were deemed 20/40, donned goggles, and left to rest.

The day of surgery we were there from 9 a.m. to 9:32 a.m.

The following day, Saturday, we came in for a super fast check up. We were confirmed doing well and at 20/20, wore the sponged goggles for a week, administered the four-times-a-day drop. Mission accomplished.

The surgery was 26 May 2006. There were two weeks of nighttime halos that have since disappeared.

On a more cautious note: We also found out that our doctor, while a good technician (it all worked out for us, Thanks God again), had some financial issues based on his off-shore accounts and other asundry issues that question his moral terpitude.

A follow-up visit and checkup a week later was administered by a very distracted office manager (non-doctor, non-nurse, non-medical assistant, basically, uh, the person who negotiates money matters and payment parties). Cue: reservations about our initial choice.

The light at the end of the laser-eye tunnel

At the suggestion of Dr. Shari Worth and her wonderful, amazing rep Ryan Fisher of Rousso Fisher P.R., our other staffer opted for the man who – we mean this literally – wrote the book on Laser Eye Surgery, Dr. Andrew Caster.

Dr. Caster administered a battery of tests, even sent us to a genetic eye specialist to determine if we were truly an adequate candidate, resumed yet another battery of tests, both pre-op and day of, and took us into a surgery room that actually looked like a surgery room, and a sterile one at that.

We had Wavefront in our right eye and regular Lasik in the left, based on which Dr. Caster determined was the best treatment. (That noted, the one of us who already had the surgery wasn’t even tested or given the option of the Wavefront, even though it was mentioned and available).

Surgery day was fine, but on the return the next day, it was discovered we had a wrinkle in our cornea. Damn. We might have slept on the googles funny, we might have wiped too closely, we’re still not sure. But Dr. Caster noted that it must have happened that morning based on the build-up of epithelial cels.

Luckily everyone at Caster Vision was on the ball and hopped to making it better.

Unfortunately, it meant a scraping of the epithelial cels and smoothing of the eye ball (at least twice, back in the surgery room) and waiting for the results. Dr. Caster wouldn't let us leave until he was sure we were on the path to a clear recovery.

A month later things are greatly improved and we’re also indebted to Dr. Warren Reingold (www.reingoldeyecenter.com), who saw us on several visits, as a favor to his former partner Dr. Caster, who was scheduled to go on holiday the day after our follow-up.

If you live in the valley and want to get laser eye surgery or just an eye doctor, we cannot recommend Dr. Reingold enough. He was super, just super. (818 763-EYES; he’s in Valley Village).

Right before our hiatus we saw Dr. Caster again, and he reconfirmed to us the notion that many may be able to perform a duty, but it’s a true journeyman who’s ready and able to fix any problems.

BTW, we also really, really liked Dr. James Hoffs, who is the Optometrist at Caster Vision. He had a super sense of humor and a great personality.

All in all, despite the fact that the second staffer surgery had a complication (one in 500, according to Dr. Caster), if we were to have it all done again, we both would’ve gone to Dr. Caster, because we were ultimately impressed with the facility, the care of sterilization, Dr. Caster’s vast knowledge and experience, and how professional Dr. Caster’s staff was throughout the surgery and post-surgery.

Here’s a little 411 on Laser Surgery and the doctors who performed our surgeries.

As a note, it should be pointed out that it’s BeansTalk’s opinion that you are dealing with an extremely delicate surgery and that even in the best of situations, there can be issues. These are your eyes. Don’t opt for the cheapest alternative.

But we rank our laser-eye surgery in top five best decisions of our lives.

L.A.S.I.K. (Laser-Assisted Intrastromal Keratomileusis)

L.A.S.I.K. is a procedure combining the benefits of the excimer laser with a manual surgical process.

Low to moderate myopia (with or without astigmatism) or low to moderate hyperopia can be effectively treated with this procedure.

L.A.S.I.K. has been performed in Canada and Europe for since the early 1990's and in the United States since 1997.

Get Plenty of Information from Dr. Caster’s website (www.castervision.com)

The Most Commonly Asked Questions About Vision Correction

1. 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 wavefront-guided custom cornea technology: 99% have 20/25 or better uncorrected vision, and 96% have 20/20 or better vision without glasses. The general rule is: more accurate results will be obtained in people who require less treatment.

2. 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.

3. 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.

4. 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.

5. When is one technique better than another?
Although Lasik is preferable for most patients, there are many situations in which IntraLasik or Advanced Surface Treatment is preferable. Advanced Surface Treatment 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.

6. Are all lasers the same?
Absolutely not! Dr. Caster usually uses the Alcon LadarVision laser, which is the most advanced laser. The LadarVision laser creates the largest treatment area, which dramatically decreases the side effects of glare, halo, and difficulty with night vision. The LadarVision wavefront-guided customized treatments are applied to 200 points on each eye; by comparison, the Visx wavefront treatments are applied to an average of 85 points on each eye. The LadarVision laser also has the most advanced eye tracker, following the position of the eye an amazing 4,000 times per second; the Nidek and Allegretto lasers track at 200 times per second; the Bausch & Lomb laser tracks at 120 times per second; the Visx laser tracks at 60 times per second. The Summit laser does not have an eye tracker at all.

We also use the Visx laser, but for most patients the results with the LadarVision laser will be superior. Other cheaper 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).

7. Everyone seems to be talking about wavefront. What does this mean?
Wavefront technology, also known as custom treatment, is a major advance in vision correction. Glasses and contact lenses correct each eye with one prescription for the entire eye. But we know that the eye is not perfectly regular, and that different points on the eye actually require slightly different prescriptions. Wavefront technology allows us to measure and treat 200 different locations on the eye, each with its own particular prescription. The result is vision that is often better than can be obtained with glasses or contact lenses, particularly with regard to night vision.

8. I have heard from several people that the Alcon LadarVision laser is the best laser. Can you tell me more about this?
At the Caster Eye Center we have extensively used both the Alcon LadarVision and Visx lasers, which are widely recognized as the two best lasers. In head to head testing in our practice involving over a thousand patients, we obtained the most accurate results with the Alcon LadarVision laser. The new wavefront-guided Custom Cornea treatment technology with Alcon LadarVision laser treats each of 200 separate locations on the eye with its own prescription; the other wavefront systems available -- Visx and Bausch & Lomb -- treat an average of 85 separate locations. In addition to obtaining the most accurate results, the Alcon LadarVision laser has the largest treatment zones of any laser (up to 100% larger than the Visx), which greatly diminishes halo and glare.

9. 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.

10. 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.

11. 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.

12. 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.

13. What if I blink during the procedure?
The eye is held open by a device known as a retractor, which doesn’t usually hurt.

14. 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.

15. Will scars form from the procedure?
There are only extremely faint scars that cannot be seen except with a microscope.

16. 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.

17. 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.

18. If I don't get a full correction, will I be able to have a repeat procedure to improve the results?
Approximately 10% 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.

19. 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 or IntraLasik usually see very well the day after the procedure, and most choose to have both eyes treated on the same day. Patients having Advanced Surface Treatment heal more slowly, so some of these patients choose to have the treatments on separate days.

20. 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.

21. 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 patients. After the brief initial screening exam and prior to undergoing a procedure at the Caster Eye Center, they 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, they only perform Lasik if they believe that they 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 10% 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.

The 411 on Dr. Caster


Dr. Caster is one of four doctors in the United States (and the only doctor in California) who is a member of the Alcon Refractive Surgery Clinical Advisory Board. Alcon is the largest eye care company in the world. In this capacity, Dr. Caster works closely with the doctors at Alcon to advance the science of laser vision correction.


W Magazine recently selected Dr. Caster as one of two top Lasik laser eye surgeons in the United States.


At the Caster Eye Center, we will only treat 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 not ideal candidates.


Caster Eye Center offers two lasers: the LadarVision6000 laser and the Visx S4 laser. These lasers use the new wavefront-guided custom cornea technology to achieve markedly superior daytime and nighttime vision.


Dr. Caster’s book, The Eye Laser Miracle: The Complete Guide to Better Vision, is now in its 5th printing and is the most widely-read book in the United States on the subject of laser vision correction.


Dr. Caster is one of only a few Lasik surgeons in Southern California (and one of less than 100 in the entire United States) to meet the extremely high quality standards required to become certified by the Council for Refractive Surgery Quality Assurance.

Dr. Caster has been honored by Visx, a laser manufacturer, as one of the "Top 50" Laser Vision Correction doctors in the United States for four years in a row.

Caster Eye Center
9100 Wilshire Blvd., Suite 265E
Beverly Hills, California 90212
Tel: (310) 274-1221
Toll free: (800) 444-5241
Fax: (310) 274-0244
E-mail: info@castervision.com

(above photo Dr. Caster and Katie Couric; Caster's appearance on NBC's Today Show)