Yes, dry eyes if severe need to be treated before considering any laser procedure. Hence the need to be seen by an expert who will not just diagnose the dry eye issue but classify or grade it, as mild dry eye, moderate or severe with a scoring.

Then, if it is mild and you are not from any background like computer IT or any systemic body condition which causes dry eye, LASIK can still be considered. We also have EpiLASIK which is done to not aggravate dry eyes as this is just a modification of LASIK.

However, if moderate or severe dry eye, then treatment is necessary before considering any laser treatment, so that the quality of vision post LASIK is not compromized.

Your check up with our doctor, Dr Anand Shroff will determine if you have dry eyes and if you do, what grade?

Dr Anand Shroff personally checks your eyes and does qualitative tests which include that for dry eyes.
This is usually graded as mild moderate or severe. Severe dry eyes means that you are not fit for LASIK and the dry eyes needs to be aggressively treatd, so your treatment plan changes. If mild to moderate dry eyes, some need to undergo EpiLASIK, a modification of first few steps of LASIK which ensures that the dryness of eyes does not worsen.

The laser we use is the Concerto 500 Hz laser, the only one in India. There are about just 10 centres in the world which use this most advanced laser.

There is no National body in India to certify centres, but what we have is far above the rest...this is the Joint Commission Accreditation or JCI, and any doctor you speak to will know the credibility of  our organization if they know that we are JCI certified. This certification or accrditation process is from the USA and they certify in simple words hospitals outside USA only and only if they are on the same standards of care and healthcare delivery.

Please read about JCI on http://www.jointcommissioninternational.org/

LASIK is not done inside or outside the cornea as such, but done on the corneal surface.
To know what exactly is done, you need to know the steps of LASIK.

Basically treating your numbers has the below two steps:

Step 1 : To create a 'Flap' to make this procedure painless and heal well. That is its only objective.

Flap creation requires the skill of the surgeon as well as the use of a good equipment to be free from 'flap related complications'.If Centers face Flap related complications due to reasons like multiple users (doctors), new inexperienced surgeons or using poor equipment creating flaps then to reduce these complications one looks at using the Intralase or a laser to create this...which uses a laser beam to make the flap. So, Intralase does not treat your numbers, it only creates the flap.

However, this itself is not free from its own set of issues (as addressed in the attachment). The frequency and other profiles with which Intralase is working currently is under an upgrade programme since it is resulting in its own complications, hence until then, we are not in favour of the same.

Further, the cost of this laser (Intralase) used just to create the flap is passed on to the patient which is an extremely high fee.

Most users of Intralase are using the VISIX laser to treat the numbers (Step 2 of LASIK). The VISIX laser, is a far older machine working at a speed of just 60 Hertz compared to the advanced systems today working at 500 Hz (such as ours). However, it is sold together as a unit as it is made by the same company.

Hence till Intralase is more well established, we work best with the Moria M2 microkeratome to create the flap and the Wavelight Concerto 500 Hz laser system with complete disposable kits.

If you have any fear of the 'flap' we too can do the bladeless or NO CUT procedure with EPILASIK, but it takes more time in recovery.

Step 2 : To treat the numbers completely, accurately with safety

Your concern is treating your eye numbers ACCURATELY WITH SAFETY. The numbers are treated by another laser technology (other than the Intralase), and if this old, then you will not have the desired outcome. VISIX or Zyoptix usually used with Intralase and has only been upgraded to customized wavefront treatments, not built from scratch for wavefront principles as our laser, the Wavelight Concerto 500 Hz.

We have treated many cases with history of Glaucoma for their powers by doing LASIK. The important thing here is for you to know your visual expectation.

Today, you face visual issues due to 2 reasons, one is glaucoma, which affects inside the eye, the second are your powers per se. The increased eye pressure affects the optic nerves and one poses a risk of having decreased vision due to glaucoma. Now, if this were to happen, it would happen irrespective of you wearing glasses, using lenses or having done laser eye surgery.

LASIK is only going to replace the specs or lenses, so the vision to expect from LASIK is the same what you enjoy today with glasses.

In some cases, crying has not resulted in any harm, in some it has as below.

Any rubbing of the eyes immediately after LASIK can pose a risk to the 'flap' which has been taken.

The risk is basically either in the form of creating folds, wrinkles or displacement of the same.
What will you feel?....symptoms of "something in my eye'  or pain if flap is shifted or displaced, unclear hazy vision or blurred vision if flap fold or flap wrinkles.

The treating doctor would know if there is any issue when he/she examines the eyes under the slit lamp check. If any issues like wrinkles etc, he has to treat the same.

We treat patients from over 92 countries and most from these places cannot revisit us.

This is the reason we have a high performance laser like to Concerto to get us accuracy in results.

If planned well, you need no more than 4-5 days in Mumbai.

This can be best answered after your eye examination with Dr Shroff. But yes, those in the older age group, usually in their 50's are advised this procedure as it is more likely that they are closer to getting a cataract at their age.

We have treated many cases of cataract who have done LASIK in their past.

This does not affect the steps of the procedure.

The only thing is to inform your eye surgeon of the history of LASIK done as today cataract treatment is not just about treating the cataracts alone but also about treating the powers of the eyes to be least dependent or completely free from glasses after cataract surgery, hence there is an adjustment needed in the calculation of the IOL power.

I understand your concerns as these are usually similar to the LASIK patients from over 90 countries that we have treated.

Usually, not more than 3-4 days is required post LASIK. Your only mandatory eye check required is your usual annual check that you must do in Australia or anywhere else in the world. However, yes, we definitely need you in Mumbai the next day of LASIK. Many even fly out the day after this check or on that evening itself, and still do fine as they follow the instructions what they would have followed in Mumbai, in their own city or country.

One of the reasons we have a high end laser like the Concerto is because we treat many patients from overseas and we also do not like to re treat them. But sure, there is a possibility of re treatment, but this possibility is one of the least compared to most centres worldwide being as low as 0.4%.

Centres abroad price their LASIK (the kind of LASIK we do) at a fee of 4000 Euros which is way above our fees, which is why they can afford to give guarantees as their initial fees itself cover what you would pay for re treatments. We do not charge you if you have any residual powers in the first year post LASIK. Any regression later in life is not due to initial treatment but due to usually very long hrs on the PC or if the candidate was not well chosen.

We counter this long term issue with computers by advising you computer prescription glasses which will not cause any numbers to return and also the check up and treatment is both done by Dr Anand Shroff, our LASIK surgeon itself, hence we have excellent results.

Yes, we have done LASIK on cases of nystagmus.

You must expect the same amount of vision as you are enjoying today. In adulthood, vision rarely improves unless it was not accurately corrected with glasses. What you may be having is also a bit of 'lazy eye' besides the nystagmus, wherein the eye inspite of correcting the powers does not read 20/20.

Vision is dependent on our optical pathway of the brain, which does not get trained in adulthood to 'read better' as it is stabilized by age 9 or 10 years..

However, all this is still general information, and specific to your case can be answered only with an examination.

To answer the Q's you have:

1. Over/undercorrection - can happen, but the need in our centre for re treating anyone is very low, less than 0.4% of the time (usually for higher powers) This is not a side effect or complication, but to get accuracy of 100% in all cases, they sometimes need this in 2 steps as part of their healing.

2. Visual acuity fluctuation- LASIK is permanent. In the healing phase of 3 months, there may slight fluctuation in vision -as sharpness or crispness goes, but this usually settles down in 3 months.

3. Halos around light sources- not seen with our Concerto Laser

4. Starbursts around light sources- not seen with our Concerto Laser

5. Decentered ablation- not seen with our Concerto Laser

6. Corneal Haze- not seen in our centre, but also only possible in EpiLASIK if one has not used the eye drops as prescribed (as these need to be used for 12 weeks)

7. Epithelium erosion- not seen in our centre

8. Loss of epithelial flap- Never had this!

 LASIK is a permanent treatment and yes, it is done when numbers are stable. If you have changing spectacle prescription, firstly it needs to be determined as to why it is changing? Is this human error and is the change in the acceptable range? which usually means a change in 0.25 to 0.75 D, usually because one never gets the eyes examined by the same person/ in the same centre, so a variation of upto 0.5 to 0.75D is sometimes acceptable and considered as stable powers. However, when we take your data for LASIK it is not dependent on just subjective correction like they do for spectacle prescription, we also take data of the surface of your eyes, independent of your answers and do checks at 25,000 points on the corneal surface to know and make sure that we are dealing with a normal conrea.

If any numbers come back after LASIK, there are reasons for them:-
1. You are still growing anatomically and hence must wait for your physical growth to stabilize, only then will your numbers stabilize. This is typical for those who are under 18 years.
2. If you do LASIK on older technology. This is not the case with our Concerto Laser, one of the most advanced lasers in the world today. 
3. Your lifestyle habits like sitting on the computers continuously for very long hours. For this Dr Shroff trains you for the correct method of sitting as well as prescribes a specific computer number for the long hours so that you do not induce a small number along the way.Most of our LASIK patients are from the IT / computer industry and cannot avoid the long hrs on the PC but with our advise have managed to keep numbers at bay.

If however a number does creep in (usually small), this can be treated with a short fine tuning treatment or if the patient desires can use glasses or contact lenses for that work.

Also, the Concerto Laser and the thin -flap LASIK or bladeless EpiLASIK that we perform , by itself has corneal savings as compared to other procedures. This is imporatant as the possibility of repeating a laser procedure in future also lies in the question "is there enough corneal tissue to treat?". Hence, when we have saved cornea in the first procedure, it always helps in future if need be.

Our rate of needing to 'enhance or re treat' is less than 0.4%, one of the least in the world as in India it is sometimes as high as 7% to 20% in some centres. We do not charge you for this enhancement when it is done in the first year after LASIK. Later in life, it is you who have to be careful regarding lifestyle and in particular this is for those sitting for long hours on the computers as it is computers which increases myopia, hence we advise the 'computer glasses' to neutralize this effect.

 I shall try and make this simple for you to understand, as your Q's revolve around technical details.Most patients understand the complex terminologies better when explained as under....

Today no one is going to tell you that they are using a black and white TV, because without doubt you will know that this is an older technology as compared to colour TV, this is an analogy to non wavefront (no laser centre will say that their laser is a non wavefront one as it equates it to something old).

However in wavefront, you have different lasers doing the job, just like you could get a colour TV which is Akai or Onida, or something completely high end, HI Fi Sony 3 D TV! thats the comparison of which 'laser' is being used ie. Nidek, B & L or what we use is the Concerto Laser. For specific advantages, the high end TV's cost more.

Now coming to the exact technique or procedure of LASIK regarding 'flap' epithelium' etc..
Again, to give you another example, please imagine a mattress with a bedsheet. The mattress is comparable to the cornea. In LASIK (with whichever laser you use, wavefront or non wavefront, Nidek, B&L or Concerto) what is done is a 'flap' is created in the thickness of the mattress. This is not done by the laser mentioned, but by a step prior to using the actual laser.The thickness of the flap (thinner the better, where we use dispposable kits to give you a thin flap to help save conrea). The flap is lifted and then the laser reshapes the cornea according to your powers and data collected in the check up (here again we have a cornea saving advantage as the laser we use, the Concerto, uses less cornea to remove powers as compared to most lasers used today).

Now, if we do not want to disturb the cornea or save as much of cornea as we can (in dry eyes / thin cornea, detected by Dr Shroff during check up), we do EpiLASIK, which is take the bedshhet away (the epithelium) and do the laser reshaping on the first layer of the cornea (without having made any 'cut or flap'). This 'bedsheet' or epithelium grows back in 4 days time. This is EpiLASIK. So EpiLASIK is just a variation in the initial steps of LASIK, the laser treating powers remains the same which is the Concerto Laser in our case.