Without examing you to find out what exactly is going on with your eyes, its tough to answer your question. There fore i can only speak in more general terms drawing upon the most recent studies of LASIK patients. All patients after LASIK have dry eye. Some more than others, and some had dry eye before LASIK. It is currently rare for patients to be more after LASIK once you get beyond 3-6 months. Not impossible but rare. Over time though, people do get more dry eye just from getting older or having changing hormone levels, or developing other conditions that can have dry eye. LASIK does not directly cause a drooping of the eyelid. Dry eye can cause some relative drooping as the lid tries to protect the irritable cornea. Again, drooping lids occur with age or for other medical reasons that would need to be ruled out, but the LASIK procedure does not do anything to the lid itself. The 'shifting' of your eye is a more complex question. Many people have a tendency for their eye to shift that comes out more in certain situations such as being tired. Eyeglass prescriptions that are very large induce some shift of the eyes that most eyes easily adapt to. In eyes that have a tendency to shift, taking away the large eyeglass prescription can on rare occasion bring out a shift. Bottom line, you need a comprehensive exam to sort these many issues. Best of luck.
The answer depends on what brand laser the surgeon uses. If they are using the VISX laser (the most popular), than I would say yes you should use the wavefront data and perform a custom wavefront based treatment. There are several ways for surgeons to fine tune the wavefront to further customize the treatment for the patient. Most importantly, using a custom treatment over a standard treatment affords a larger treatment zone, especially for astigmatism and far sightedness. This is very important in obtaining best outcomes. IR (iris registration) definitely helps in patients who have astigmatism as well and is only available with waverfront/custom treatments.
i really do not personally like the idea of lifetime warranty for LASIK. Its misleading. Immediately after surgery we know that a very small percentage of patients under respond to the laser and will benefit from an enhancement. During the first 3-6 months after surgery a very small percentage will heal more aggressively than predicted and have a return of part of their prescription and potentially need an enhancement. And then for the rest of their lives a small percent of all patients eyes will change as they get older and acquire a new prescription and potentially benefit from an enhancement. The caveat here is that not all changes in the eye would benefit from additional laser surgery. And the idea that the surgeon needs to warranty the laser beyond the initial healing period imparts the idea that the laser failed. The effects of LASIK are permanent, eyes change. I do not find that my enhancement rate relates to the preop prescription. to some degree the younger you are when you have LASIK the greater the chance your eyes will change over your life therefore the higher the chance you might want an enhancement. To answer your specific question, i think all LASIK surgeons should offer free enhancements, as medically appropriate, for the first year and price their surgery accordingly. I do not think there should be a lifetime warranty period.
Everyone has a different pupil size, and yes of course its larger at night. Basic physics dictates that larger pupils, with our without LASIK, have worse vision than smaller pupils. the question is whether LASIK makes this worse. The short answer is you dont know in advance. Every eye is different; different prescription, different pupil size, different curvature, etc. what we do know is that with current technology, there is no direct relationship between pupil size and night glare. The chances of this issue are sporadic, and fortunately rare. There may be a relationship with the amount of correction performed and pupil size and glare, ie high corrections and large pupils but again, we are not currently seeing more than the isolated patient with worse glare at night. All patients immediately after LASIK have night glare and halos. It improves each week for up to six months after surgery at which point the vast majority of patients do not report a problem. Hope this helps.
