The IntraLase is a most amazing device for refractive and corneal surgery. Not only is Yonge Eglinton laser the centre with the most experience with this technology, we are also using it to modify astigmatism after corneal transplants. Normally, astigmatism is very common occurrence. This describes the oval shape of the cornea that occurs when the transplant is healed. This can be treated with glasses, but these cause a lot of distortion. Contact lenses of the hard variety can also correct the problem. But this doesn't fix the problem, only masks it, and gives relatively good vision. To permanently change the astigmatism, something must be done to the cornea. We see the challenge of rehabilitation after a new cornea is to have the person achieve good vision with glasses or even without any correction at all. When corneal transplants began over 100 years ago, just getting a clear new transplant was a miraculous thing. We have moved ahead a lot in the past 3 decades, yet still patients after a corneal transplant cannot see, due to high astigmatism. We believe that the time has come to move beyond just a clear transplant and obtain good vision for the patient. How do we do this? First, if there is a very high astigmatism, we use the IntraLase to make very precise curved incisions in the cornea. these incisions can be done to incredible precision and with a perfect curve, resulting in a marked decrease in the amount of astigmatism. This may not correct all the astigmatism though. We then use the Excimer laser (Visx Star S4) to do a custom reshaping of the cornea. Many of our patients can now see well with a thin glasses prescription or even without glasses. This is a much more advanced and better goal for somewhat undergoing a transplant for Keratoconus or other problem.