If you have a really bad astigmatism, you should make sure to have the surface of your eyes mapped. I wanted lasik because I have such severe astigmatism in both eyes that contacts never worked properly and always moved around. Well, I found out that many of us with severe cases of astigmatism can't have lasik because we have an eye disease keratoconus (KC), it's a thinning of the cornea that causes a cone (or a bow) usually on the bottom of your cornea because of gravity. That is why many astigmatic people have trouble with contacts. I would make positively sure that you have thick enough corneas to have the procedure done. If done and you have KC you will get a quick fix but will end up worse than before and will need a corneal transplant. There ARE contacts that will work for astigmatism, and KC, you have to find the right Doctor and lense fitter. Anyway, I would only have surgery in the US. Also, with insurance, they may not cover any costs once you return to the US if you have problems. AND the most important, many people have to go back and have "touch up" procedures to get the best result. Mine would have been covered for 2 years, but if you have it done in Japan/Taiwan and in 6 months need a correction can you afford to fly back, take time off work etc????