LASIK in 1999: Astigmatism/Presbyopia Setting In?

[holden]

Hello,

At age 30, my wife had successful LASIK surgery in 1999 to correct an Rx of (R) -3.75 -1.25 x180 and (L) -3.25 -1.75 x180. She had not worn glasses or contacts since until last October, when it became apparent that she was having a lot of difficulty driving at night.

At age 37, she finally agreed to get an eye exam in October 2006. The results confirmed that her astigmatism had returned with a slight bit of myopia. Her Rx from that exam is (R) -.25 -.75x180 and (L) -.25 -.50 x120. At the time, she agreed to wear her glasses for driving at night, but steadfastly refused to consider them for anything else. After all, she had the LASIK done because she wanted to be glasses-free.

For the first few months, she kept to this usage level. Then over the last 6 months, she is now wearing them for the blackboard at school, anytime she uses the computer or when she is reading. (She doesn't hold the book at arm's lenght though) She also wears perscription sunglasses for driving during the day. It also appears that her eyes have changed further since the exam she had in October 2006.

My questions are:
(1) Is she a candidate for LASIK in the future?
(2) Is she developing presbyopia earlier than usual. or is it the astigmatism that is cauing her issues on the PC and for reading?
(3) Is the increased usage a sign that she is becoming more depdendent on correction (given her strong reluctance to wear glasses)?

Thanks,
Holden

[LasikExpert]

(1) Is she a candidate for LASIK in the future?

There is nothing that you have said that indicates she is not a candidate for Lasik enhancement surgery, except that her refractive error is very low.

(2) Is she developing presbyopia earlier than usual. or is it the astigmatism that is cauing her issues on the PC and for reading?

Presbyopia actually starts at around age 10, but does not normally become problematic until after about age 40. It is possible that your wife is starting to have trouble with presbyopia. Her very slight myopia will actually delay the effects of presbyopia. When myopic, the eye is naturally focused for near objects.

If all she had was myopia, she should be able to remove her glasses to see more clearly objects near. Your wife's myopia is very low and her astigmatism is also relatively low, but any astigmatism can cause a blur effect.

(3) Is the increased usage a sign that she is becoming more depdendent on correction (given her strong reluctance to wear glasses)?

She obviously prefers the quality of her vision with glasses, but there is probably more to this situation.

Since your wife is undoubtedly not fully presbyopic and has been able to accommodate (change focus), it may be that she has had residual refractive error that she has been "focusing around" the refractive error all along.

The next time she has a refraction (which is better, one or two?), have her ask her doctor for a cycloplegic refraction too. This will paralyze the natural lens within the eye so it cannot accommodate. A significant difference between her manifest refraction (with accommodation) and cycloplegic refraction (without accommodation) could indicate the reason she is having more difficulty now. It may also better indicate if Lasik enhancement surgery is appropriate.