Myopic with questions/concerns

If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.

Myopic with questions/concerns

Postby snevius » Wed Oct 04, 2006 6:29 pm

I am scheduled to have Lasik surgery next week. I am nearsighted and my primary motivation is to simply not have to wear glasses anymore. I am 46 years old and I read on this website about presbyopia: that "Presbyopia may not be noticed in a myopic person because the need for accommodation is diminished by the myopia. Presbyopia can be masked by myopia." Do I have presbyopia now and just aren't aware of it? Right now I can see up close quite well without my glasses - well enough to read a book or the paper. Will I lose that ability and have to wear reading glasses if I go through with this procedure? If so, what am I really gaining? It seems more like swapping what I have now - needing glasses to see close up vs. needing glasses to see far away. Thanks for your help.
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Postby LasikExpert » Wed Oct 04, 2006 7:23 pm

When the natural lens is in a relaxed state, the eye is focused for distance vision. To see an object within about 20 feet or less, the lens changes shape to change focus. This is called accommodation and is how we are able to see objects near.

At around age 40 presbyopia becomes problematic. Presbyopia is the lack of accommodation. This is when it is less possible to see near objects clearly and reading glasses or bifocals are necessary. At age 46 you would probably be very presbyopic.

There are two ways to describe myopia (nearsighted, shortsighted) vision. One is that you cannot see things far away. The other is that you can see things close. If you have surgery to remove your myopia and are presbyopic, you will not be able to see things close. You will immediately need reading glasses, but reading glasses will probably provide the near vision that you require.

Your analysis is exactly correct. With full correction surgery you would be swapping glasses to see far away for glasses to see near. Only you can decide if this is an advantage.

Monovision is a technique that is a "workaround" for presbyopia. One eye is made moderately myopic for near vision, and the other eye is fully corrected for distance vision. After a few weeks the brain recognizes the difference and combines the two to provide adequate distance and near vision. Adequate is not the same as excellent and some people do not like monovision's effects. We have a detailed article about Lasik Monovision that you may want to read.

Before you have any surgery, I highly recommend that you get fitted with disposable contact lenses that correct you to the target for surgery. Wear those contacts religiously for several weeks to experience full-time vision with that correction. This technique is ideal for intended full correction, intended under correction, or intended monovision. An alternative would be to wear your glasses, but never take them off and use reading glasses over your glasses every time you need to see items near.

Only after this kind of real world experience can you make an informed decision about having surgery. In theory full correction of your myopia sounds great, but I have found that nothing screws up a perfectly good theory faster than reality.
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Postby slim » Wed Jan 16, 2008 5:05 am

Glenn,

The topic of Presbyopia is probably the most confusing part of my research as I am 38 years old and close to the time where this going to be an impact to me.

I guess my confusion lies on the "near" distance I'm going to lose. Currently being nearsighted I can see well far and near with my glasses on. If I take my glasses off and am at my usual distance from my monitor I can't read a thing (and obviously can't see anything at a distance). If I come within 1'-2' of the monitor I can read things clearly...

My question is what's that near vision one could expect to lose when in their 40-50's and have their myopia corrected? Would one not be able to see 5, 10 feet away clearly and would have to be corrected with "reading" glasses?

Until recently I was figuring the worst I would eventually need reading glasses for the computer, maybe some time out as I tend to sit a good 3+ feet away from it, but was never expecting to need them for something across the kitchen, or even the other side of the dinner table? Which until recently I would consider farsighted... I guess that's more "mid-sighted??".

Jim-
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Re: Myopic with questions/concerns

Postby beingbobbyorr » Wed Jan 16, 2008 6:05 am

snevius wrote:... If so, what am I really gaining? It seems more like swapping what I have now - needing glasses to see close up vs. needing glasses to see far away. ...


For an extreme myope like me (-8.5, -10), full distance correction (with ICLs, not Lasik) will:

(a) let me throw away heavy glasses all the time in exchange for light (presbyopia-correcting) glasses just for reading and computer work. The difference in weight sitting on the bridge of my nose will be substantial.

(b) not needing glasses or contact lenses for sports (playing ice hockey) will be a miracle.

I tried monovision for a day and 'got it', but the quality of vision was below my standards, and so I will settle for using +1 reading glasses.
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Postby croanster » Wed Jan 16, 2008 12:48 pm

I think it's a choice everyone needs to make for themselves. It all depends - what do you want to achieve by having surgery? If you want to ditch the glasses completely, monovision may be the way to go.

I was longsighted and was used to having to put glasses on for close work but enjoyed really good uncorrected distance vision all my life. It was the deterioration in my distance vision that mainly prompted me to have Lasik. When the time comes for me to use reading glasses, it won't be a problem for me because thats what I'm used to already.

I think trialing the various options with contacts is the best and safest way to make an informed decision if you are in any doubt.
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Postby slim » Wed Jan 16, 2008 6:13 pm

Thanks for the feedback, I pretty much resigned to the fact that I would eventually need to get reading glasses... that being with or without getting laser surgery... only difference being I would have to get the perscription change on my glasses/contacts.

The thing I'm trying to get clarification on or feedback on isn't around having to wear reading glasses to work on the computer, etc... but rather what distance I would expect to need those glasses for as I always thought of reading glasses for something that is 2-3 feet from your eyes, and something that is 5'+ being considered as "far"... So what I'm trying to determine is should I expect that when presbyopia sinks in (and especially have laser surgery) should I expect things at 5'+ to be blurry, thus requiring reading glasses to make it clear, or I would I only expect to need them for actually "reading" of things close up?

So I'm fine with reading glasses if it's just for reading but would have to reconsider if that mid-vision (5'+) was impacted as well...

Thanks again, the forum has been a great source of information.
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Postby cshen » Sat Jan 19, 2008 6:45 pm

What about CK procedure? I heard that with CK, you won't need reading glasses.
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Postby LasikExpert » Sun Jan 20, 2008 4:27 am

Conductive Keratoplasty (CK) is a surgical technique that uses radio waves to temporarily induce myopia (nearsighted, shortsighted) vision and/or reduce hyperopia (farsighted, longsighted) vision. A small amount of myopia can reduce the need for reading glasses, but will do so at the cost of distance vision quality.

Read our article about CK monovision.
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Postby rosecmd » Mon Jan 21, 2008 4:45 pm

As others have stated, you really do need to simulate the goal of your lasik to fully understand the effects of presbyopia. Also, do a search on this forum for "sudden presbyopia"...you will find that there are several active people on this board who are in their 40s-50s who were nearsighted and wore progressive lenses who lost that ability to see up close and they just moved things closer to "survival see". It's a swap, a trade-off. If your surgeon overshoots the mark a bit and you are made somewhat farsighted over the new, sudden presbyopia, I can guarantee you won't like it.

You will still need some kind of glasses after lasik even if you are perfectly corrected due to your age and the need for glasses to see anything up close from about 18 inches to 3 feet - it all depends on your eyes. I don't like the term "reading glasses" - they are not just for reading, but to see anything at all up close (food on your plate, to cook or any other up close chore or task, computer, your children's faces, your own face, to put on a necklace, hook a bra, items on shelves in the store, and on and on.) You will reduce your dependence on glasses overall and likely end up with good distance vision. Near vision is often defined as arm's lenth distance. Mid-range can be anything from 3 feet to up to 20 feet, and distance is after that. But, it all depends on how and where you spend your time and what your vision needs are...healing is an issue too.

Looking back, I see that I had little concept of what it would be like to lose my near vision. Now, I'm kind of used to it, but it was a journey.
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Postby slim » Mon Jan 21, 2008 7:49 pm

But isn't it true that regardless if one gets laser correction surgery or not you will eventually lose your near vision with age and you'll eventually be in reading glasses in either case.

As it stands today I really can't do much without contacts/glasses. I can't read the computer without them, see sharp outside of 2 feet, etc... However, I can definitely undertand if I lost that ability to see sharp within that 2 feet window without assistance it would likely be a shock (don't know what you have until its gone). Again though after years wouldn't I expect to lose that regardless; not being able to see at any distance without the need of glasses/contacts?

I'm definitely trying to get my expectations straight... If I could potentially ditch glasses for 5 or 10 year (stretching it there) it's worth the money to me. After that if I required glasses/contacts I figure I wouldn't be in any difference situation than I would have been without the surgery ~ the requirement of some type of assistance to have clear vision at all levels.

I tell you, this is the last area of concern for me in regards to surgery. I've been wanting to do this for the last 7-10 years, understand all the potential side affects, recovery time, etc... ,etc... the forum has definitely been helpful.
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Postby LasikExpert » Mon Jan 21, 2008 10:26 pm

slim wrote:But isn't it true that regardless if one gets laser correction surgery or not you will eventually lose your near vision with age and you'll eventually be in reading glasses in either case.


Absolutely. Your eyes will continue to change after Lasik in the same way they would have changed without Lasik. Sudden presbyopia is normally only an issue for someone who is in the early stages of presbyopia, usually right at age 40. There are some advantages of myopic (nearsighted, shortsighte) correction with glasses that can reduce the need for bifocals or reading glasses. These advantages may be removed with Lasik for full distance correction. A good way to test this is to try contact lenses with full distance correction. This is as close to what vision could be like after Lasik as possible.

slim wrote:I'm definitely trying to get my expectations straight... If I could potentially ditch glasses for 5 or 10 year (stretching it there) it's worth the money to me.


Even if you need reading glasses in a few years, successful Lasik would mean a reduced need for corrective lenses at other times.
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