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Lasik Doctors


Hyperopia (Farsighted-Longsighted) Correction Difficulty with
Lasik, Bladeless Lasik, PRK, etc.

When you hear about those 20-Minute Miracles who have instant perfect vision after refractive surgery, you are not hearing about people with hyperopia (farsighted, longsighted), you are not hearing about high hyperopes, and you absolutely are not hearing about high hyperopes with astigmatism (irregular cornea).

Hyperopia is significantly more difficult to predictably and reliably correct than myopia (nearsighted, shortsighted) vision. Hyperopic correction is significantly more likely to regress and regress at a greater percentage than myopic correction. Hyperopia with astigmatism is a most challenging refractive surgery correction. Hyperopia correction of more than about 3.00 diopters with conventional or custom wavefront Lasik, Bladeless Lasik, PRK, and LASEK is very difficult to correct successfully without inducing additional problems or without experiencing rapid regression. Vision recovery from hyperopia is often significantly longer than recovery from myopic correction.

As with nearly all excimer laser based refractive surgery, hyperopic correction can be performed with both conventional ablation and wavefront-guided ablation.

Current techniques in myopic correction are simple: A laser removes tissue in the center of the cornea to make it flatter. That's about it. For a shift in refractive power to reduce hyperopia, the center of the cornea needs to be steepened with a "bulge" outward. Think of the old saying, "If you can't raise the bridge, lower the water." Myopic correction raises the bridge. Hyperopic correction lowers the water. As with lowering the water under a bridge, steepening the cornea is difficult.

With excimer laser assisted hyperopic correction such as Lasik, Bladeless Lasik, PRK, LASEK, and Epi-Lasik, the cornea is reshaped by removing a ring of tissue around the outer edge of the cornea. By leaving the center of the cornea thick and thinning the outer ring, the cornea changes shape relative to the original shape of the cornea to give the net effect of a bulge outward in the center.

All techniques are very difficult to perform well. The bulging may not be centered or spherical, causing regular or irregular astigmatism. Knowing just how much energy to apply and where, is an art as much as it is science. The cornea tends to naturally regress back toward its original shape. Lasik, Bladeless Lasik, PRK, LASEK, and Epi-Lasik hyperopic correction also tend to regress, but at a relatively slow rate and will usually stabilize long before full regression back to preoperative levels.

For all its technical foibles, hyperopic correction is often considered very successful by the patient. The reason is that hyperopes really cannot see very well at any distance. The greatest advantage of hyperopic correction is for someone who is also presbyopic. Before presbyopia, the natural lens can somewhat "focus around" the hyperopia. When you are presbyopic, you get hit with the full effect of the hyperopia. That is why presbyopic hyperopes are often the most satisfied patient even if the surgery is a marginal success. Any amount of improvement is significant in its ability to help presbyopic hyperopes function day-to-day and is greatly appreciated.

Rather than attempting hyperopic correction by reshaping the cornea, the lens-based techniques of P-IOL and RLE may be much more appropriate. These techniques also have limitations, such as the inability to correct astigmatism, but should be considered as an alternative to Lasik, Bladeless Lasik, PRK, LASEK, or Epi-Lasik.

    Consider and Choose With Confidence

Last updated Saturday, August 18, 2012

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