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Sudden Need For Reading Glasses After Lasik, Bladeless Lasik, PRK, etc.

The effect of full distance correction in older patients may have surprising, and undesired, results.

Image of man looking over reading glasses.  
Even if you didn't need reading glasses before, you might need them after Lasik.  

There are two ways to look at myopia (nearsighted, shortsighted) vision. One is that you cannot see things far away very well. The other is that you can see things close very well.

Near & Distance Vision Accommodation

When a normal sighted person looks at something distant, the natural lens of the eye relaxes to its normal shape. When that same person looks at something close, the muscles around the lens stretch or squeeze the lens to change its focus. This change of the lens shape for close vision is called accommodation.

Someone who is myopic has a lens with a normal shape that focuses on things close. To see something close, accommodation is not necessary; the lens is already set to focus on things close. As we mature, the natural lens in our eye expands, firms, and loses its ability to accommodate. This normal condition is known as presbyopia and becomes problematic for most people between 40 and 60 years of age.

Presbyopia Masked by Myopia

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. The lens may be unable to accommodate, but since the lens is already focused for close vision and the corrective lenses take care of the myopia, the lack of accommodation is not so well noticed.

When a person has refractive surgery to remove all of the myopia, suddenly the lens is expected to accommodate. Since accommodation has not been as much of an issue before refractive surgery, the muscles may be weak. The stiffness of the lens was not an issue before, but now this stiffness reduces the amount of accommodation possible to change from distant to close vision. This is what is often called "Sudden Presbyopia".

Dealing With Presbyopia

There are a number of ways to deal with the focusing changes and challenges caused by presbyopia. People with a small amount of residual nearsightedness can simply remove their glasses to read. Some may need to use reading glasses for close work such as reading, using a computer, or sewing. Bifocals and trifocals can also be used to provide both near and far vision correction without having to constantly put on and take off a pair of glasses or switch between two pairs of glasses. Monovision can help by providing one eye focused for near vision and one eye focused for distance vision. The brain will combine the two images to create one focused image of near and far.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

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Recent Lasik and Presbyopia Medical Journal Articles...

Related Articles

Safety and efficacy of a hydrogel inlay with laser in situ keratomileusis to improve vision in myopic presbyopic patients: One-year results.

J Cataract Refract Surg. 2015 Feb;41(2):306-12

Authors: Garza EB, Chayet A

PURPOSE: To study the safety and efficacy of implanting a hydrogel corneal inlay (Raindrop Near Vision Inlay) concurrently with performing laser in situ keratomileusis (LASIK) to treat myopic presbyopia and to compare the results with results of the same treatment in emmetropic and hyperopic patients.
SETTING: Two private clinics, Tijuana and Monterrey, Mexico.
DESIGN: Prospective nonrandomized clinical trial.
METHODS: Bilateral myopic LASIK was performed and a corneal inlay was concurrently implanted in the nondominant eye under a flap created using a femtosecond laser. Primary safety outcomes were the retention of corrected distance (CDVA) and near (CNVA) visual acuities. Efficacy was evaluated on the basis of uncorrected near (UNVA), intermediate (UIVA), and distance (UDVA) visual acuities. A patient questionnaire was used to assess the preoperative and postoperative incidence of visual symptoms, the ability to perform common tasks with no correction, and patient satisfaction with vision.
RESULTS: Thirty eyes were enrolled. At each postoperative visit, the mean CDVA and CNVA were within one half line of preoperative measurements and no eye lost 2 or more lines of CDVA. The mean binocular UDVA, UIVA, and UNVA were better than 20/25 Snellen at all postoperative visits. By 6 months, 93% of patients had a binocular Snellen acuity of 20/25 or better across all visual ranges. According to patient questionnaires, 1 year after surgery, visual symptoms were at preoperative levels, 98% of all visual tasks could be easily performed without correction, and 90% of patients were satisfied or very satisfied with their overall vision.
CONCLUSION: A hydrogel corneal inlay with concurrent LASIK was safe and effective for treating myopic presbyopia.
FINANCIAL DISCLOSURE: Drs. Garza and Chayet are consultants to and investigators for Revision Optics, Inc.

PMID: 25661123 [PubMed - in process]


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