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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

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

Recent Lasik and Presbyopia Medical Journal Articles...

Related Articles

Relationship between induced spherical aberration and depth of focus after hyperopic LASIK in presbyopic patients.

Ophthalmology. 2015 Feb;122(2):233-43

Authors: Leray B, Cassagne M, Soler V, Villegas EA, Triozon C, Perez GM, Letsch J, Chapotot E, Artal P, Malecaze F

OBJECTIVE: To evaluate to what extent the modification of corneal asphericity to induce spherical aberration (SA) can improve the depth of focus and to determine whether preoperative adaptive optics assessment (Voptica SL) can predict an optimal SA value for each patient.
DESIGN: Comparative, prospective clinical trial with paired eye control.
PARTICIPANTS: Patients ≥45 years old who are hyperopic from +1.00 to +2.50 diopters (D), with eyes suitable for LASIK surgery.
INTERVENTION: Bilateral hyperopic LASIK surgery using a 200-Hz Allegretto excimer laser. The dominant eye was operated using a conventional profile. The nondominant eye was programmed with an aspheric ablation profile and -0.75 D monovision.
MAIN OUTCOME MEASURES: Primary outcome was the correlation between postoperative SA and depth of focus, defined as the pseudo-accommodation value (PAV = [1/reading distance {m}] - minimum addition [D]). Main secondary outcome was the comparison of depth of focus between patients with an induced SA close to the optimal one (group 1), patients with an induced SA far from the optimal one (group 2), and patients for whom SA induction did not increase the depth of focus (control group).
RESULTS: We included 76 patients. Between preoperative and postoperative assessment, the mean increase of distance-corrected PAV for near vision was +0.25±0.64 D (P < 0.001) for dominant eyes and +0.63±0.55 D (P < 0.001) for nondominant eyes. As the level of negative or positive postoperative SA increased, PAV for intermediate and near vision increased. Among the 37 eyes that followed the preoperative adaptive optics assessment, the mean PAV increase at near was significantly higher (P < 0.05) in group 1 (0.93±0.50 D) than in group 2 (0.46±0.42 D) and than in the control group (0.35±0.32 D). The mean optimal SA value determined by the dynamic simulation procedure to optimize the depth of focus was -0.18±0.13 μm at 4.5 mm.
CONCLUSIONS: Aspheric hyperopic LASIK can increase the depth of focus without impairing far vision, but this benefit would be maximal and reproducible if we could define and achieve an optimal SA value determined by preoperative assessment using an adaptive optics instrument.

PMID: 25444348 [PubMed - indexed for MEDLINE]


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