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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

Symmetrical Versus Asymmetrical PresbyLASIK: Results After 18 Months and Patient Satisfaction.

Cornea. 2015 Jun;34(6):651-7

Authors: Soler Tomás JR, Fuentes-Páez G, Burillo S

PURPOSE: The aim of this study was to report visual, topographic, and satisfaction comparative results between symmetrical and asymmetrical presbyLASIK after 18 months.
METHODS: Longitudinal, comparative case series of hyperopic presbyopes who underwent presbyLASIK, in a private clinical setting. Monovision symmetrical (plano target both eyes) versus asymmetrical [dominant eye (DE) = plano target; nondominant eye (NDE) = -0.50 diopter (D) target]. Pre- and postoperative variables included monocular and binocular, distance and near, uncorrected visual acuity (VA), best corrected visual acuity, spherical equivalent, addition (Add), topography SimK (Km), and topographic astigmatism. Topographic central corneal power increase was measured 3 and 18 months postoperatively. Data were reported as mean, range, and standard deviation and analyzed with Student t-test (P < 0.05 for statistical significance) and Pearson correlation coefficients.
RESULTS: The symmetrical group consisted of 16 patients and the asymmetrical group of 14 patients, with a mean age of 53.5 ± 2.3 and 51.9 ± 2.5 years. Postoperative results, after 18 months, for symmetrical versus asymmetrical presbyLASIK were as follows: distance UCVA 0.8 ±0.20; 0.9 ± 0.2 (P < 0.01); near UCVA 0.9 ± 0.2; 0.8 ± 0.2 (P < 0.01); SE -0.20 ± 0.50; -0.3 ± 0.3D (P < 0.01); Add 0.5 ± 0.5; 0.9 ± 0.9 (P < 0.01); mean Km 44.8 ± 1 D; 43.9 ± 1.1 D (P < 0.01); mean central corneal power differential 1.4 ± 0.8 D; 1.7 ± 1.1 D (P < 0.01), respectively. Stability: -0.16 D, DE -0.13 D and NDE -0.16 D, and SE predictability -0.40; DE -0.28 D and NDE -0.53 D. Safety index 1.0; 1.0, efficacy distance VA 0.8; 0.9, and near VA 0.90; 0.8. More than 90% were within ±0.50 D of the intended target. Twenty eyes required enhancement, and results were not significantly different. Mean satisfaction (0-10 points) for symmetrical patients was 7.0 ± 2.6 and 7.3 ± 2.8 points for asymmetrical patients.
CONCLUSIONS: Symmetrical and asymmetrical presbyLASIK significantly improved distance UCVA, near UCVA, after 18 months.

PMID: 25830759 [PubMed - indexed for MEDLINE]


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