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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

Two target locations for corneal inlay implantation combined with laser in situ keratomileusis.

J Cataract Refract Surg. 2014 Nov 20;

Authors: Corpuz CC, Kanamori T, Huseynova T, Tomita M

PURPOSE: To compare the visual acuity outcomes between 2 target locations for corneal inlay implantation with concurrent laser in situ keratomileusis (LASIK) to compensate for presbyopia.
SETTING: Shinagawa LASIK Center, Tokyo, Japan.
DESIGN: Retrospective cohort study.
METHODS: Bilateral LASIK was performed simultaneously with inlay implantation in the nondominant eye. The preoperative and 6-month postoperative uncorrected distance (UDVA) and uncorrected near (UNVA) visual acuities were evaluated. Patients were divided into the following 2 groups based on the pupil center to Purkinje reflex distance (Pp-Pk): small (≤300 μm) and large (>300 μm). Each group was divided into subgroups according to the distance of the inlay center to the Purkinje reflex (I-Pk) or to the midpoint between the pupil center and Purkinje reflex (I-M). The inlay position was classified as 0 to 100 μm, 101 to 200 μm, 201 to 300 μm, and 301 to 400 μm from the Purkinje reflex and from the midpoint.
RESULTS: Of 1008 patients, 992 were available for postoperative follow-up. The UDVA and UNVA improved in both subgroups with all inlay positions (P < .0001). There were no statistically significant differences in UDVA or UNVA within or between the small Pp-Pk group and the large Pp-Pk group (P > .05). The Spearman rank-order correlation showed weak associations between the inlay distance and visual acuity.
CONCLUSION: The amount of inlay decentration had no influence on postoperative visual acuity.
FINANCIAL DISCLOSURE: Dr. Tomita is a consultant to Acufocus, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

PMID: 25465218 [PubMed - as supplied by publisher]


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