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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

[Supracor, Laser Correction of Presbyopia: One-year Follow-up Outcomes].

Cesk Slov Oftalmol. 2014;70(4):146-50

Authors: Machačová H, Vlková E, Michalcová L, Trnková V, Rybárová N

PURPOSE: Evaluation of one-year postoperative results after Supracor laser procedure.
METHODS: The study group consisted of 8 hyperopic patients (16 eyes) seeking alternatives to wearing glasses for both distance and near vision. These patients underwent Supracor refractive surgery in the Department of Ophthalmology of The University Hospital Brno in the time period from July 2012 to February 2013. The patient mean age at operation was 57,2 years (±4,6), mean binocular uncorrected near visual acuity was Jaeger No. 13, distance visual acuity 0,5 (±0,19). Average follow-up period was 15,5 months (±2,4). We evaluated binocular uncorrected and best corrected distance visual acuity (UDVA, BCDVA), near visual acuity (UNVA, BCNVA), and intermediate visual acuity (UIVA, BCIVA) 12 months after surgery, further the stability of visual acuity, objective refraction, mesopic contrast sensitivity, occurrence of complications, and patient satisfaction.
RESULTS: In all 8 patients, binocular UDVA of at least 1,0 was achieved. The mean spherical equivalent was +0,25 D (±0,64). UNVA was Jaeger No. 3 or better in 7 patients (68,7 %), 5 of them could read Jaeger No. 1. UIVA Jaeger No. 1 was achieved in 5 patients (62,5 %), Jaeger No. 2 in 2 patients (25 %), and Jaeger No. 4 in 1 patient (12,5 %). In all eyes, preoperative mesopic contrast sensitivity was within the normal range for the given age. Postoperatively it remained within the normal range in 11 eyes (68,7 %). In 5 eyes (31,3 %) we found adecrease below the lower limit in higher spatial frequencies (12 and 18 cycles/degree) during the entire follow-up period. According to the patient questionnaire, 7 patients (87,5 %) were fully satisfied with the outcome of the surgery and they felt independent of wearing glasses, 1 patient was dissatisfied. 7 patients (87,5 %) did not report the presence of photic phenomena (halo, glare), 1 patient suffered from these problems. We did not encounter any intraoperative or postoperative complications.Conlusion: According to our first experience, good distance, near, and intermediate visual acuity and arather high patient satisfaction can be achieved with the use of the Supracor procedure. Supracor seems to be asuitable method of presbyopia correction in motivated, adaptable patients who meet strict indication criteria. With regard to the small number of patients in our study group, agreater number of patient evaluations will be required in the future, and long-term results will be of interest as well.Key words: Supracor, presbyopia, LASIK, refractive surgery.

PMID: 25354821 [PubMed - in process]


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