Presbyopia

[yahuda]

My perscription for reading glasses is based on +3.00x -1.50 x 100 with progressive bifocals at 2.50. I recently had a comprehensive study on my eyes for Lasiks Surgery and was told that I am more than acceptable as a candidate for the surgery; however, due to my age and degree of presbyopia, I would need to wear reading glasses. For me the results was not enough versus the risk to merit the surgery. Is this common with patients having presbyopia or is there newer methods of surgery offered that would correct the disorder?

[LasikExpert]

Congratulations to you and your doctor for recognizing that although Lasik would probably be able to correct your refractive error, it would not provided what you desire.

Just so everyone understands, presbyopia is when the natural lens of the eye is unable to change focus to objects near. Presbypia normally is noticed after about age 40 and is when reading glasses or bifocals are required.

Many people who are presbyopic have Lasik incorrectly thinking that it will resolve all their vision problems. There are no surgical techniques that reliably and predictably resolve presbyopia. There are some workaround techniques.

A small amount of myopia (nearsighted, shortsighted) vision can limit the effects of presbyopia, but at the cost of distance vision. Multifocal contact lenses can provide near and distance vision, but not everyone is satisfied with the effects. Monovision, when one eye is slightly nearsighted and the other is fully corrected, can provide near and distance vision, but is incompatible for some people and has its own set of limitations.

I recommend that you try monovision correction with contact lenses. If you are satisfied with the effect, discuss the possibility of having laser eye surgery to gain the same effect without contacts.

[tricia77]

I have almost the same situation with presbyobia. The strength of my contacts +3.00 for left and +1.50 for right. I am 62 years old, have worn monovision contacts for 12 years. Most of the time with no problem. I "expect" if I have Lasik, not to have to wear contacts/glasses at my work computer all day long. My distance vision is somewhat blurred by my contacts...can't read a street sign till I'm almost there.
If I have to wear reading glasses to read the evening paper, I can deal with that. If I still can only read the street signs same as now, I can deal with that. Am I expecting too much from Lasik? My surgery is scheduled in 10 days, I'm still looking for a clear expectation.
Thanks for any help you can be.

[LasikExpert]

Tricia,

I think you may want to consider something altogether different than Lasik.

You say that your contacts are +3.00 and +1.50 to provide you monovision. You also say that your distance vision is not great. This indicates to me that the natural state of your eyes is plano (no refractive error) or slightly hyperopic (farsighted, longsighted). The contacts correct you to moderate/low myopia (nearsighted, shortsighted) vision.

To achieve vision with Lasik that is equal to your vision with contacts would require hyperopic correction. Hyperopic Lasik is not nearly as predictable as myopic (nearsighted, shortsighted) Lasik. The probability of a good outcome is much less. Yes, you can still get a good outcome, but it is just not as likely. You know all those "20 Minute Miracles" you hear about? They were not hyperopic Lasik corrections.

At age 62 you are undoubtedly fully presbyopic. That means that the natural lens within your eye is no longer able to change focus. Refractive Lens Exchange (RLE) is the process of removing the natural lens of the eye and replacing it with an artificial lens that provides the desired focus. Since your natural lens is no longer changing shape to change focus, RLE may be an appropriate alternative.

You can have RLE with monovision correction, or you can investigate the new multifocal artificial lenses. They are designed to provide focused vision for objects near, mid-range, and far.

RLE is exactly the same as cataract surgery. Cataracts are when the natural lens of the eye becomes cloudy. Cataract surgery may not be a procedure your Lasik surgeon performs. You may be well served to seek the opinion of a cataract surgeon to see if RLE would be a better choice.

One of the major advantages of RLE is that you would not need cataract surgery in the future. Since we all develop cataracts if we live long enough, RLE would mean one surgery, whereas with Lasik you would also need cataract surgery at some point in the future.

Another possible advantage of RLE is that it may be paid by your insurance. If you already have a cataract developing, then your major medical insurance (including Medicare) may pay for the operation.

For may reasons I believe you should investigate RLE before making a final decision about Lasik.