farsighted and lens surgery

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farsighted and lens surgery

Postby GeneralPatientInquiry » Sun Jun 04, 2006 4:47 am

I am considerring having Lasik surgery and have met and completed the screening with my local doctor. I have hyperopia of +5.75 (and wear the same prescription contact lens in both eyes). The doctor is willing to perform Lasik, but has given me another option. He has suggested Clear Lens Replacement because my vision is so poor. I was ready to go for Lasik, but am now reconsidering after he has given me this other option. In recent days I have began to research the CLR and am starting to feel quite nervous about this option, but I do not know if Lasik will "be good enough" for my poor vision. Is it possible to get "good correction" through Lasik with my current vision? Is CLR really that dangerous or risky?
Greg, Oregon
This post is a reprint of a previously requested inquiry received by USAEyes.org via email.
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Joined: Tue May 30, 2006 8:00 pm

Postby LasikExpert » Sun Jun 04, 2006 5:00 am


Let's start with a stark reality. Lasik for hyperopia (farsighted, longsighted) vision is not nearly as successful or predictable as Lasik for myopia (nearsighted, shortsighted) vision. Lasik for the significantly high 5.25 diopters of hyperopia that you have is probably going to be a long process with fluctuating vision, multiple surgeries, and vision that is not very likely to be as good as the vision you have with contacts.

Clear Lens Replacement (also called Clear Lens Exchange, Refractive Lens Replacement, and the currently accepted standard name of Refractive Lens Exchange - RLE) would seem to be an alternative reasonable to consider, but your age is a key factor.

RLE is essentially cataract surgery. The natural lens of the eye is removed and an acrylic or silicon artificial intraocular lens (IOL) takes its place. Your retina doctor will probably recommend acrylic over silicon. Visit Refractive Lens Exchange for all the details.

The problem with RLE and a conventional IOL is that you are no longer able to change focus from near to distance. Changing focus is called accommodation and virtually all current intraocular lenses do not accommodate with the exception of one. I'll get back to that one later.

At age 40 most people start to lose accommodation. This is called presbyopia and is a natural consequence of aging. The loss of accommodation is small at first, but before long it is difficult to read menus without moving them far away or using reading glasses. As a double whammy, (medical term there) the combination of presbyopia and hyperopia usually provides poor vision at nearly all distances.

Okay, I've painted a pretty bleak picture, but you do have some alternatives.

The most obvious is to continue using contacts and reading glasses as the presbyopia progresses. This is undoubtedly the least invasive, but at some point vision is really going to be poor.

I highly recommend you consider monovision correction. This is a process that corrects one eye for near vision and one eye for distance vision. You need to try this first with contacts, then if you are appropriate for monovision with RLE. For all the details visit Monovision.

You can have RLE with a standard IOL and immediately start using reading glasses to see things close, or you can opt for the new accommodating IOL called CrystaLens. A bit of warning, CrystaLens does not always work for everyone and can take months before it works well. Another alternative for near and distant vision is a multifocal lens. There is more about multifocal lenses at the RLE link above.

In summary with the least invasive first: You can use contacts and later use reading glasses. You can use contacts with monovision. You can have RLE with a conventional IOL and use reading glasses. You can have monovision RLE. You can have RLE with an accommodating or multifocal IOL.

Keep in mind that if you live long enough you are going to need cataract surgery. Doing so now may actually be better for you than doing it later when your health may not be as good as it is now. Discuss these issues with your doctor.

I do not personally recommend any corneal based surgery such as Lasik, PRK, LASEK, Epi-Lasik, CK, or LTK for you. None of these techniques are very good for someone with as much hyperopia as you.

If you decide to have RLE with a conventional IOL, then just about any good cataract surgeon can do this. Use our 50 Tough Questions For Your Doctor to help evaluate a potential surgeon. They are designed for Lasik patients, but will work for RLE.
Glenn Hagele
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Lasik Info &
Lasik Doctor Certification

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