Whether you were born nearsighted or you’ve reached the age where you stash reading glasses all over the house, the possibility ditching eyewear or contacts altogether holds considerable appeal.
Today, you can choose from a variety of surgical procedures to reduce your dependence on corrective lenses. Robert Filer, M.D., a Mills-Peninsula Medical Center ophthalmologist and cataract surgeon, describes options and limitations for improving your eyesight with surgery.
LASIK
Popular for more than 20 years, LASIK is the most common type of refractive surgery—surgical methods that correct or improve vision deficits such as nearsightedness, farsightedness and astigmatism. LASIK (laser-assisted in situ keratomileusis), an outpatient procedure, uses a laser to reshape the eye surface, or cornea, improving how your eye focuses light onto the retina.
“If you’re 21 years old and nearsighted—and if you’re a good candidate—LASIK is fantastic because then you’re likely free of glasses for 20-plus years,” Dr. Filer says. “But after age 40, as your eyes lose the ability to focus close-up, you’ll still eventually need glasses to read. LASIK can’t fix that condition, called presbyopia.”
An estimated 9 out of 10 people who choose LASIK achieve vision between 20/20 and 20/40 without eyeglasses, according to the American Academy of Ophthalmology. You may be disappointed if you expect perfect vision without glasses or contacts. Some people still need corrective lenses for certain activities, such as reading, driving or tasks requiring very sharp, detailed vision.
Very nearsighted or farsighted people are less likely to experience optimal results, and may need an additional treatment to achieve the desired vision correction. And for some people, the surgery’s effects lessen over time, Dr. Filer says; if the cornea is thick enough, a second surgery, called an enhancement, may be done to fine-tune the results.
PRK
An older procedure than LASIK, photorefractive keratectomy (PRK) also uses laser technology but treats the cornea from the surface down instead of creating a hinged flap, as in LASIK surgery.
If you have thin corneas or certain other conditions, such as corneal dystrophy, PRK can be safer than LASIK, Dr. Filer says. Otherwise, “LASIK would be the treatment of choice because you’ll be much, much more comfortable after the surgery.” The two procedures provide similar results, but PRK involves a longer healing time, he says.
Cautions and Questions
In addition to those with thin corneas or certain corneal disorders, people who play contact sports, such as wrestling or martial arts, may not be ideal LASIK candidates. Your glasses prescription must also be stable, with no changes for at least a year.
“Refractive surgery isn’t for everyone,” Dr. Filer says. “But if the examining physician does a good, thorough exam and the corneas are thick enough, they’re great procedures for the right candidate.”
Also weigh LASIK’s potential side effects, which include severe dry eye, nighttime vision problems and even partial vision loss, according to the FDA.
If you’re considering LASIK, the American Academy of Ophthalmology offers a list of questions to ask your doctor.
And remember, no procedure can guarantee glasses-free vision for life.
“People over 40 are so frustrated because even if they had LASIK, they still have to do something for close-up work, which becomes more of an issue as you become older,” Dr. Filer says.
If you have presbyopia or are not a good candidate for LASIK, ask your ophthalmologist about refractive lens exchange, also called clear lens extraction—essentially cataract surgery for people who have not developed cataracts. The surgeon removes your natural lens and replaces it with an artificial multifocal lens that allows you to focus at different distances.
Speak with your doctor about the risks, which are similar to cataract surgery and include the possibility of retinal detachment, particularly if you’re very nearsighted.
If you only need to correct presbyopia so you can read the fine print, you might want to stick with reading glasses or progressive lenses for now. “Some way to give people over 40 their reading vision back is probably one of the biggest areas of eye research,” Dr. Filer says. And while new procedures come out all the time, “personally I don’t think the technology is there yet.”
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