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Medical Forum / General / Vision / December 2004Does LASIK accelerate presbyopia?
Question for you LASIK experts and eye docs out there: I'm 39 and considering having custom LASIK done (my eyes are in the -7.5 range with -1.25 astigmatism). I don't need reading glasses now. I work at a computer all day, and believe I'd prefer having crisp far vision and occassionally wear reading glasses, rather then compromising my far vision by having monovision done. That is of course unless I'd need reading glasses to see a computer screen clearly. Here's a couple things I don't understand: 1) I understand that myopia delays presbyopia. But who would need reading glasses first, assuming it was the same person and all other things are equal: Someone who has LASIK done and is corrected to 20/20; the same person who never had LASIK done and who wears contact lenses and is corrected to 20/20; or a person who always had uncorrected 20/20 vision? 2) From what I've read elsewhere and from talking to people who had Lasik (who with contacts didn't need reading glasses, and suddenly after Lasik, their close vision was poor), I'm guessing that in the above scenario, the LASIK person would need reading glasses first. But why would that person need reading glasses sooner than the person whose contact lenses corrects his vision to 20/20? 3) How many years can someone reasonably expect that monovision will work, considering presbyopia gets worse over the years? If monovision is a temporary fix, then it kind of confirms for me that I don't want to have that done. 4) Do most people with presbyopia need reading glasses to see a computer screen, or is that far enough away that they don't need reading glasses to see it? Or do they just set their computer monitors so it shows everything larger? No need for the anti-Lasik folks to warn me of the dangers of LASIK, and no need for bickering in this thread between the anti-Lasik group and the pro-Lasik group. I'm just trying to learn more about presbyopia, and would also be interested in hearing from those who had LASIK done around age 40, and how their close vision was affected.  SignatureDK > 1) I understand that myopia delays presbyopia. But who would need reading > glasses first, assuming it was the same person and all other things are > equal: Someone who has LASIK done and is corrected to 20/20; the same > person who never had LASIK done and who wears contact lenses and is > corrected to 20/20; or a person who always had uncorrected 20/20 vision? Bzzzt... myopia does not delay presbyopia significantly. Presbyopia just presents less of a problem for myopes, because they can remove their glasses and see better up close than the rest of us; they have their reading glasses "built-in", and some regret losing the excellent near vision myopia gives. So one answer is that all three of your examples would be expected to develop presbyopia in the same time frame, _all other things being equal_. Which they never are. If your distance refraction is +0.50 (a little bit hyperopic) you'd still be considered "20/20" but presbyopia will bother you sooner. If your distance refraction is -0.50 (a little myopic) you might still eke out "20/20" but presbyopia won't bother you until later. If you have some astigmatism, that can actually help reduce the effects of presbyopia too. All of this variability is superimposed on the individual rate of presbyopia, working distance, and tolerance of blur. > 2) From what I've read elsewhere and from talking to people who had Lasik > (who with contacts didn't need reading glasses, and suddenly after Lasik, > their close vision was poor), I'm guessing that in the above scenario, the > LASIK person would need reading glasses first. But why would that person > need reading glasses sooner than the person whose contact lenses corrects > his vision to 20/20? Those who have LASIK and suddenly find their near vision poor were probably used to removing their glasses and relying on myopia to assist them up close. Or their surgery went a little to far and made them hyperopic. We usually advise older LASIK candidates with close occupations about the value of retaining a little myopia after surgery. > 3) How many years can someone reasonably expect that monovision will work, > considering presbyopia gets worse over the years? If monovision is a > temporary fix, then it kind of confirms for me that I don't want to have > that done. Monovision will always improve near vision somewhat, but it can't be relied on to match good binocular vision, and (surgical) monovision can't be adjusted as presbyopia gets worse. Because monovision can be designed in varying degrees, and because presbyopia bothers some sooner than others, and because some tolerate more monovision than others, it's hard to pin down a prediction about a specific age where it'll no longer work. > 4) Do most people with presbyopia need reading glasses to see a computer > screen, or is that far enough away that they don't need reading glasses to > see it? Or do they just set their computer monitors so it shows > everything larger? At first, glasses are only necessary for very close work, like reading medicine bottles and threading needles. Further away means less trouble, so it doesn't affect computer monitors until later, and you can compensate somewhat by moving further away and increasing font size. -MT > So one answer is that all three of your examples would be expected to > develop presbyopia in the same time frame, _all other things being equal_. > Which they never are. They never are. It's nice to read this statement. > > 2) From what I've read elsewhere and from talking to people who had Lasik > > (who with contacts didn't need reading glasses, and suddenly after Lasik, > > their close vision was poor), I'm guessing that in the above scenario, the > > LASIK person would need reading glasses first. But why would that person > > need reading glasses sooner than the person whose contact lenses corrects > > his vision to 20/20? Guess what? In the last fair I did in Naples, there came a woman aged 52 who had refractive surgery from a -11 and -6 myopic condition, who was so happy of her success that demonstrated to me how she could read the fine print at 40 cm with no trouble at all, and then proceeded to look at the snellen chart at 3 meters reading with normal vision. Her case was really a miracle. She confirmed that her surgeon also talks about her case as a true miracle, because they NEVER find such good response to the surgery, which was done 5 years ago. These rare cases do occour, and are just another good test that verifies Dr. Bates findings that the mental side of vision is what really matters. This woman was so impressed by idea that her mind would have got well with the refractive surgery, that she underwent it and after 5 years has not developed any problem, neither the problem of presbyopia. She was convinced that the laser was her solution, and up to now she is regarded by all as a UNIQUE case. It is the mind that governs all the processes in the body. It would have been a very interesting experiment to try to see if her true faith could have been used in the treatment without glasses. But this cannot be done now, since the surgery is irreversible, as far as we know. >> 1) I understand that myopia delays presbyopia. But who would need reading >> glasses first, assuming it was the same person and all other things are [quoted text clipped - 6 lines] >and see better up close than the rest of us; they have their reading glasses >"built-in", and some regret losing the excellent near vision myopia gives. Amen! Ten years ago I used to be able to close one eye, hold something about 2 inches from my open eye and focus right in on it. It was like having a magnifying glass built into my eyeball. :-) Now I'm presbyopic and the 2 inches has become 6 inches. Trouble is, I'm still myopic, so I can't see clearly anything further than about 9 inches. I can read without glasses as long as I hold the page within this range. If I wear single vision glasses for distance, I can't read with them. My solution, at least for now, is of course obvious: Bifocals. >[...] >> 4) Do most people with presbyopia need reading glasses to see a computer [quoted text clipped - 6 lines] >it doesn't affect computer monitors until later, and you can compensate >somewhat by moving further away and increasing font size. Yes. I can still see my computer screen clearly through the distance portion of my bifocals. But I know that this will not last. Most of the 50-somethings I know need to pull the screen closer and look through the reading part of the lens. For 60-somethings, even this doesn't work because they would have to pull the screen too close. They need computer glasses. I'm sure I'll get there too one day... :-( "Mike Tyner" <mtyner@mindspring.com> wrote in message > Bzzzt... myopia does not delay presbyopia significantly. Presbyopia just > presents less of a problem for myopes, because they can remove their glasses > and see better up close than the rest of us; they have their reading glasses > "built-in", and some regret losing the excellent near vision myopia gives. This is so true. At 39, the age of the original poster, and with my short sight (-4.5), I had never thought about presbyopia. I was, however, thinking of Lasik but am now glad I never had it done. Since then, presbyopia has cut in but, as Mike points out, I treasure the excellent near vision which myopia gives. The clear near-vision is so useful then I would no longer contemplate Lasik. Never. No way. Regards George > Question for you LASIK experts and eye docs out there: I'm 39 and > considering having custom LASIK done (my eyes are in the -7.5 range [quoted text clipped - 37 lines] > -- > DK I'm 38 and I had lasik a few years ago. Flap wrinkles (Striae) make reading a bit of a challenge even though I use reading glasses. Actually, I can only read out of one eye unless the font is pretty big. Contacts, even the rigid kind, don't offer much improvement. |
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