Being that it’s a presidential election year, we are hearing a lot about the candidates. But no matter what year it is, I am always asked by patients if they are candidates…for vision correction surgery. I would like to use this month’s blog post to talk about some new options which make more people eligible for vision correction surgery.
Myopia
Myopia is a condition where people have good near vision but need correction to see at distance. Their eyes are either too long or focus too much. Most moderate to high myopes (correction of -3.00 and above) are candidates for laser vision correction: LASIK or PRK. Some of the very high myopes (-9.00 and above) might be better suited to an ICL, a lens that goes in the eye over the natural lens that refocuses the eye at distance. This lens has provided excellent vision to patients who were told in the past that they were “untreatable.”
Low myopes are also candidates for laser vision correction but if they perform lots of near tasks or are over 40 years old we may move with caution before operating on them. Presbyopia is the the loss of the ability to focus at near as a person ages, beginning around age 40 in most of us. A high myope over age 40 will come to office complaining about how they have to put reading glasses on over their contact lenses to see at near. Most of them are agreeable to laser vision correction to eliminate the contacts because they are used to having excellent distance vision by wearing contacts the entire day; reading glasses are not that much of a bother because their level of myopia is more of a handicap than a help. Low myopes usually have the option of removing their glasses or contacts to perform near tasks. Permanently correcting their vision for distance usually means glasses for reading all day where they used to wear the glasses mostly to drive. This is usually not a favorable swap for most people unless they have made a lifestyle choice to have better distance vision for the purposes of sports or other leisure activities. Some of these patients do well with monovision, where one eye is corrected at distance and the other left uncorrected. This costs less and maintains near vision.
Hyperopia
Hyperopia is the opposite of myopia but does not exactly behave in an opposite manner. Hyperopic eyes are relatively weak or are shorter than average. In younger patients who have robust ability to focus, the hyperopia is silent because the patient is able to compensate. These patients often have “pilot vision” because, technically, the further objects are from them, the clearer they are. High hyperopes (+4.00 and above) may find themselves in reading or reading/distance glasses relatively early in life. The lower hyperopes function well until…presbyopia starts to set in. As these patients approach 40 they find their reading vision slips. As 40 starts to fade in their rearview mirror, their distance vision may also start to slip, requiring glasses for just about everything.
While hyperopia is amenable to laser treatment, it is used less frequently today for two reasons. While myopic laser (flattening the cornea to reduce the focus power) stays relatively stable over time, hyperopic laser (steepening the cornea to increase the focus power) has a tendency to fade over time with loss of effect. Additionally, just correction a distance deficit is not enough for these patients; they want to recover their reading vision, too. That is even more challenging with the laser. Thankfully, over the last 10 years, ophthalmologists have become more comfortable with the concept of lens replacement surgery to correct hyperopia. This is the same surgery used for cataracts except that the lens we surgically remove is not damaged by cataract, it’s just too weak for that person’s eye. Employing either a monovision strategy (one eye near, one eye far) or multifocal lenses (each eye sees near and far independently to simulate focus) we can get hyperopes out of glasses and contacts for the rest of their adult life.
“Plano Presbyopes”
Plano presbyopes are people who have little or no refractive error at distance but just lose the ability to read after age 40. If these patients do well with a reading contact lens in one eye only (monovision) they might be a candidate for some type of vision correction surgery. This area is controversial because there is still resistance in some camps to performing surgery on a “20/20 eye.”
Special cases
Suppose that you have lived your entire life with a “good eye” and a “bad eye.” If your bad eye is affected by amblyopia (commonly known as lazy eye) or damaged by an injury or other disease, the odds are that the eye cannot be helped. But if the eye sees poorly because of a high refractive error or extreme levels of astigmatism and can be corrected with glasses or contact lenses–which may have proven to be too uncomfortable to use–then it is sometimes possible to rehabilitate the vision w/ laser or lens replacement surgery. This is especially helpful in presbyopes, where the bad eye can be converted into a reading eye and reduce the need for reading glasses.
So don’t let all the Republican and Democratic candidates have all the fun! Call us today at 305-598-2020 to schedule a free evaluation at our Miami, Florida location to see if you’re a candidate for vision correction surgery!
By: Dr. Charles Kaiser
Center For Excellence in Eye Care
