LASIK Over 40

By Dr. Shawn P. Brittain, OD & Dr. Dawne R. Griffith, OD

Published on July 20, 2006

If you are over 40 or fast approaching, there are things to consider when contemplating LASIK. As you add birthdays, there are changes in the eyes that cause the eyes to decline in ability to focus from far to near. This progressive inability to focus is called presbyopia.

If you have worn glasses or contact lenses in early adulthood, you were able to focus normally for close tasks through the same prescription that you used to see clearly in the distance. However, a person nearing 40 and beyond will notice that near tasks are increasingly difficult through that same prescription. You may find yourself sitting back further from your reading material or computer, or using brighter light to see more clearly. For some, removing their glasses allows for better vision up close. At this stage, your eye doctor may prescribe a bifocal in your glasses or suggest readers over your contacts. Essentially, your eyes need separate prescriptions for far and near.

LASIK can correct for one distance only, and for obvious reasons almost everyone elects to have the distance vision corrected. LASIK does not reverse the far-to-near focusing loss. Once LASIK has been performed, people over 40 will still need help looking at things within arm's length. The options for addressing your new need for near correction are as follows:

Reading glasses. This is the most common preference since it allows for both eyes to work together at any given viewing distance. Store-bought over-the-counter readers often work well for this. The strength needed for your eyes depends on your age and the viewing distance. Low to medium powers work best for those under 50 and for viewing at fingertip length. Medium to higher powers work better for those over 50 or who need a very close viewing distance.

Monovision. This option involves correcting your dominant eye for distance clarity and your non-dominant eye for near. The advantage is not needing reading glasses for most near tasks. The possible disadvantages include interference with distance clarity and some decrease in depth perception. For those who have not already experienced monovision with contact lenses, it is strongly recommended that you discuss this option with your doctor. People who are curious may be given the opportunity to simulate monovision with hand-held lenses or trial contact lenses to determine if it will be a suitable option for them.

Undercorrection. This is the least advisable option. The distance vision is intentionally not fully corrected, which allows for usable vision at mid-ranges. This results in slightly strained vision for near, and moderately blurry vision for very far distances. A low powered pair of glasses is worn for activities such as driving to sharpen distance vision.

Medical researchers are pursuing several options that may assist in refocusing the eyes for multiple distances or better yet, aid in the partial restoration of near visual function. Presbyopia may have multiple causes. It is commonly believed that the loss of flexibility of the crystalline lens (which is located behind the pupil), or loss of tension and strength of the muscles that flex the lens, are the main contributing factors of near vision decline. At this time there are no approved procedures that correct presbyopia, but hopefully within this decade new options will become clinically tested and FDA approved.

If you are fortunate enough to only need reading glasses for close work, then your only challenge is presbyopia, and LASIK is probably not the best choice for you. Until an effective procedure is introduced to combat presbyopia, people with good distance vision but requiring readers for close tasks will be best served in that modality for now. If you are over 40 and considering LASIK, it is important to know what to expect after your surgery. Research your options, talk to your eye doctor, talk to your LASIK surgeon and staff. A well-informed patient tends to be a more satisfied patient!

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