This article is for educational purposes only and is not medical advice. Please see the full disclaimer at the end.
Many patients in their mid-forties come to us tired of distance glasses and newly frustrated with reading glasses, hoping LASIK will solve both. It cannot. The reason takes only a few minutes to understand, and it often changes which procedure makes the most sense.
The cornea, the clear dome at the front of the eye, does most of the focusing, and its power is fixed. Behind the iris sits the natural lens, which is flexible. When you look at something close, a ring of muscle lets the lens thicken and focus more strongly. That is how you read.
Nearsightedness, farsightedness and astigmatism are mainly problems with the shape of the cornea or the length of the eye. Laser vision correction fixes them by changing the curve of the cornea.
Presbyopia is a different problem in a different place. The lens slowly stiffens throughout life, and by the mid-forties it can no longer change shape enough to focus up close. Reshaping the cornea does nothing for this, because the cornea was never the part doing that job.
If you are nearsighted, you have probably been able to take off your glasses and read comfortably up close. That is not strong near vision. Your nearsightedness has been working like a built-in pair of reading glasses.
LASIK removes the nearsightedness. Distance vision becomes sharp, and the easy reading without glasses goes away the same day. This is not a complication; it is the expected result of the procedure. But it feels very different when you hear about it beforehand, and a proper consultation always covers it.
What you gain: sharp, natural distance vision.
The trade-off: reading glasses for close work, starting right away.
One eye is corrected for distance and the other is left slightly nearsighted for near.
What you gain: most everyday tasks without glasses.
The trade-off: slightly less depth perception and slightly less crisp night driving. About one in five people cannot adapt to it, which is why it is tried with contact lenses before surgery.
The eye's natural lens is replaced with a lens implant.
What you gain: distance and near vision from one procedure, and you can never develop a cataract.
The trade-off: it is surgery inside the eye, so the risks are higher than with LASIK, and it is not covered by insurance.
Age is a rough guide, but the condition of your lens is what really decides it. In the mid-forties, with a clear and healthy lens, LASIK or monovision is usually the sensible choice; replacing a perfectly good lens is a big step for this problem. By the mid-fifties, most lenses show early changes on examination even when vision still seems good. At that point lens exchange is no longer an over-reaction: it treats presbyopia, corrects your prescription and takes cataract surgery off your future.
In between, it is a real conversation about how much you drive at night, whether you read on paper or on screens, how monovision felt if you have tried it, and what your lens actually looks like on examination.
A promise that laser treatment alone will give you full-range vision after 45. No laser procedure on the cornea can restore focusing to a stiffened lens. Patients who believe otherwise are the ones who end up unhappy.
Being steered straight to lens exchange at 44 without a serious discussion of the alternatives. Lens exchange is a good operation and the right answer for many patients, and it is also the most expensive option.
Dr. Feiz performs all three procedures, so his recommendation follows your eyes. When the best answer is to stay in glasses for now, he will tell you.
Can LASIK fix my reading vision?
No. Reading vision fades because the lens inside the eye stiffens with age. LASIK changes the cornea, which is a different structure, so it does not restore near focus.
What is monovision?
One eye is corrected for distance and the other is left slightly nearsighted for close work. The brain adapts and uses whichever eye is sharper. About one in five people cannot tolerate it, so it is tried with contact lenses before any surgery.
Am I too old for LASIK at 45?
No. LASIK works well at 45 and older. What changes is what it gives you: clear distance vision, and reading glasses for close work unless you choose monovision.
When does lens exchange make more sense than LASIK?
Usually from about age 50, especially if your lens already shows early changes, if you are farsighted, or if your prescription is too high for safe laser treatment of the cornea.
Will I need reading glasses someday anyway?
Yes. Presbyopia happens to everyone who lives long enough, whether or not they have had laser vision correction.
If you are in your forties or fifties and want to know which approach fits your eyes, Dr. Feiz will examine you personally and explain your options. Call Eye Care of East Bay at (925) 705-7299 or contact us online to request an evaluation.
This article provides general educational information only. It is not medical advice, diagnosis or treatment, and reading it does not create a doctor-patient relationship with Eye Care of East Bay or any of its physicians. Every eye is different, and the right choice for you depends on a full eye examination.
Do not delay seeking professional care, or make decisions about surgery or medications, based on what you read here. Talk with a qualified eye care professional about your own situation. If you have sudden vision loss or another emergency, call 911 or seek immediate medical care.