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I never realized that laser surgery could help me see more without reading glasses!”

Surgery Options

Presbyopia Laser Vision Correction Surgery

About


If you have developed noticeable presbyopia symptoms and don’t want to wear reading glasses, bifocals or contact lenses anymore and if your are under age 50 and have not begun to develop cataracts, presbyopia laser vision correction (also called LASIK monovision) may be a good option to consider-especially if you are also nearsighted or astigmatic. Talk with your doctor about whether presbyopia laser vision correction is right for you.

Like ordinary LASIK surgery, presbyopia laser vision correction can also correct existing refractive errors besides presbyopia, including nearsightedness, farsightedness and astigmatism.

If you’ve had LASIK before, you can still have presbyopia laser vision correction as a touch-up procedure (also called an enhancement).

How presbyopia laser vision correction works

    Laser vision correction for presbyopia uses the same equipment as other LASIK surgeries. Your surgeon uses a highly specialized laser-called an excimer laser -to reshape the cornea and give you focused vision.

    The excimer laser emits pulses of very concentrated and cool, invisible ultraviolet light. When targeted to specific spots on the cornea, it gently and precisely reshapes the cornea by removing extremely tiny amounts of tissue (25 100,000ths of a millimeter at a time), without disturbing other tissue.

    With presbyopia laser vision correction (unlike conventional LASIK surgery), one eye is corrected to focus for distance vision and the other is corrected to focus perfectly for near vision. Your brain effortlessly selects the image you want to focus on at each moment, so you see well at near or far distances. This is sometimes called "monovision."

    If you haven’t tried monovision before but are interested in this approach, your doctor can help you try monovision in advance using specialized contact lenses. This is an important step to confirm you would be able to adjust easily.

Types of laser vision correction

    There are different laser vision correction techniques and technologies to choose from for you presbyopia laser vision correction. Your eye doctor can carefully evaluate your eyes, health history and refractive error, as well as your age, lifestyle and career considerations and help you decide which type is appropriate for you.

    • Conventional LASIK corrects your vision based on your prescription for contacts or glasses. Your level of vision correction is determined using the familiar "which is better, this or that?" vision test. This type of LASIK can correct the main types of refractive error: nearsightedness, farsightedness and astigmatism.
    • Wavefront-optimized LASIK is a newer technology that corrects refractive errors while accounting for both the natural curvature of the eye and the unique characteristics of each individual’s eye. Because this type of LASIK follows the shape of the eye more closely, it has less risk of inducing subtle vision problems, called higher order aberrations, than conventional LASIK.
    • Wavefront-guided LASIK, sometimes called custom LASIK, creates a personalized map of existing higher order aberrations to correct refractive error and these more subtle vision problems. In some cases, existing higher order aberrations are severe enough to require this special treatment.

    Higher order aberrations may include subtle blurring, less clear visual contrast and even mild glare, halos or starbursts around lights at night.

    Newer-generation lasers will deliver the best results, but all three types of LASIK surgery have been shown to be very safe, with the highest satisfaction rates overall of any elective surgery. Which procedure is right for you depends on:

    • Your eyes-some patients have corneal scarring or other conditions that may prevent them from having Wavefront LASIK, and a few patients have higher order aberrations that may require Wavefront-guided LASIK.
    • Your goals-Wavefront-guided and Wavefront-optimized LASIK are the newest technologies and generally deliver better results. However, they may cost a few hundred dollars more per eye, depending on your provider.

    Your eye surgeon will work with you to recommend the most suitable option for your eyes.

Other laser vision correction choices

    The type of laser vision correction surgery is just one choice that must be made before your presbyopia laser vision correction. You and your surgeon must also decide how the corneal flap will be created.

    To perform laser vision correction, your surgeon will create a very thin flap in the cornea of your eye. Most patients feel little or no pain and do not see this occur. The flap is folded back so that tissue can be removed from the middle layer of your cornea to correct your vision. When the surgery is completed, the flap is folded back into place so that your eye will heal more easily.

    There are two ways the flap can be created:

    • Traditional technique-using an automated instrument called a microkeratome
    • All-laser "bladeless" technique-using a high-energy laser, called a femtosecond laser

    Both techniques have certain advantages. Here are a few things you should know about the "bladeless" or all-laser technique before you and your surgeon make your choice. "Bladeless" techniques:

    • May be more predictable, reduce the incidence of epithelial defects and can be customized for eyes with oval or asymmetrical surfaces.
    • Have been shown to give patients a better quality of vision with fewer higher order aberrations during the first three months after surgery.
    • May cost a few hundred dollars more per eye, depending on your provider.
    • Take about 10 seconds, while the traditional flap only takes three seconds.

Whatever you choose, you can rest assured that laser vision correction has been shown to be a very safe procedure using all of these approaches. Learn more about what kind of outcomes can be expected from presbyopia laser vision correction.

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Glossary

Not sure what a particular term means? Click on words in bold to pull up the glossary tab.

FAQ

I’m happy with my glasses and contacts. Should I have laser vision correction?

    Most surgeons agree that if you are comfortable wearing contact lenses or glasses and are not bothered by being dependent on them, you should carefully evaluate the risks and benefits of vision correction surgery before making a decision.

Can I have laser vision correction if I play extreme contact sports?

    Presbyopia laser vision correction is a type of LASIK surgery. Many members of the military, pilots and professional football and basketball players have had successful LASIK procedures. However, regular participation in contact sports such as boxing or wrestling may disqualify you for LASIK. If you are disqualified for LASIK because of these types of activities, PRK may be a more appropriate option.

Will my eyes look different after laser vision correction?

    No. Your eyes will look the same.

Related Content

Glossary Entries

Astigmatism
Common vision problem and type of refractive error. Caused by either irregularity in the curvature of the cornea or the lens of the eye. People with astigmatism generally have difficulty seeing fine details at all distances. Treated with corrective lenses, laser vision correction or toric IOLs.

Bifocals
Eye glasses that combine two lenses made for focusing at different distances. Typically the upper lens provides clear distance vision and the lower lens clear close vision for reading and seeing fine details.

Cataract
Clouding of the eye's lens that blocks passage of light to the retina, resulting in impaired vision. Often a result of normal aging, cataracts form when protein clumps cloud areas of the eye's lens. As the cataract progresses, vision worsens and often requires surgical replacement of the damaged lens with an artificial one.

Close or near vision
Vision that allows you to see objects close up well, sometimes called “reading vision.”

Conventional LASIK
Laser surgery that corrects the main types of refractive error (nearsightedness, farsightedness and astigmatism) based on your prescription for glasses or contacts. Conventional LASIK is usually compared to Wavefront-guided and Wavefront-optimized LASIK, variations of LASIK surgery that are more customized to each individual's eyes.

Cornea
Clear, curved surface at the front of the eye through which light enters the eye. Along with the sclera (the white part of the eye), provides external protection for the eye. Often called the window of the eye. During many types of vision correction surgery, such as LASIK, the cornea is reshaped to reduce or eliminate the main types of refractive error - nearsightedness, farsightedness and astigmatism.

Distance vision
Vision that allows you to see objects far away.

Epithelial defects
Defects in the epithelium (protective layer of cells on the cornea) can allow invasion by bacteria, fungi, viruses or Acanthamoeba. Can be initiated by mechanical trauma or nutritional deficiencies. Symptoms are progressive redness, foreign body sensation, ache, sensitivity to light and tearing.

Excimer laser
Type of "cold" laser that emits ultraviolet light. Used in refractive surgery to remove corneal tissue and reshape the corneal surface.

Farsighted, farsightedness (or hyperopia)
Common vision problem and type of refractive error. Caused by too little curvature of the cornea or too little distance between the front of the eye and the retina at the back. Both structural defects cause light entering the eye to focus incorrectly on the retina, resulting in blurred close-up vision. Treated with corrective lenses, laser vision correction or multifocal or accommodative IOLs.

Femtosecond Laser
Type of high energy laser used in "all-laser" or "bladeless" LASIK to create the corneal flap.

Glare
Appearance of additional luster around lights that can interfere with vision, especially night vision. Sometimes occurs as a side effect of LASIK surgery and often decreases with time. May also be caused by cataracts or other eye conditions.

Halos
Appearance of rings around lights at night. Sometimes occur as a side effect of LASIK surgery and often decreases with time. May also be caused by cataracts or other eye conditions.

Higher order aberrations
More complex irregularities of the eye that can cause vision problems such as difficulty seeing at night, glare, halos, starbursts or double vision. Some small degree of higher order aberrations are normal and do not usually cause noticeable vision problems.

LASIK (laser in-situ keratomileusis) surgery
Type of laser surgery in which the cornea is reshaped to improve vision. Either a microkeratome or a femtosecond laser is used to surgically create a thin, hinged flap of corneal tissue. The flap is folded back, and an excimer laser is directed to the corneal surface exposed beneath the flap to reshape the cornea for corrected vision. Then the flap is brought back into place.

LASIK Monovision
LASIK surgery to correct vision so that one eye focuses clearly on far objects and the other eye focuses clearly on near objects. The brain combines the two images to create clear vision at all distances.

Microkeratome
Precision surgical instrument used to create the corneal flap in the uppermost layer of the cornea during LASIK.

Nearsighted, nearsightedness (or myopia)
Common vision problem and type of refractive error. Caused by either too much curvature of the cornea or too much distance between the front of the eye and the retina at the back. Both structural defects cause light entering the eye to focus incorrectly on the retina, resulting in blurred distance vision. Treated with corrective lenses, laser vision correction or multifocal or accommodative IOLs.

Presbyopia
Also called age-related focus dysfunction. Common vision problem that develops naturally over time. Characterized by loss of the eye's ability to focus at close distances or on fine details. Treated with reading glasses, contact lenses, presbyopia laser vision correction (also called LASIK monovision) or presbyopia lens replacement surgery.

Refractive error
Irregularities in the cornea, lens or shape of the eye that prevent correct focus at any distance.

Starbursts
Appearance of rays or fine filaments of light coming off a light source, such as a headlight of a car. Can become longer and denser at night. Severity of starbursts varies-they may be experienced differently in terms of size, shape, length of rays, the density of rays and transparency (whether the light source is visible through the starburst). Sometimes occur as a side effect of LASIK surgery and often decreases with time. May also be caused by cataracts or other eye conditions

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