LASIK Surgery for Farsightedness Due to Aging (Presbyopia)

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KEY POINTS

• Presbyopia is the loss of clear close-up vision that happens naturally as people get older.
• LASIK is a type of eye surgery that uses a laser to change the shape of the cornea. Reshaping the cornea changes the way the eye focuses. If you only need eyeglasses for reading, LASIK may not be right for you.
• Ask your provider how long it will take to recover and how to take care of yourself at home.
• Make sure you know what symptoms or problems you should watch for and what to do if you have them.

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What is LASIK surgery for presbyopia?

LASIK is a type of eye surgery that uses a laser to change the shape of the cornea. The cornea is the clear outer layer on the front of the eye. LASIK is an abbreviation for laser in situ keratomileusis.

Presbyopia is the loss of clear close-up vision that happens naturally as people get older. Around the age of 40, the lenses of your eyes start to lose elasticity and flexibility. With less elasticity, the eye may be unable to focus sharply on close objects. You may need to hold things farther away from your eyes to see them clearly.

When is it used?

LASIK works best if you need to have your vision corrected because you are nearsighted, farsighted, or have astigmatism. Reshaping the cornea changes the way light rays enter your eye. This changes the way the eye focuses. If you only need eyeglasses for reading, LASIK may not be right for you.

Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Very accurate measurements are needed for LASIK. Contact lenses can change the shape of the cornea. Do not wear rigid contact lenses for 3 weeks or soft contact lenses for 2 weeks before your appointment for evaluation for surgery. Ask your provider how long before the procedure to stop wearing your contacts.
• Plan for your care and a ride home after the procedure.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Do not wear eye makeup, perfume, or cologne on the day of the surgery.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.

What happens during the procedure?

The surgery is done in an office with laser equipment. The provider numbs your eyes with eye drops. Then he or she makes a small cut part way into the cornea. The provider leaves one edge of this tissue attached to your eye, forming a flap. The flap is then opened, like a door on a hinge. Your provider uses the laser to remove thin layers of tissue inside of the cornea until it is the right shape to improve your vision. The removal of tissue changes the shape of the cornea so that light rays can focus on or closer to the retina, which improves your vision. At the end of the procedure, the provider replaces the flap. No stitches are needed.

There are 2 kinds of LASIK surgery that may correct presbyopia:

• Monovision: The only currently available FDA-approved LASIK procedure provides monovision. This means one eye is corrected for better distance vision, and the other eye is corrected for better near vision. Many people cannot adapt to seeing different distances with each eye. This can cause problems like loss of depth perception. It's a good idea to try monovision with contact lenses first to be sure you can adapt to it before you have monovision LASIK.
• Multifocal LASIK: A laser reshapes your cornea into different zones for near, far and middle vision. In each zone, light is bent (refracted) differently. Your brain then selects which zone it needs to see through to get the sharpest vision, depending on whether an object is near or far away. Multifocal LASIK is usually done on both eyes. This type of LASIK is not yet FDA approved.

What happens after the procedure?

Usually you will be able to see well in a few hours. You will have little or no pain. Your eyes may feel dry for a few days or weeks. Your provider can prescribe eye drops to reduce the dryness.

If needed, your provider can repeat the procedure at a later time to fine-tune your vision.

Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid
• How to take care of yourself at home and when you can return to your normal activities
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of LASIK?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• Your eyes may be over-corrected or under-corrected, and you may still need glasses. If needed, your eye care provider can repeat the surgery to improve your vision.
• You may have scarring that causes an irregular astigmatism. Some people have trouble with glare or night vision after this procedure.
• In rare cases, the cornea gets severely inflamed (keratitis). This may need treatment with eye drops or more surgery.
• Very rarely, you may get an infection, which can cause your vision to be worse than it was before the procedure.
• Very rarely, the flap may be moved if there is minor injury to the eye, because the flap will never heal to the same strength as the cornea.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.