We've all seen it: someone holding an object FURTHER away just to read what is written on it? Perhaps you are doing this yourself? I am often presented with patients who are annoyed by this loss of near or reading vision that comes with age, or as we call it, presbyopia. This common condition affecting individuals after age 40 is caused by a lack of flexibility in the eye's focusing lens which prevents it from adjusting (accommodating) when we change focus from a distant object to a near one. While loss of accommodation occurs naturally and is generally not noticeable to us during the first three decades of life, this gradual loss of near vision starts to become noticeable as we enter our 40s.
How is presbyopia treated? In most cases, people initially reach for low-powered reading glasses, which are available over-the-counter at most drug stores and dollar stores. However, reading glasses or "cheaters" don't fully correct the presbyopia if you already need glasses or contacts for myopia, hyperopia, or astigmatism. Another potential solution is the new prescription eye drop called Vuity, which contains a medication that constricts the pupil and assists the eye's ability to accommodate. Far from a perfect solution, Vuity must be placed in the eye daily, doesn't fully correct the presbyopia, may have side effects, and doesn't address the underlying problem of a dysfunctional lens.
What about LASIK? Laser vision correction such as PRK, LASIK, or SMILE, reshape the cornea to correct primary refractive errors such as myopia, hyperopia, and/or astigmatism. However, they do not specifically correct presbyopia, as they do not treat the dysfunctional lens. Patients in their 40s may still be a candidate for LASIK, but in order to maintain near vision will need some form of blended vision or monovision, where we intentionally create or retain some near-sightedness in the non-dominant eye while correcting the dominant eye for distance. If you already have experience with monovision with contact lenses, this may be an option for you. Far from perfect, monovision does reduce your overall depth perception (judging of distances), and may lead to a feeling of dizzyiness in some people.
The most definitive way to permanently correct presbyopia is to remove the dysfunctional lens and replace it with an advanced technology lens implant in a procedure called a refractive lens exchange (RLE). Advanced technology lenses such as the RxSight Light-adjustable lens and the Alcon Vivity lens both create and extended depth of focus that preserves most of your near vision while maintaining excellent distance vision with minimal side effects. The Alcon PanOptix lens takes the near vision to the next level with potential for 20/20 vision throughout the entire range of vision from distance to intermediate and near vision. Having RLE with an advanced technology lens doesn't require monovision to see up close, and prevents you from needing cataract surgery in the future. It's often our go-to solution for those wishing to finally get rid of glasses (and their ongoing expense!) for decades or longer!
If you're ready to reduce or eliminate your need for reading glasses once and for all, give us a call today to schedule a consultation for LASIK or refractive lens exchange. We evaluate each patient individually and develop a custom vision correction plan that best serves your visual needs.