Can myopia, presbyopia and astigmatism be corrected in 1 surgery?

Doctor's Answer

Myopia and astigmatism (and hyperopia) are treated very well with LASIK or other refractive surgeries, but there is no procedure/surgery that will 'correct' or 'cure' or prevent presbyopia (Lao Hua).

So why can't presbyopia be corrected? Presbyopia is loss of the autofocusing ability of the eye and is due to age-related enlargement and stiffening of the lens inside your eye.

The lens in your eye is like a sealed pillow, where the filling slowly gets more and more as the lens cells grow and divide throughout life. Old skin cells can just drop off, but old lens cells remain with you inside the lens because they are trapped there by the lens capsule. If you can imagine the situation, a pillow will get harder and bigger if you stuff it with more and more cotton/feathers, and similarly, this happens in your eye's lens as you get older. There is no way to stop or reverse this process, so your eye's lens goes from 'autofocus' to 'single focus' when presbyopia develops.

If someone already experiences presbyopia (above 40 years of age) and would still like LASIK for correcting myopia/hyperopia/astigmatism, it is usual to offer 'monovision' to reduce the need for reading glasses after LASIK. This means that one eye is corrected to see in the distance, and the other eye is intentionally made mildly myopic (~-1.5D). That means distance vision relies mainly on one eye, and near vision the other. As you can tell, this is a compromise and may not suit everyone. It is not done for younger people because being able to see clearly with both eyes at any distance is always a nicer experience.

Some years ago, people tried other things for presbyopia, but all of them fell by the wayside and are not done much (if at all) nowadays. These include 'presby-LASIK', 'Intracor', Kamra inlay, Raindrop inlay…etc. They all either did not work predictably or gave rise to many unwanted side effects. The company that made the Raindrop inlay actually wound up and closed shop. Be very careful if you see any place advertising treatments for presbyopia-there is no perfect solution and the 'best' so far remains monovision, which itself is a compromise.

Your other question is essentially-when is the best time to do LASIK? The general advice is once you fit the age criteria and your spectacle power is stable, and you have made up your mind to have some surgery done, then it's best to do it earlier rather than later.

If you are 33, and you do LASIK to make both eyes see well in the distance, everything (near and far) will be clear for the next 10 years or so until presbyopia sets in. At that time, reading glasses will eventually become necessary, just like other people with 'perfect' vision.

If you wait 10 years until presbyopia sets in, you will have lost those 10 years of clear vision for everything, and still have to deal with the presbyopia-ie you will have to consider LASIK with monovision at that time.

Have a think about the issues raised above, and consider discussing it further with a doctor if you are still interested in surgery to correct myopia/hyperopia/astigmatism.

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