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

Doctor's Answers (2)

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.

Dr David Chan

"Ophthalmologist with over 20 years of experience"

Your question is one that many laser manufacturers have tried to answer for decades. Firstly, do be aware that laser vision correction (LVC) was never intended to solve the issue of presbyopia in middle age. LVC (eg PRK, LASIK & ReLex SMILE) does try to attempt to address some limitations of presbyopia via various techniques like monovision or improvements in depth of focus.

Understand that none of the existing LVC techniques addresses the root cause of presbyopia which is the fact that the changes are occurring deep in the eye where the lens is slowly losing its ability to change its shape to accommodate different distances of focus. 

Whether to undergo surgery at this time of your life really depends on you. If your aims are to enhance your experience with your hobbies, sports and work then by all means do it now. After all, that would mean that you would not be burdened with glasses or contact lenses for at least 15 to 20 years.

Even when you are 50 years old, you should only need to wear glasses for reading. However, if you are looking for a LVC technique that solves your astigmatism and myopia today as well as your presbyopia in 15 years time then I would say that the LVC techniques currently will not meet ALL your needs.

The above is a good example of why it is important for surgeons to customise their treatment and advice to the patients' expectations and needs. A happy patient is one who is fully informed of any treatment’s advantages and limitations and is then able to make an informed choice as to whether the treatment result is going to improve his or her quality of life.

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