How old is too old for LASIK surgery?

Hi Annette

When everyone gets above 40 years of age, we get something called 'presbyopia' (or Lao Hua/老花 in Chinese). I think you probably mean that you have myopia, astigmatism and presbyopia.

Presbyopia is the gradual loss of autofocusing power of the eye. As you lose this ability, things are only clear/in focus at one particular distance at any one time.

Say you wear glasses/contact lenses to look in the distance-then distance vision is sharp but near is not. If you take your glasses/contact lenses off, then near is sharper (depending on how much astigmatism you have) but distance is no longer sharp.

The effect of having LASIK surgery is like having contact lenses on all the time.

Therefore, if you have LASIK above 40 years of age, you will have to consider options to help with focusing at different distances. 46 is not 'too old' for LASIK, neither is 50, or 55, for that matter. People of this age who have LASIK done can minimize wearing glasses, but glasses will likely be needed some of the time depending on their visual needs because of the problem of presbyopia.

When people have LASIK at say, 25 years of age, everything, far and near will be sharp after LASIK. But when they get to 40 years of age and above, presbyopia will still appear.

People with myopia and astigmatism, who are above 40 years of age, have a few options to deal with the focusing problems.

1. Progressive/bifocal spectacle lenses
2. Separate distance and near glasses
3. Wear contact lenses for distance vision and reading glasses over the contact lenses for near vision
4. Monovision contact lenses (one side corrected for far vision and the other for near vision)
5. (Multifocal contact lenses)-the effect is somewhat less predictable and less effective than above

If you are considering LASIK and are above the age of 40, you should explore the option of monovision (like monovision contact lenses), since this compromise will give fairly good far and near vision and minimise the need to wear glasses.

So, when do we say it truly is not worthwhile to have LASIK any more?

That would be when you are nearing the age when many people start to get cataracts. Since cataract surgery can also correct refractive errors, and cataracts will blur vision despite LASIK, it would not be worthwhile to get LASIK done and then need cataract surgery done as well relatively soon after the LASIK.

Generally speaking, many people start to get some cataract in their 60s, in which case, LASIK would give less 'return on investment' beyond about 60. There is no official 'too old' for LASIK age, but this age of 60 may be a general rule of thumb.

There is theoretically no age limit for LASIK surgery. But in practical reality, most patients age 65 years and above would have some degree of cataract and would be better serve by a cataract operation.

If you are 46 and suffer from myopia, presbyopia (lao hua) and astigmatism, you can go for LASIK or TransPRK.

For patients age 40 years and above, most eye surgeons will advise mono-vision laser vision correction where the dominant eye is corrected to see well for near and the non- dominant eye is corrected to leave a small amount of residual myopia (about 1.50 dioptre or 150 degrees) to see well for near.

The difference between the two eyes are deliberately kept at no more than 1.50 dioptres so that in this way, binocular vision is still preserved for both distance and near!

It's true that once you have passed the age of 40, you may want to think about your other options besides LASIK. This is because, more likely than not, you would be affected by a mild degree of presbyopia and you may even have a mild degree of cataract.

Both of which, will potentially negate the benefits of LASIK since you may need reading glasses after or may even need cataract surgery sometime in the near future. Hence, after determining how much presbyopia or cataract you have, you may consider the other options available.

Having said that, at 46 years old, if you have no signs cataract at all and are open to having Monovision LASIK (where one eye is corrected for distance and the other eye is corrected for near), LASIK may still be an amenable option for you.

Discussing these options with your surgeon involves a detailed and thorough process where your surgeon will try to understand your daily activities, preferences, personality and expectations in order to give you the best advice. There is no straightforward answer for this, so it would be best to get a full consultation with an eye doctor that you are comfortable with.

Hope that helps.

Dr Claudine Pang

There are no strict limitations for when a person is no longer able to have LASIK. For patients older than 40, the surgeon will have to take into consideration the presence of other age-related eye conditions like cataracts. Should cataracts be a cause of poor vision, the surgeon may consider the option of cataract surgery instead. Via this path, the patient can have their cataracts replaced with a lens implant and potentially be spectacles independent for both near and far distances. In a patient with presbyopia (老花眼), LASIK corrects myopia and astigmatism to enable a patient to see at far distances without glasses. Some modification of the treatment can be done to help reduce the need for reading glasses as well.

Dr David Chan