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Jun Wei
VIP
from Singapore asked a question

Is there any evidence to show that LASIK can worsen presbyopia?

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Eye & LASIK
I am 21 years old and keen to do LASIK. But I have one concern: is it possible that LASIK can worsen presbyopia or cause earlier onset of it? Is there any data showing this?
DOCTOR’S ANSWER (4)

Hi Jun Wei

LASIK will not worsen presbyopia ('Lao Hua'), nor will it accelerate its development.

In other words, presbyopia develops at the same rate and becomes manifest at a particular age (around 40 years of age or so) whether you had LASIK done or not.

Why so?

LASIK purely alters the shape of the cornea (the clear window at the front of your eye). Presbyopia on the other hand involves the loss of autofocusing capability of the lens of your eye. This lens is inside your eye, completely separate from the cornea and not affected at all by LASIK or any other laser refractive procedure.

Presbyopia is a much misunderstood condition, and there are endless myths about it.

But it is very simple. It is like your autofocus camera got stuck and cannot autofocus for all distances.

If you are myopic (shortsighted), and you are presbyopic, and you don't wear glasses/contacts, your eye's focus is stuck at near. So you can see near without glasses, yes, but far is all blurry until you put the glasses on. When you put the glasses on, far is clear, but near is not clear anymore. The problem is the autofocus is stuck-which is presbyopia.

If you are plano/emmetropic (neither long nor shortsighted), and you are presbyopic, and you don't wear glasses/contacts, your eye's focus is stuck at far. So you can see far without glasses, yes, but near is all blurry until you put the glasses on. When you put the (reading) glasses on near is clear, but far is not clear anymore. Again, the autofocus is stuck, this time it is stuck at far focus.

Presbyopia is caused by the age related enlargement and stiffening of the lens of your eye. It is like stuffing a pillow fuller and fuller with cotton/feathers. Your eye's lens has cells inside it that are trapped within a capsule. Over time the lens cells slowly grow and divide and have no where to go. Like the pillow that gets stuffed fuller and fuller, it gets stiffer and harder. Eventually it fails to respond to ciliary muscle contractions anymore. This process is independent of procedures such as LASIK.

There is, however, to my knowledge one paper showing apparent progression of presbyopia after LASIK: (Tsuneyoshi et al. Am J Ophthalmol 2014; 158:286-292. (https://www.ncbi.nlm.nih.gov/pubmed/24853261)

One of the likely causes of this is because people who wear glasses naturally require less accommodative effort, than emmetropes, contact lens wearers or post LASIK patients. This is explained by the thin lens formula. (Apologies, could not find a way to paste a diagram of the formula)

In this study, the authors state: 'Unfortunately, in the current retrospective  study, we did not have the add power data obtained with the patients wearing contact lenses before LASIK.' In essence, if the authors had compared pre-operative add requirements while wearing contact lenses, vs post-LASIK add requirements, they may not have seen the apparent progression of presbyopia that was reported.

Therefore, there is still no evidence of a real effect of LASIK on presbyopia, that is greater than what you might see with, say, a contact lens wearer. People who wear spectacles for myopia correction, however, may notice a greater effect on their near vision after LASIK than what they had experienced while wearing glasses. But that would most likely be due to a side benefit of their glasses, rather than a detrimental effect of the LASIK surgery.

Consult Doctor
0 561 views 0 Doctors agree 11 Apr 2018

Hi Jun Wei,

To my knowledge there is no data to show that LASIK can worsen presbyopia.

What you need to understand that when LASIK is performed to treat any eye degree, it does not stop the eye from aging. And presbyopia is basically an issue with the aging eye. At about 40 years old, human eyes start to lose its full ability to focus for near.  This is compensated for by being short-sighted.

Whether you are not myopic by virtue of being simply "lucky" or not myopic because you had LASIK done to treat your myopia are the same when you get to around 40.  You will start to be affected by presbyopia then.  

Similarly, if you are myopic and did not bother to have LASIK before and are wearing contact lenses, you will still feel the effect of presbyopia while you are wearing your full correction in your contact lenses.

Having uncorrected myopia "neutralizes" the presbyopia, so to speak.  But that will mean having to live with poor vision for far, which may young and active people will not be happy about!

Hope that helps to clarify your question :-)

Dr Han

Consult Doctor
0 575 views 0 Doctors agree 11 Apr 2018

Dear Jun Wei

To begin, I would like to explain the concept of LASIK and presbyopia.

Presbyopia is caused by the loss of elasticity of our crystalline lens, resulting in the inability to focus well at near. This is part and parcel of ageing. Most people generally experience this onset in their 40s.  

LASIK is a type of laser vision correction procedure that is performed by an ophthalmologist using laser to reshape the front part of the eye called the cornea.

LASIK does not alter your focusing ability. Hence, it does not worsen presbyopia or cause earlier onset of presbyopia. Patients with healthy eyes will not lose their focusing ability after LASIK. However, as they approach or enter their 40s, focusing ability will be reduced and a pair of reading glasses may be required. 

Hope I have addressed your concerns with regards to the relationship between LASIK and presbyopia. I would recommend for you to go for an eye evaluation to determine your suitability for LASIK and have further discussion with an ophthalmologist.

Dr David Chan

Senior Eye Consultant 

Consult Doctor
0 547 views 0 Doctors agree 13 Apr 2018

Hi Jun Wei,

This is a frequently asked question. There is no evidence nor reason to suggest that Lasik can worsen presbyopia as presbyopia is a condition that occurs in middle age due to stiffening of the native lens, whilst Lasik is corneal-refractive surgery.

The most common reason why people believe that Lasik worsens presbyppia is that the patients pre-existing short-sightedness means that NO accommodation is required to see near objects. Hence once presbyopia sets in for everyone after the age of 40 years old, myopic patients are still able to see by removing their spectacles.

Patients who have undergone vision correction for distance, and subsequently develop presbyopia will not be able to see near objects simply by removing their spectacles (since they don't have any residual short-sightedness, and hence do not wear spectacles)

This is most likely the source of the mistaken impression that presbyopia is caused by Lasik surgery.

Patients who have performed Lasik many years ago and subsequently develop presbyopia have several options to deal with their new state, including monovision enhancement and PiXL treatment of the non-dominant eye.

In summary - Lasik is still a great option for young people and very few people have ever regretted their decision to be spectacle-free. Have an indepth discussion of your concerns with your treating ophthalmologist and they would be able to clear up any concerns that you have.

ESG

Consult Doctor
0 450 views 0 Doctors agree 16 May 2018
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