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Presbyopia: Replacing Those Bifocals with Surgery

Treating Presbyopia with Surgery You know you have reached a certain age when you just can’t seem to focus. No, not late-onset attention deficit disorder, but an eye condition that makes your vision less sharp than it used to be: presbyopia.

Typically, the problem starts around age 40 and strikes even those who have had perfect vision. You may have had vision correction surgery in the past, but Father Time has little regard for all of that. You're still going to find yourself straining to read tiny labels and fine print and you know that it's time to throw in the towel and admit defeat. You are going to need reading glasses at the very least, or possibly bifocal lenses. Or - let the wailing begin- you may even need trifocals. But wait, there is another option!

Surgery for presbyopia is another treatment to consider, but you have to make sure you have done your homework. Know all of the risks and the possible side effects before you schedule your consultation, so that you can weigh these against the potential benefits. You have to make sure that you are a good candidate for surgery both medically and mentally. (Some people have really unrealistic expectations that can lead to disappointment afterward). Your eye care professional can help you make this determination, however gathering a little information about the procedures beforehand will give you a starting point for that conversation.

LASIK and monovision options
Most of us have a dominant hand that we use when we write, grab things or push open doors. There are a lucky few who are ambidextrous, meaning they can use either, but they are a rarity. What many people are not aware of is the fact that they also have a dominant eye, the one that locks on a sight target. In the majority of people who have right hand dominance, it's the right eye that's dominant.

When you get fitted for contact lenses, in some cases the doctor may opt to fit your dominant eye with distance correction while the other eye will be fitted for near correction, giving you monovision. The same concept can be applied to LASIK for presbyopia, where the doctor corrects the dominant eye for one field and the non-dominant eye for another. This can be disconcerting to some people and they may be very unhappy with the results so many doctors suggest that they try monovision with contact lenses first before committing to the surgery itself.

LASIK is not the only surgical procedure that is used to produce monovision, but the cautions remain the same no matter what surgery you choose - make sure that you'll be able to adapt to this new type of vision before you commit to any procedure, or you may be very unhappy in the end.

Another LASIK procedure used to treat presbyopia is Multifocal LASIK (sometimes called Presby LASIK). During this procedure, the surgeon creates different vision zones on the cornea of the eye, and each zone allows the patient to see clearly at a different distance. (Think of it like having built-in bifocals.) There have been some promising results with this surgery, but it is still in the experimental stages and is not yet FDA-approved.

Out with the old and in with the new
Another option for those with presbyopia is refractive lens exchange (RLE). In this surgery, the eye’s natural lens is removed and replaced it with an artificial one. Typically, this procedure is used to treat cataracts, and it's not FDA-approved for presbyopia, but it may still be used off-label for certain patients. Artificial lenses are not perfect, however, and glasses or contacts will likely still be needed after surgery.

The future is getting clearer
There are number of other tests going on as medical science looks for new and better ways to treat the various conditions of the eye. These are not FDA-approved procedures yet, but are showing great promise in the field of presbyopia treatment:

  • IntraCor: This is an intrastomal correction procedure that uses a laser to introduce gas bubbles into the inner layer of the cornea. Because it does not involved cutting or incision of any kind, there is less chance of complications such as infection or inflammation.

  • Corneal Inlays and Onlays: These inserts are surgically implanted in the cornea to improve near and intermediate vision. They work similarly to contact lenses, except that they become a permanent part of the eye and don't need to be taken out, cleaned, or replaced by the patient. (However, they can be removed by a surgeon if complications arise.)

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