Dr. Soloway: It would be unusual to be both nearsighted and need reading glasses at first, even more than 10 years after RK. More than likely you have had a farsighted shift. Either way, laser surgery can be performed in most patients that have had RK in the past to improve the distance vision without glasses. CK or conductive keratoplasty might not be advised after RK as it can have the adverse effect of re-opening the RK incisions and causing an unpredictable result. Monovision with the laser can also be considered.
Gennell Winkler of Scottsdale, Ariz., asks: Is eye surgery right for me? I am 75 years old and I (a) wear bifocals, (b) am in good health except I have COPD and bronchitis, and (c) walk approximately 1-2 miles a day. Thank you.
Dr. Soloway: I have performed laser eye surgery for vision correction in patients up to 84 years young but it was a very unique case. I have done surgery on people in their 70's as well but that too is rare. Usually lens-based surgery is advised as there are typically some lens changes toward cataracts and lens-based surgery can then actually improve a patient's resulting vision by removing any opacity in the patient's optical system (that is, the cataract).
Sara Abrams of Richmond, Va., asks: My vision deterioration started around age 42 (I am 53). Prior to that time, I had never needed glasses. As time has passed, my close-up vision has continued to decline and I now find that my distance vision is also affected. Night driving is almost impossible. Would surgery be a benefit for me? Is the cost reasonable? How do I find a competent vision specialist to make the decision?
Dr. Soloway: Most likely you are farsighted and were able to control the distance vision with the same focusing muscles used for reading by normal sighted people. I would venture to guess that when you were younger (in your teens for instance) you saw things far better than all your friends. Far sighted laser surgery is available but it is important that your prescription has stopped changing or at least you accept the strength of eyeglasses found to be needed on a dilated or focusing muscle paralyzed eyeglass examination. The parameters of pupil size are slightly more limited in farsighted surgery, but it is available, and the cost is usually the same as nearsighted surgery. Finding a competent surgeon can be challenging as you need to separate the hype from the reality. I suggest getting as many recommendations from friends that might have had the surgery, learning as much as possible in advance about the surgery, and visiting with a few specialists in your area to see who is experienced, and not trying to be too sales-y, will be seeing you after the surgery and practices in an office that you feel comfortable in. Since consultations for vision correction surgery are typically complementary, you can check a few offices without much financial impact (it might only cost you your time).
Bill Thomas of Jackson, Miss., asks: I am 56 and have better than average vision, 20-10 or 20-15, but suffer from presbyopia. The lens replacement seems quite invasive and I was wondering about the less invasive surgical options. What else is out there? I was particularly interested in an experimental surgery that tightened the muscles around the eye.