Doctors Answers Questions About Eye Surgery
Oct. 26, 2005 — -- Almost everyone older than 45 will develop presbyopia, or the loss of close-up vision. Some cope by wearing reading glasses or contact lenses, but surgical options are becoming increasingly popular.
Are these surgeries safe? What is the recovery like? Who is a good candidate? Here, tackling a sampling of your questions is Dr. Barrie Soloway of the New York Eye and Ear Infirmary.
Kelm Brueschke of Urbandale, Iowa, asks: I am a type 2 diabetic and want to know if that precludes me from being a candidate for Lasic eye surgery?
Dr. Soloway: Diabetes in and of itself would not preclude you from having LASIK eye surgery, however, all the other caveats would apply such as the need for the prescription to be stable and the diabetes under control, including any retinal vascular problems.
H. Porter of Charlotte, N.C., asks: Is surgery to correct presbyopia recommended for someone who wears contacts for distance vision and astigmatism and wears glasses for reading?
Dr. Soloway: Most people who want their presbyopia corrected surgically are having it done in addition to getting their distance vision corrected as well. With current techniques for surgical presbyopia correction, one might find it difficult to use contact lenses afterwards. Some of the methods you might consider if you are found to be appropriate anatomically would be monovision lasik surgery which can be done in the United States as it is fully approved.
Angelo of Jersey City, N.J., asks: Without adequate lighting, I have to strain my eyes to read and I am only 39 (40 in March, 06). I am worried that if I even am a candidate for surgery, presently, how long before I would need another to correct my ever-changing eyes? I currently use my glasses two weeks at a time vs. my contacts (L-5.5, R-5.0) for one week at a time. I am very curious, please advise me, Thanks!
Dr. Soloway: It is unusual but not unheard of that someone in their 30s needs reading glasses. It is possible that your distance prescription is too strong as this would have the same effect. Surgery for the distance alone might be OK if that portion of your exam isn't changing. Unfortunately, the reading portion will deteriorate gradually over the next 25 years.
Kathy Duff of Gainesville, Fla., asks: I have been wearing glasses since I was 15 for myopia. The prescription has not changed much over the years, except for a little change causing me to wear bi-focals. I am 41. I have been wanting to see if surgery could fix my vision, as I hate wearing glasses and contacts. I want to wake up and see clearly and not have problems swimming. I also feel it interferes with some of the assignments I have been given at work. My husband says that it will not fix the presbyopia, and I will still need glasses. I'd rather wear glasses for when I am reading than wear glasses 24/7. May I have your opinion?
Dr. Soloway: The decision to have laser eye surgery when a patient is already using glasses for reading, on top of their contacts, can be a difficult one and each patient reaches their answer differently depending on their own personal desires and needs. Some patients, when made aware that they will need reading glasses, wonder why anyone would have the surgery. Others using contacts and readers over the contacts view it as a way to at least get rid of one of the two. I like to ask my patients what they are hoping to accomplish with the surgery. I get many different answers, but try to lump them into one of two categories: surgery for vision reasons such as fog, skiing, etc., and surgery for glasses reasons -- the "I hate glasses" sort of patient. The vision group tends to do best with distance correction in each eye and doesn't mind using reading glasses. The glasses group will typically make good monovision patients which will minimize their use of glasses the most. If you would rather wear glasses for reading instead of 24/7, then you have realistic expectations of what the surgery can do and should consider checking to see if your eyes are appropriate for surgery.
Nancy of Raleigh, N.C., asks: I am 54 years old and wear progressive, biofocal glasses. I have extreme dry eyes and tried plugs in my eyes. I also have tried contacts, but they make my eyes feel even drier. I have been told lasik surgery would make my eyes even drier. Would a lensectomy work for me? (I already have the beginning of a cataract in each eye, but it is the slow-growing kind).
Dr. Soloway: Most patients get drier after LASIK surgery and if you already have extreme dry eyes, you "have been told" correctly. Other methods of excimer laser (the laser used in LASIK) surgery such as surface treatments of PRK or EpiK might be considered. Lensectomy shouldn't make the dryness worse, but does have some risk due to the fact that it is intra-ocular surgery, so infections or bleeding, though rare, could cause the vision to end up worse. Depending on the level of your cataract (worse is better) it could however be an excellent choice.
