Choosing the best surgical treatment option for presbyopia is very important. Many patients who need surgery for presbyopia will also develop cataracts in the next 10 years. While vision can temporarily be improved with glasses, eventually cataract surgery is required to restore vision.
Surgery for presbyopia involves either monovision LASIK or removing the inflexible natural lens from the eye and replacing it with a new lens that will help you to focus better. This is called a Refractive Lens Exchange (RLE). These lenses are called intraocular lenses, or IOLs.
Several types of procedures and IOLs are available. Decisions about which procedure is best for you should be made in consultation with Dr. Oyakawa. The right presbyopia solution for you will depend on your eye health, lifestyle, and personal preferences.
LASIK Vision Correction of Presbyopia
One of the first effective surgical options for presbyopia correction involved achieving what is known as "Monovision" during LASIK. The refractive error is corrected in the dominant eye and the other eye is set to see near. This can also be done in a patient who can see distance well in both eyes. One eye can be made nearsighted with the excimer laser.
What you can expect with Monovision LASIK
Dr. Oyakawa recommends Monovision LASIK only for myopic eyes with no signs of cataracts. Dr. Oyakawa himself has had Monovision PRK.
Recently, Dr. Oyakawa underwent presbyopia correcting cataract surgery with the Crystalens AO in the near eye set for mini-monovision.
- Successful Monovision adaptation occurs in 3 to 4 weeks in about 80% of patients
- Main advantage is not needing reading glasses for seeing near
- Disadvantage is some decrease in depth perception
- Patients in their 40s usually adapt to Monovision in 1 to 2 weeks, while older patients may take longer
- Patients who do not have significant astigmatism can try contact lenses before Monovision LASIK
- A few patients may need to use glasses for night driving or prolonged computer work and reading
- Some patients use one disposable contact lens in their near eye for good binocular vision during sports, such as tennis
- In rare situations, some patients may decide to have the eye with near vision corrected to allow distance vision
Refractive Lens Exchange "Off-label", click here.
During an elective procedure known as refractive lens exchange (RLE), the eye’s natural lens is replaced with an artificial lens. There are artificial lenses that also correct presbyopia. At the same time any refractive errors such as myopia, hyperopia, or astigmatism are corrected. This technique can also be used for patients beyond the range of correction for LASIK. An added benefit is not needing cataract surgery in the future. This results in freedom from glasses most of the time and in a significant number of patients complete freedom from glasses.
RLE is cataract surgery before the lens becomes a clinically significant cataract. This is essentially a specialized cataract surgery and will be discussed in the cataract surgery section.
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