What's new
Van's Air Force

Don't miss anything! Register now for full access to the definitive RV support community.

Pirep ? Lasik Eye Surgery - A little long

RFazio

Well Known Member
I recently had Lasik surgery done to my eyes and decided to write a Pilots Report about it for those curious. To keep this on the proper topic I wanted the procedure to be able to fly my RV-6 without glasses. I am 60 years old, and had perfect vision all my younger life. When I reached 45 or so I started to lose my close up vision, totally normal, ( presbyopia ). I started using glasses for reading when my arm was not long enough to hold the material far enough away. The glasses got stronger and my vision worse. Around 50 years old or so I noticed my distance starting to get bad. Very slight at first, but then worse. At around 55 or so I got a pair of prescription glasses made up. They were progressive lenses with distance at the top and progressively stronger reading glasses at the bottom. I hated them. For distance they were ok but I couldn?t use them for reading. I ended up using my old standby glasses off the shelf for reading and the prescription ones for mainly driving and flying. They were ok for that because I could see the panel and distance with the same glasses. I passed my driving eye exam by the skin of my teeth in 2012, at 60, and my third class medical doctor marked down that I needed to have the glasses with me, not necessarily on. During the day I could drive and fly fine. At night I needed them. My distance was starting to get bad and I wanted to have the Lasik procedure done to make my distance perfect. If I needed glasses for reading that was ok, but I couldn?t stand having to wear glasses all the time. According to my doctor Lasik for distance would work perfectly on me and by correcting my distance vision my close up would also get better. I would probably see the instrument panel fine without glasses. So I decided to have it done. My third class medical doctor, Dr Nattis, did the Lasik procedure at the TLC laser eye center, on Long Island, NY. The cost was $4000.00, payable without interest over a year?s time.

I went in on a Thursday morning to the TLC center. The surgery took less than 15 minutes. I laid down on a table and got my eyes zapped buy two different lasers, for about 45 seconds each. The only thing I felt was slight pressure on my eye when the flap was being cut. This was done with a cup that is pressed down on the eye ball. That is all I felt. It literally lasted 10 seconds or so. The laser to the eye was completely painless. Once done, I got a snazzy pair of goggles and was sent home, with my wife driving, because I couldn?t see anything. Everything was super blurry. They give you a valium because they want you to sleep after the procedure. By the time I got home my eyes were starting to burn, slightly, not too bad, like I got some soap in my eyes. I tried to sleep, and actually did for about two hours. When I woke the burning was already starting to ease up. The procedure was at 8:30 am and by 12:30 pm the burning was gone. I had no feeling of sand in my eyes, which I was told some people get. At 12:30 pm, I could see, but barely. I noted that up close, like one foot, I could see clearly but any distance was completely blurry. I thought, he had made a mistake and burned me to close up vision rather than distance! By the end of the day I could see better but still only close up. One thing I also noticed is any light or bright thing had a halo around it. This I was told was also totally normal and would go away. The next morning I drove to his office to get my post-op check up. Luckily I didn?t have to go too far because driving that morning was a little sketchy. My distance was still pretty bad. I told the Doc that I thought I was seeing too close up and had no distance. He told me it?s day one, wait and let it heal. Then the second day I noticed an improvement in my distance but still worse than my distance was before the procedure. On the third day I felt comfortable driving. My distance was now about the same during the day as it had been before the procedure, the weird thing was at night it was better. Up close I needed no glasses of any kind, and my distance glasses made my vision way worse than without them. All of my collection of glasses was worthless at this point.

Monday and Tuesday I noticed very slight improvements in the distance. I was really starting to get nervous. They told me it could take a week to 10 days for my eyes to be healed and thus my vision the best it would be. Wednesday, I woke and noticed a distinct improvement in my distance vision right away. The TV from across the room was crystal clear, which it had not been up to this point. Once outside I could see better in the distance. I also noticed that up real close, like reading a magazine I had to move it a little farther away than the previous few days. Too close, and it was blurry. Another thing I noticed was when I first woke up in the morning my vision was the best, after being awake for half an hour or so I would notice it getting slightly worse. I was now hopeful I would get the vision I had wanted.

Thursday, one week after the surgery I went in for a checkup again. The doctor told me I would just pass the motor vehicle vision test. Thursday through Saturday showed slight improvements, but on Sunday the distance really got better. Then on Tuesday, 12 days after the procedure my distance vision was much better. I could see all the way out into the distance with almost no blurriness. I was getting excited. If my vision stayed like this I would be happy, I needed no glasses, except for really close up reading, or dim light reading. I could see off into the distance really nice. When I first got the procedure done I could read a license plate at about 20 or 30 ft. Now I could read it out to over 200 ft. I was using the computer, watching TV, driving and ready to fly, all without glasses. My buddy told me he wanted all the glasses I had lying around the hanger. I said maybe.
Two weeks later I went in for another check up. My vision had been getting slightly better for distance. I noticed my left eye seemed to be focused much closer than my right. I could read up close easy with the left eye and distance was better with the right. I told the Doc this and he just said give it time. My vision at this point about three weeks after the procedure was 20/25 in the right eye and 20/60 in the left. He also told me I was ok to fly with that vision.

Now another two weeks, five weeks after the procedure I was in the Doctor?s office again. I had not really noticed much difference in my vision, but when it was tested the right eye was 20/15 and the left was 20/25. As far as I?m concerned it?s perfect. I can see up close very clearly and off in the distance It gets only slightly blurry far away. I use no glasses at all, except if I?m trying to see something tiny up close. I can read, use the computer, drive and fly with excellent vision.
 
Thanks for the Pirep...

Considering the exact same thing for the same reasons. Made a consultation appt today.
 
Love Lasik

I did Lasik about 15 years ago at age 45. Unlike Richard F, I needed distance correction since I was a kid - about 20/200 and astigmatism.

I pair about $4,000 15 years ago and thought it was some of the BEST money I ever spent!!!! That being said, not everyone has the same great results that I had

When I had the Lasik done, I had immediate improvement in my vision - I mean as soon as the flap was laid back down. My vision was 20/20 or better in both eyes. Within a couple of years, I started needing reading glasses, which have gotten progressively stronger over the years.

15 years later, my distance vision now needs a little boost. I didn't really notice it until I got a pair of glasses with a little distance correction. I had a pair of sun glass bi-focals made just for flying.

When I'm not flying, I now wear bi-focal contacts - which are good but not great. For most things, I don't need to wear readers and my distance vision is about the same as not wearing any glasses.

For real detail work or heavy duty reading, I'll use my reading glasses.
 
Crystalens

I opted to go with Crystalens. Not cheap, but so far, I love them.
Left eye, November 6, 2012. Next day 20/25.
Right eye November 13, 2012. Next day 20/20 both eyes.
Distance is great. Reading is fine if print is not too small and light is good. This continues to improve with practice.
I have worn glasses since the 5th grade. It was great to go into the drivers license office and walk out with "no restrictions".
My eye surgeon was a college roommate of my FAA Doctor and understands FAA requirements.
 
20/20

Richard
Are you saying that your new 20/25 left eye was modified so you can read a little better with that eye. And your new 20/15 right is set up for distance.
Thanks
Bill J
 
No

I wanted perfect distance in both eyes. It ended up being that the left eye is focused a little closer. My Doctor still thinks it will get better at distance and worse at close up with time. But I kind of like it like it is. Supposidly you can't do mono vision for flying. That is where one is focused close and one far. I have very slight mono vision now.
 
I wanted perfect distance in both eyes. It ended up being that the left eye is focused a little closer. My Doctor still thinks it will get better at distance and worse at close up with time. But I kind of like it like it is. Supposidly you can't do mono vision for flying. That is where one is focused close and one far. I have very slight mono vision now.


I went thru this June 2012, It that is exactly what happened to me... My distant vision over the next 6 months improved while reading got worse...

I'm thinking of getting reading contact lenses and just wear it in my non dominant eye. Yet wondering how that would affect my depth perception. If the contacts do not work, well I just wouldn't wear them again.
 
If you guys like the results of Lasik surgery, wait till you are ready for cataract surgery. Prior Lasik makes cataract surgery technically a little more difficult, but still very doable. The procedure takes only a few minutes, zero pain, wear a patch for 24 hours and you are done. At the 24 hour check, I had nearly 20/20 without correction, colors are much more vibrant, and no more halos or flares with night driving. I also got rid of 5 diopters of astigmatism. With correction I have 20/15, which is pretty cool. Since the lens is artificial, many people find they never need to change their prescription over time.

Jim Berry
RV-10
 
Unless they've changed the rules, you can do monovision *surgically* & fly, but you can't do monovison with contacts & fly. Supposedly their logic is that you can adjust to the depth perception issues if it's permanent, but they assume that since contacts can be removed, you'll never totally adjust. At least that's the story I got.

N15JB, did you get regular CLR, or one of the newer tech variable/multifocus types of CLR? Supposedly, there are some lenses available now that can mostly eliminate the presbyopia issues. That's what I'm looking for. :)

Charlie
Edit: just read on the Crystalens site that they are what I was trying to describe. Thanks, Mel and What was your experience with the presbyopia issue?
 
Last edited:
a different take on it

I've been following this type of eye surgery since it was developed in Russia and then was available in Canada, before it was available in the USA. Back in the early 1990s, people from the NH area used to go up to Montreal to get it done. I very nearly did it, and have thanked my lucky stars since then that I never did it. This is why:

I'm 60 years old now, and thus about 40 in the early 90s when I was considering it. I've worn pretty strong, and ever-increasingly strong, distance glasses since first grade. Without glasses, I'm 20-200+ ; off the chart. With glasses, I'm at least 20-20 or better. Over the last 10-15 years, my prescription has gradually gotten somewhat less strong.

I wore contacts throughout the 80s and until about 15 years ago. I quit wearing them because, while I could see distance OK, seeing close things with the contacts in became more and more difficult. For example - going to a restaurant and reading the menu - impossible with the contacts (and thus permanently so with surgery)

The really big difference over about the last 15 years is the near vision. As we get older, our eyes' ability to focus closely diminishes. If I need to see something very close, I just pop off my glasses, and I can see very close things as though I was using a magnifying glass. If I was wearing contacts (the same as if I'd had surgery, except the surgery is unremovable), it would drive me absolutely NUTS being unable to see anything close very well. And I'd be completely unable to see anything that's very close.

Based on what I've seen in myself, I'd recommend giving very careful thought to getting the surgery. While it may work wonderfully for distance, especially for younger people, it will INCREASE your need for close glasses (that you might not otherwise need at all) as you age. And in my opinion, while glasses are a pain (altho the new lightweight plastic lenses are far less of a pain than the old heavy glass lenses were), part-time glasses that would always be being misplaced or not at hand when needed would be an even larger pain. The glasses may be a bit of a pain, but I can see clearly at distance, they are "progressives" for close, and I lift them up when I need to see very close. For me, fulltime glasses are less obnoxious than part-time glasses.
 
I hear you Brian; I've been through the same progression. I quit wearing contacts when presbyopia kicked in in my mid 40's, & now wear 'progressive' lenses. That's why the newer clear lens replacement lenses that are supposed to solve the presbyopia issue are so interesting to me. They are intended for cataract sufferers, but as an eye doctor friend once told me, 'everybody has cataracts to some degree'. :) The only real downside (other than money) is that the surgery is a bit more invasive than lasik, but I have less fear of that than having the surface of my eye sliced off.....

Charlie
 
Best money you can spend. Cost me 3K 17 years ago when I was 43. I still don't wear glasses at all and have excellent vision. I'm a bit baffled that i still have good near vision, maybe because i read a lot every day.
 
This is interesting. I'm 54 and have been wearing glasses since I was 40. Started out with only readers and have progressed (maybe regressed?) to wearing progressive bifocals now. I inquired to my AME who is a general practitioner a couple of medicals ago whether or not Lasik surgery would help me. His response was that it would but advised me not to do it until I was finished flying because the FAA didn't allow it. Perhaps I need to check again.:confused:
 
Thanks, Mel and What was your experience with the presbyopia issue?

I've worn very strong progressive lenses for many years.
The Crystalens so far are great.
Normal print in good light is no problem. I need "readers" if print is very small or light is dim. But that is improving with practice.
Distance is fantastic!
 
I checked into Lasik 5ish years ago when I started having issues with contacts. I started wearing my glasses a couple days a week and my eyes perscription wise got better for 3 years. My doc wouldn't recommend LASIK until my eyes had stabalized for a year.
He only recommended 1 doctor locally, he said the best doctors don't have to advertise.
My second class medical was suspended the day of the surgery, reinstated and back at work the next day 20-15. For the medical I had a 30 day and 6 month follow up.
Very happy overall, distance and outside vision is better than glasses or contacts but low light and computer screens not quite as crisp. My wife gave me a one week pass of telling her all the "stuff" I couldn't see before.
 
Lens implants

I chose not to have Lasik surgery many years ago, choosing rather to stay with gas permeable contacts for my nearsightedness. I actually wore bifocal contacts for a couple of years about twenty years ago until I found out at that time they were not allowed by the FAA. (My AME was a NASA Flight Surgeon. When I pointed out the new regs to him, he said, "Oh, I'll have to study up on that.") :eek:

Two years ago I had both lenses replaced due to cataracts. I now have 20/15 in the right eye and 20/20 in the left. (On one test right after surgery I actually read at 20/10 level in the right eye!)

I am very pleased with my vision. I do have to occasionally wear readers to read the fine print, but that's a small inconvenience in my book. YMMV

Sometimes there are benefits to getting older! :)

P.S. Toric...that's the word! Someone mentioned Toric lenses. In 2009, my optometrist noticed I was developing cataracts. In 2011, the one in the left eye was starting to adversely affect my vision. Because I was wearing hard lenses (gas permeable) which re-shape the cornea, I had to go through a waiting period of several months to allow my cornea to relax to its natural shape before having the lens implant surgery. Not surprisingly, I had some astigmatism in both eyes, so my ophthalmologist gave me the option of three lenses: standard, Toric and Crystalens.

I chose Toric and believe it was the right choice for me. While the Crystalens corrects both cataracts and presbyopia, the FAA requires more paperwork from the treating physician and a longer waiting period. For some pilots, Crystalens may be a good choice. The Toric is a medium price choice among the three, requiring a slightly higher co-payment than standard. The Crystalens per my insurance would have cost me the most co-payment. The Toric corrects not only the cataract problem and the distant vision problem, it also corrects the astigmatism (irregular curvature of the cornea). My surgery was done by an ophthalmologist who does lens implants exclusively four days a week in Birmingham.
 
Last edited:
I had LASIK about 12 years ago. I thought it was great.
7 years ago I developed cataracts in both eyes due to family history and my running ultramarathons.
I then opted for implants, not the Crystal lens as Mel received as they were just becoming available at the time & quite pricey. I went with standard lens.
Cost was a $100 per eye co-pay. One eye had to be done twice due to the LASIK having reshaped the cornea and was difficult to hone in on a correction level. I had one eye set for intermediate, one eye for distance. I now see 20/20 & 20/15. I see perfect and no longer need reading glasses as I did with the low light LASIK.
Would I do it again? Absolutely, even though I was always a weenie and would freak out with adding eye drops in my eyes prior to my first surgery.
 
I went from 20/20 as a 20 year old to about 20/60 as a 48 year old. My prescriptions move slightly every few years. I've worn glasses and contacts, and prefer contacts. However, in recent years, the combination of age and more distance correction has meant I need to wear "cheaters" for up close work.

I'm scared to death of eye surgery, and have always known it would push me to cheater glasses sooner, so I've rejected the idea. I continue to reject the idea because even if I had my distant vision fixed today, I'd need reading glasses. Not gonna get corrected and still need correction.

On my last visit to the eye doctor, I explained that I'm looking for a way out of being double corrected. And he suggested multifocal contacts. These are contacts which have different focal rings - a couple each for far, medium, and distant vision. My brain adapted well to the different focus points and now I only need the multifocals. No more cheaters and no eye surgery.

A win from my perspective.

Just another option to consider.
 
Radial K

I had a procedure done to both eyes at once about eight years ago. I was rather myoptic. Wearing glasses/contacts since I was a teen,
it's been nice not to having to swap out glasses for prescription sunglasses and back any longer. I even had perscription dive mask.
My medical was on hold for six months while I "healed". It was worth it in the long run. Now that I'm getting older, some of the very
fine work is requiring readers. But apparently, I would have had to use the readers even if I didn't have the surgery.
Five grand for both eyes. A little dry eye. No biggy. My vision is a sharp as it was a year after the procedure.
No scalpel touched my eyes....all lasers.
 
Last edited:
And he suggested multifocal contacts. These are contacts which have different focal rings - a couple each for far, medium, and distant vision. My brain adapted well to the different focus points and now I only need the multifocals. No more cheaters and no eye surgery.

A win from my perspective.

Just another option to consider.

I also use the multi-focals, I wore bi-focals for a year and then the FAA approved the multi-focals. When I put them in, it was like being 20 again. They are a compromise though, I cannot see quite as good up close as with my bi-focals, but it is a good (and easily reversible) compromise.
 
I had mine done around 13 years ago, wore glasses since I was very young but never had very bad vision, just bad enough. I tried contacts and could not tolerate them. I was warned that my vision close up would suffer if i had lasik and in a few years it did. However,even with diminished close up vision I passed my medical without correction and tested to 20/20 for long distance. I do not wear any correction in the airplane and have no issues reading all of the instrumentation.

I have a very active outdoor sporting life so the trade off was good for me. I was always defogging, cleaning, wiping, and rain, well that sucked. So I am happy with the decision and would do it again if it becomes necessary.

I had one experience that was priceless. They over correct in surgery. As you heal, some of the correction is diminished and your supposed to settle in to 20/20 or so. But for a short while, a few days, you have eagle vision. I went to the Grand Canyon and was able to view it with the eyes of an eagle. That is a memory that will last a life time.
 
N15JB, did you get regular CLR, or one of the newer tech variable/multifocus types of CLR? Supposedly, there are some lenses available now that can mostly eliminate the presbyopia issues. That's what I'm looking for. :)

Charlie

Charlie,

I got the regular lens in one eye, and a toric lens in the eye that had astigmatism. That was a $1300 extra cost item, but well worth it. I delight in annoying my friends by showing them how well I can read micro-type without glasses.

Jim Berry
RV-10
 
SuperFocus lenses

I have computer vision. By that I mean that I've stared at a computer screen for 30+ year and my eyes now are perfect at about 24 inches. Distance vision started getting worse until at age 50 I could not pass the distance test any more. I tried wearing regular lenses and bi-focals. I could see distant stuff OK but the panel was blurry and I ended up looking under my glasses to see the panel. Two years ago I tried SuperFocus lenses which have an adjustable focus. I am in love! I can back them off of the distant setting just enough so that everything is in focus! I don't know if they'd work for everyone but they have been great for me.
 
I'll try to add some insight to this discussion, from the perspective of someone doing the procedure rather than receiving it...

The most important decision about LASIK surgery is where to have it done. This is a surgical procedure and if you suffer an infection or other complication you can lose your vision. Rare, but I'd be willing to go to great lengths to seek out the best facility to do the surgery, not the most inexpensive. You want the procedure done by someone close to your home, or be prepare to stay in lodging near their facility for days afterwards. Experiencing a problem that needs emergency attention after the surgery and not being close to the facility is a bad thing. My wife suffered complications from her cataract surgery and needed immediate sophisticated laser tomography analysis of the interior structure of her eye to diagnose the problem. You are not likely to find that capability at a local emergency room.

You want a physician who will tell you that you are not a good candidate for this surgery if that is the case. If they do, thank them. There is nothing worse then having the procedure done and not getting an acceptable outcome. All of our eyes and visual defects are different and some problems cannot be properly corrected by LASIK.

Fitting eye lenses either inside or outside the eye is an art and a balancing act. The many different corrections needed to provide best vision are frequently not possible with the tools available now. The best that can be done is to provide a balance of the different corrections for the needs of the patient. One of the amazing things about modern LASIK surgery is that a laser analysis can be done of the eye in a raster fashion. The amount of correction needed at each point on the eye's surface can be individually sculpted by the laser. This can only be done prior to the surgery by a facility that has this analytical capability. When the pulsed laser fires it makes the correction in the same raster fashion correcting for astigmatism and focus at each point.

2/3rds of the image forming in the eye is done by the cornea and this is where LASIK surgery is done. The front surface of the eye is sliced nearly completely off using a vibrating razor blade and folded out of the way so that the laser correction can be done underneath the front surface. After the treatment is finished this flap is folded back over the surgical site and held in place by surface tension. Some physicians will put a stitch in that is removed the next day.

The other 1/3rd of the image forming is done by the lens inside the eye. This lens does the focusing and with age, usually by about ~45, stops working. This is where cataracts are usually formed and cataract surgery frequently replaces this lens. You can choose to have your normal (non-diseased) lens replaced just like you choose to have your normal cornea operated on for LASIK. In both cases you probably will pay out-of-pocket for the procedure. If your cornea is not thick enough to allow enough correction with LASIK to achieve the visual acuity you desire you may choose to have your lens replaced instead. If you have health insurance and need cataract surgery and the lens is replaced you will usually not have much, or any, cost for the surgery.

Personally, my cloudy lenses were replaced during cataract surgery with lenses that gave me the widest range of sharp vision. My far distant vision is not tack sharp but nearly excellent. My near vision is much better than it was prior to surgery. I've had presbyopia (def. "old eyes") for at least 20 years. I tossed my trifocal glasses away after the surgery and don't need glasses at all for most things now. Being able to wear non-prescription sunglasses and read the instruments is great. I had to take my trifocals off to land before the surgery. Trying to see over the nose in the flare with my glasses on had me looking through the near distance lens on my trifocals. Not a good thing.

The lens in our eye focuses the image on the retina using a different technology then a conventional lens does. We are just starting to be able to produce gradient-index lenses now that may offer help for presbyopia. There are constant improvements coming for vision correction. We're lucky to live in a time where so many of these eye problems can be fixed. I'd be totally blind if I lived just a century ago, rather than the 20/15 vision I have today.

Pilots in WW2 who had their canopies shot up frequently got shards of plexiglass embedded in their eyes. Sir Harold Ridley noticed that these pilots didn't suffer infection or rejection of this material and the idea of using this material to replaced diseased lenses was proposed and developed. Glad something good came from that!

Diseases of the eye can be treated successfully if detected early. Doing an "annual" on your eyes, eg. having an eye exam, is as important as doing one on the plane.

Protecting your eyes from damage is also worth the effort. Many injuries can't be fixed. Welding, grinding, using a nail gun etc have inherent risks that you can decide to protect yourself from. Sunglasses that provide UV protection are important. We are just starting to realize the extent of how damaging UV is to our skin and eyes. If you have brown eyes you are more likely to suffer from cataracts, or suffer from them earlier. Light colored eyes like mine? More likely to suffer macular degeneration. Macular degeneration is something you want your ophthalmologist to find as early as possible on your annual eye inspection. Found early it can be treated. Wait too long and there may not be much that can be done about it.

Sorry if this got crazy long. As someone who spent a lot of time grounded by failing vision I hope this helps keep you flying, or gets your back in the air sooner.
 
Does anyone have more recent Lasik experience to share and more specifically, monovision correction? I've talked to my AME and he said I would just need glasses to correct the monovision when flying and could get a statement of demonstrated ability (SODA) to get rid of the corrective lenses requirement assuming I pass. Any comments to ease my fears would be appreciated. I'm having the procedure tomorrow morning. Thanks.
 
I really, really wish I had done monovision... However, I have no current info on FAA requirements for this process, so do your own due diligence. Like call AOPA. I had PRK by choice since endorsed by US Navy at the time. Amazing distance vision still after 8-10 yrs. But have to use readers...
 
Last edited:
LASIK

Gary: Can't help with the recent part. At age 42 I had both eyes done at the same time back in 97. Vision before surgery was around 20/70 distant with very good near vision. After surgery I had very slight monovision that eye doc, medical examiner & faa deemed acceptable without further correction. I was off work for a month from my corporate flying job. Still passing the 1st class physical without glasses at age 60 and don't wear readers to read. I do have bifocals with a slight amount of correction that I use for really intricate close up work or for landing at night, don't need them but appreciate the extra sharpness.

Don Broussard

RV 9 Rebuild in Progress
 
LASIK vs. Cataract

Ok so I'm going to rise to the bait and throw in my $.02 worth. This is long, and probably not terribly interesting unless you're considering surgery.

LASIK and PRK, as currently practiced, are really excellent procedures for most people who currently depend on glasses. They have low risks, and outcomes are good or excellent in the overwhelming majority of patients. Serious problems are very rare.

First, some background.

The eye works like a camera, focusing light on a sensor in the back (the retina). It has two lenses. One, the cornea, is fixed in power and is responsible for about two thirds of the total lens power of the eye. Throughout adulthood, the corneal power changes very little in the absence of disease.

The second lens is inside the eye, behind the iris. The coolest thing about this lens is that it can change its power when you're young, allowing you to bring your natural focus closer which allows you to clearly focus on near objects, even if the natural resting focus of your eye is set at distance. This crystalline lens is the fastest aging part of the eye, beginning to stiffen in adolescence and becoming so stiff by the middle of your forties that you have difficulty focusing on near objects without reading glasses or bifocals. By the time you're 60, the lens is so stiff it can barely change its focus at all and the reading glasses or bifocal need to be strong enough by themselves with no help from the lens. Aging changes in the lens can also change its power, resulting in changes in glasses.

The lens also begins to yellow and eventually becomes cloudy. By age 70 or so in many people the cloudiness is such that it interferes with activities of daily living and we call it a cataract. There is a wide age range where cataract surgery is necessary, with most studies averaging early mid 70s. In our practice the average is around 70-73, but I typically operate on about one 40year old a month. There are large regional differences in the rates of cataract surgeries at any given age, driven by cultural and economic factors (mostly).

LASIK and PRK work by removing tissue from the cornea to change its curvature and therefore its lens power. The total central thickness of an average cornea is about 550 microns, and nearsighted LASIK typically removes about 15-20 microns for each diopter of change.

Cataract surgery removes the lens inside the eye and replaces it with a plastic implant lens. By carefully measuring the existing corneal power and the overall length of the eye, you can pick an implant that should give you the desired postoperative focus. Risks and accuracy of cataract surgery are about the same as LASIK for most patients, and stability long term is better. Most cataract patients come out of surgery needing only reading glasses or no glasses.

The plastic implants are inferior to a youthful natural lens, mainly because they are either fixed or limited focus. They are far superior to even a modest cataract though, and probably superior to an "average" 60 year old lens.

In patients without significant cataracts we often do the same surgery but call it "Clear Lens Extraction" or "Lensectomy," mainly as a semantic exercise to differentiate who's writing the check. Insurance companies generally won't pay to get you out of glasses, but we're happy to do it if you want.

Now to the reason for the background:

For most people under forty who need glasses or contacts but don't want them, LASIK or PRK is the answer. The ability of the young lens to change its power is awesome.

For most patients 60 and over who want out of glasses, clear lensectomy or cataract surgery is probably a better option. It will usually last the rest of your life, and you'll never get a cataract.

For anybody with even a mild, asymptomatic cataract I'd avoid LASIK. The corneal change is permanent, but the cataract will continue to worsen, and you'll be back in the operating room sooner rather than later. Why have two surgeries when one will fix the problem?

It's kind of like choosing whether to top overhaul a high time engine. If you know you're going to wan to go through the bottom end soon, just bite the bullet and fix the whole thing.
 
Back
Top