In my 25-year career as a LASIK surgeon, having corrected over 105,000 eyes, one of the most common questions I receive from patients over 40 is how to address both distance and reading vision. This can be a point of confusion and requires careful consideration before proceeding with the procedure.

Understanding Age-Related Vision Changes

As we enter our 40s and beyond, the lens in the eye naturally changes, losing elasticity and hardening into more of a plate shape—a process called presbyopia. This condition makes it difficult to focus on nearby objects, even if your distance vision is corrected. As a result, many people end up relying on reading glasses or bifocals. By age 45, most individuals notice these changes and require some form of correction.

Monovision Laser Vision Correction

One potential solution for presbyopia is monovision laser correction. Much like having a dominant hand, everyone has a dominant eye. In monovision, the dominant eye is corrected for distance vision, while the non-dominant eye remains slightly nearsighted to improve close-up vision. The brain adjusts to this setup, typically over a few weeks, allowing for more freedom from glasses or contacts.

However, monovision has its limitations. For individuals who spend a lot of time reading or doing close-up work, it may cause eye strain. It can also affect depth perception and night vision. Additionally, as presbyopia progresses, even those with monovision may need reading glasses, but they will be less dependent on them.

My Personal Experience with Monovision

As someone who underwent monovision LASIK myself, I’m very pleased with the results. That said, I recognize it’s a compromise. While my distance vision is clear, it’s not quite as sharp as it was when I relied on both eyes, plus glasses or contacts. For activities like tennis, I sometimes wear a contact lens to enhance distance vision, bringing both eyes into full focus.

Is Monovision Right for You?

If you’re over 40 and thinking about LASIK, talk to your eye doctor to determine if monovision might be a suitable option. It’s typically ideal for those in their early 40s, as the brain is more adaptable at this age. It’s especially effective for individuals who have already adjusted to monovision through contact lenses or those who never needed glasses for distance but have noticed a decline in reading vision. For those over 50 who have never tried monovision, adapting may be more challenging. Additionally, not all types of vision correction are compatible with monovision. A thorough consultation with your doctor will help you understand the options and make the best choice for your vision needs.

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Monovision LASIK is a specialized laser vision correction procedure that can help people with presbyopia reduce or potentially eliminate their need for reading glasses for most near activities. What is presbyopia? Presbyopia is a common age-related condition that makes it difficult for your eyes to focus on near objects within your arms reach and closer. It typically begins to develop in people over the age of 40.

How Monovision LASIK Works

Monovision LASIK works by optimizing one eye for distance vision and the other eye for near vision. This is done by reshaping the cornea, the clear front part of the eye, using a laser. The dominant eye is typically corrected for distance vision, while the non-dominant eye is corrected for near vision.

What Conditions Can Monovision LASIK Treat?

• Presbyopia
• Myopia (nearsightedness)
• Hyperopia (farsightedness)
• Astigmatism

What Procedures Can Correct Monovision?

• LASIK: LASIK is the most common type of laser eye surgery. It is a safe and effective procedure that can correct a wide range of vision problems, including monovision.
• PRK:  PRK is another type of laser eye surgery. It is similar to LASIK, but it does not involve creating a flap in the cornea. PRK is a good option for people who have thin
  corneas or other eye conditions that make them ineligible for LASIK.
• IOLs: Implantable lens implants (IOLs) can also be used to correct monovision. IOLs are artificial lenses that are implanted inside the eye. IOLs are a good option for people who have cataracts or other eye conditions that cannot be corrected with laser eye surgery.

Can Monovision LASIK help with Presbyopia?

The short answer is yes. While the actual condition of presbyopia cannot be corrected with LASIK, as presbyopia is a hardening, or loss of flexibility to the lens within the eye and LASIK only corrects the corneal surface of the eye, Monovision LASIK can be used to accommodate for the lack of up-close vision caused by presbyopia. This is done by leaving one eye slightly undercorrected as a small, myopic prescription acts as a natural magnifier and prevents or limits the need for reading glasses for up-close work.

Risks of Monovision LASIK

There biggest difference between LASIK and mono-vision LASIK in regard to risk is a patients inability to accomodate to the variation in prescription between each eye. Since with monovision, one eye is left slightly undercorrected, for a very small percentage of patients find they struggle to acclimate to the vision discrepancy between their eyes. When this happens, we simply remove the prescription in the undercorrected eye during a re-treatment and the patient will just need over-the-counter reading glasses at some point in their life for up-close work.

Is Monovision LASIK Right for You?

Our skilled LASIK surgeons have the expertise to assess whether monovision LASIK is the ideal choice for you. In a personalized consultation, our LASIK specialists will meticulously examine your eyes and assess your vision to determine if you are a good candidate for the procedure.

Interested in learning if you’re a candidate? Get started by taking our free candidacy test, or by booking a free consultation with our LASIK experts. Find out if monovision LASIK can give you better vision for a brighter future. Don’t let blurry vision hold you back – contact us today and let’s work together towards natural vision.

Sources:
• Mayo Clinic: https://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/in-depth/lasik-surgery/art-20045751
• Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/8577-presbyopia
• American Academy of Ophthalmology: https://eyewiki.aao.org/Monovision_LASIK

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LASIK for Patients Aged 18 to 38

Since LASIK is an elective procedure, there is no rush to treat anyone. During the teen years and early 20s, a patient’s eyes may change dramatically. To be considered a candidate for LASIK, a patient must be at least 18 years old and have a stable eyewear prescription.

Age and prescription stability are only two of the factors doctors consider when assessing LASIK candidacy. They also look at the patient’s goals for the procedure, eye health, overall physical health, occupational needs, corneal shape and thickness, myopia versus hyperopia and other factors. All these help the doctor determine the safety and efficacy of the proposed procedure.

LASIK for Patients Aged 39 to 59

As patients near their 40s, presbyopia becomes a factor in their vision correction needs. Presbyopia refers to age-related changes to the lenses inside the eyes, which makes it more difficult to focus on nearby objects. Monovision LASIK is one possible option for patients with this condition. During the procedure, the doctor corrects one eye for distance vision and the other eye for up-close vision.

Admittedly, monovision does sound strange. And although it does take time for patients to adapt, most of them are happy with the results. If a patient is considering monovision LASIK, the doctor may do a “trial” with glasses or contact lenses to test if this new way of seeing works prior to treatment.

LASIK for Patients Aged 60+

Patients in their 60s and beyond often begin to develop cataracts. If their cataracts are slow growing, and the patient’s refractive error is relatively mild, laser vision correction may be great for them. Their doctor would determine whether the LASIK would be performed before or after cataract surgery.

I do not consider there to be an upper age limit for laser vision correction. I have treated patients in their 70s and 80s with the goal of reducing their dependency on glasses or contacts. One of my happiest patients is a man in his 80s who no longer needs glasses after wearing them for 68 years.

While important, a person’s age is only one factor affecting her vision correction needs. Only a thorough eye exam and consultation with a qualified eye doctor can fully determine if LASIK is the best choice.

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Laser vision correction is capable of treating nearsightedness, farsightedness and astigmatism at any age. However, you must have a comprehensive preoperative evaluation to determine if you are a candidate. This includes a complete eye exam and several advanced diagnostic tests. The doctor evaluates your eye health, as well as corneal regularity and thickness. This article covers some eye health issues and diseases that may affect your candidacy for LASIK.

Eye Diseases & LASIK Candidacy

As you age, vision loss from eye disease becomes more likely. Common diseases that may decrease your vision include cataracts, glaucoma and macular degeneration. If your vision is significantly reduced because of eye disease — to the point where you can’t even see well with glasses — LASIK is not an option.

Cataracts & LASIK Candidacy

Cataracts eventually cause blurred, cloudy vision. However in early stages, cataract progression may be revealed by frequent eyewear prescription changes to maintain good vision. You must have a stable prescription for at least one year in order to qualify for LASIK. Therefore, an early cataract may disqualify you for LASIK, but it may not be severe enough to require removal.

Cataract surgery removes the cloudy natural lens and replaces it with an intraocular lens implant. Despite sophisticated calculations, most patients still have a small amount of refractive error after surgery. This error is usually so small that most patients function well without prescription eyewear. However, patients who desire more precise vision correction should consider laser eye surgery after their cataract surgery. Both LASIK and PRK are excellent laser vision techniques that further improve your vision. Your surgeon will recommend the best technique for you.

Presbyopia & LASIK Candidacy

If you’re over 40, you likely experience presbyopia, or difficulty focusing on nearby objects, and you treat the condition with reading glasses. However, monovision LASIK may offer a more permanent solution. During the monovision procedure, your dominant eye is corrected to be used as your distance-vision eye, and your non-dominant eye is then corrected for near-vision.

For those who were nearsighted before the procedure, the non-dominant eye is left slightly under-corrected. If you were not nearsighted prior to the procedure, your non-dominant eye will be corrected to be slightly nearsighted.  This non-dominant eye allows for better reading and other close-up work, but it will see less well in the distance. At first, you may not feel comfortable with one eye for distance vision and the other for near vision. However, as each day goes by, your brain will adapt to processing the images.

One month after monovision treatment, close to 90 percent of patients are comfortable with their vision. They are able to function at distance and near without glasses. Many doctors offer a preoperative monovision trial with contact lenses to make sure that the adaptation will be successful.

Age does not automatically disqualify you from receiving LASIK, but many factors affect your candidacy for the procedure. Only an evaluation by a qualified LASIK professional will tell you whether laser vision correction is right for you and which technique is recommended for your treatment.

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Write Down Questions

Everyone has a different experience with LASIK, especially when it comes to vision improvements and side effects. Some people experience extremely clear vision just a day or two after the procedure, while others experience gradual improvements over several months. This is why your doctor encourages you to schedule follow-up appointments in the days, weeks and months after the procedure.

You might notice certain changes to your vision when you get home after the treatment. Some patients report seeing halos around lights or describe poor night vision right after surgery. If this happens, make a note of it, so you will remember to bring it up at your next follow-up appointment. Open communication with your doctor is essential to the success of LASIK treatment. If you are alarmed by any side effects or vision changes, call your doctor immediately.

Protect Your Eyes

Many patients begin to rely too heavily on their improved vision after LASIK treatment. They forget their eyes are still sensitive, vulnerable organs that require protection, especially when they might be exposed to dangerous conditions or substances. After LASIK, protect your investment in your health by taking care of your eyes.

Wear goggles when you swim in chlorinated water, wear sunglasses when you venture outside into bright sunlight and use safety glasses when working with caustic chemicals or heavy machinery. Right after the procedure, your doctor will provide you with a list of rules to follow during your recovery. You might be instructed to take baths rather than showers, avoid wearing eye makeup or stay out of the pool.

Inform Your Employer

If your occupation requires your vision to be corrected for safety purposes, inform your employer as soon as you undergo LASIK treatment. The company will need to amend any requirements about the use of corrective lenses based on your current visual acuity. Ideally, employees should discuss this with their employers prior to the procedure and keep them updated.

You might have to provide your employer with a written statement from your physician attesting to your improved vision. It is important to take care of this as quickly as possible, so you are not penalized at work.

Inform the DMV

Additionally, you will need to change your vision status with the Department of Motor Vehicles  (DMV). If your driver’s license is issued with restrictions for corrective lenses, you might get in trouble if you are ever pulled over for a traffic violation. According to WKYC, a state trooper pulled over Cleveland resident Meredith Crock for speeding. When he inquired about her contact lenses, she informed him she no longer needed them because of LASIK. He wrote her two tickets: one for speeding and the other for failing to update the DMV.

Invest in High-Quality Sunglasses

Like many people with poor vision, you might have relied on prescription sunglasses for years. Now that you have had LASIK, you can shop for a pair of regular sunglasses with no corrective lenses. You can have fun picking out the style you want, but you should also focus on protecting your eyes from harmful UV rays.

You might be tempted to purchase 10 pairs of cheap sunglasses for variety’s sake, but it would be a better idea to invest in one or two pairs of high-quality sunglasses. Select polycarbonate or polyurethane lenses for maximum impact resistance and consider brown or green tinting for better glare protection. Look for lenses that block 100 percent of UV light, so you do not risk sunburn or other vision-related damage. Check out these other tips for choosing sunglasses that protect your vision and suit your lifestyle.

Life after LASIK can be difficult to get used to at first, but eventually your improved visual acuity will become normal rather than novel. As long as you take care of your eyes and follow all legal and occupational requirements, it will not be long before you adjust to seeing the world without a blurry haze.

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Types of Refractive Errors & When They Occur

The most common refractive errors are nearsightedness, farsightedness and astigmatism. All of these are caused by light not bending — or refracting — correctly as it hits the eye. Nearsighted individuals have difficulty seeing objects far away. Farsighted individuals have difficulty seeing objects up close. Those with astigmatism have football-shaped eyes, which causes objects to appear blurry.

Most children have clear distance and up-close vision. Starting in adolescence, some develop a refractive error and need corrective lenses. The prescription for these lenses may change often from adolescence into early adulthood. In adulthood the prescription stabilizes and varies little thereafter.

As many people enter middle age, they develop a condition called presbyopia. This is caused by the natural lens of the eye becoming inflexible, which affects the ability to see up close.

Types of Vision Correction

Glasses are the oldest method of refractive vision correction and have been around for hundreds of years. Contact lenses have been available since the 1950s. Both glasses and contacts change how light focuses on the retina, which corrects the refractive error and improves vision. Reading glasses help those with presbyopia see up close.

Since the 1990s, a laser vision correction method called LASIK (laser assisted in situ keratomileusis) has been available as a third option to correct refractive vision problems. LASIK reduces or eliminates refractive errors by changing the structure of the cornea, which is located on the front surface of the eye. This restores visual function.

LASIK is a two-step process. First, the doctor uses a laser to create a flap in the eye’s cornea to preserve the skin of the eye called the epithelium. In the second step, the doctor uses another laser to etch an individual’s own corrective lens prescription on the cornea below the flap. The flap is then put back in place.

No stitches are used in LASIK, and healing is fast for the majority of patients. In fact, many are able to return to work the next day. Numbing drops are used, so patients experience very little discomfort. While side effects and complications may occur, they are rare and usually temporary.

Patients with presbyopia may benefit from monovision LASIK. Monovision corrects one eye’s distance refractive error, while the other eye is left mildly nearsighted for near vision.

Symptoms Versus Cause

Glasses and contact lenses only improve the symptoms of refractive errors. LASIK reshapes the surface of the eye, therefore addressing the structural cause of blurry vision due to refractive errors. This allows the eye to focus without the use of glasses or contacts. LASIK addresses the cause of refractive errors, not just the symptoms.

Each person’s eyes are different. Always consult with a trusted, experienced ophthalmologist to determine which vision correction solution is best for you.

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Conventional LASIK

Conventional LASIK is one the most common laser vision correction procedures. It starts with the doctor cutting a small flap in the top layer of the eye’s cornea with a microkeratome blade. (A microkeratome blade is an extremely thin, machine-operated blade that oscillates back-and-forth very quickly.) Once the flap is gently pulled back, the doctor uses an excimer laser to reshape underlying layers of the cornea. According to the medical journal Cornea, this form of LASIK is virtually painless and has been proven safe for people with mild to moderate prescriptions. Conventional LASIK allows for vision correction within the first 24 to 48 hours (often sooner), with vision possibly continuing to improve in the weeks following the procedure. Current Opinion in Ophthalmology found that this type of LASIK was approved for use in the US Air Force in 2003 for non-flying military personal and for aviators in 2005.

IntraLASIK

Unlike conventional LASIK, IntraLASIK does not utilize a blade when creating the corneal flap. Instead, doctors use a femtosecond laser. According to the Journal of Cataract & Refractive Surgery, this allows doctors to have better control over the thickness of the flap created and helps them prevent any inconsistencies in thickness that may have been created by a conventional blade. As with conventional LASIK, individuals needing mild to moderate correction tend to benefit the most; however, individuals with glaucoma, or who may be at risk for glaucoma, may find IntraLASIK a better option. Some physicians believe that the use of the metal blade in conventional LASIK tends to raise a patient’s eye pressure. IntraLASIK significantly reduces this risk. Similar to conventional LASIK, recovery from IntraLASIK is generally painless. Patients see an increase in their vision almost immediately and may find their vision continues to improve in the weeks following the procedure. Perhaps the main difference between IntraLASIK and conventional LASIK can be found in the price. In an interview for All About Vision, Vance Thompson, M.D., assistant professor at the University of South Dakota School of Medicine, reports the cost per eye to be approximately $300 more for IntraLASIK when compared to conventional LASIK.

PRK

Unlike conventional LASIK and IntraLASIK, a corneal flap is not created for a photorefractive keratectomy (PRK) procedure. Instead, doctors use a solution to gently loosen and remove a very fine layer of cells on the cornea. The remainder of the procedure is the same in that an excimer laser is used to reshape the remaining corneal layers. Recovery for PRK differs as well. Patients typically experience some discomfort as the cells re-grow. Doctors usually place a bandage contact lens on the eyes after the procedure and may tell the patient to wear it for several weeks. This contact lens will have no prescription, but it protects the thin layer of cells as they re-grow. Although it is possible for PRK to be performed on any patient with healthy eyes, it is more commonly suggested for those who have thin corneas or whose professions put them at risk of being struck in the face and eyes. According to Current Opinion in Ophthalmology, the U.S. Army and Marine Core suggest PRK.

To Customize or not to Customize?

Custom software maps out almost the exact path needed to correct the patient’s vision. This map is as unique to an eye as a fingerprint is to a finger. A study in Ophthalmology showed that this software helps doctors reduce the possibility of error and even increase patient satisfaction. Custom LASIK and IntraLASIK both carry a slightly higher price tag; however, patients find it comforting to know that custom LASIK may eliminate the need for future vision enhancement procedures.

What’s on the Horizon for LASIK?

LASIK technology is continuously improving. Currently, young to middle-aged adults benefit the most from laser vision correction. However, patients experiencing presbyopic, or age-related, vision changes can get excited. According to Der Ophthalmologe, trials for presbyLASIK are currently underway and show positive preliminary results — 91 percent of participants no longer need glasses or contacts.

Which LASIK is right for you? Only a comprehensive consultation with a skilled LASIK doctor can give you that answer. It’s important to remember that every procedure carries a certain amount of risk, and outcomes will vary.

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