Friday, August 1, 2014

The best age to have LASIK

So, young, middle, or old? What's the best age?

Is there a best age to have LASIK? I get asked this question quite often when patients enquire about this surgery and the short answer is yes, with some caveats.

I suppose when we decide to have something done (eg surgery), or even when we buy something, we want to get the best that we can get for what we pay. In other words, value. Even more importantly for surgery of course, we want to get a good outcome, and we want to ensure quality and safety, but value is a common factor that pervades many aspects of our lives.

LASIK is somewhat different from other types of surgery, because what you get out of it is influenced by the age when it is done. Let's take a few scenarios.

A typical patient in their 20s comes for LASIK. In such a situation, both eyes are corrected for distance, so everything is clear after surgery, whether it is something far away or something close up that is being looked at. However, when this patient gets to his/her early forties, they are just like any other patient who does not wear glasses for distance, ie near vision for reading slowly starts to get blurry, and they find they have to start holding things further away. This condition is called presbyopia. At some point, reading glasses are needed for comfortable close work like reading.

When a patient comes for LASIK and they are already in their forties or older, presbyopia is an issue that needs to be considered straight off, at the time of the pre-LASIK consultation. This is because LASIK cannot 'cure' presbyopia as such. The usual option offered to patients who desire spectacle independence is monovision, with its attendant compromises. PresbyLASIK is unfortunately unpredictable in its effects, and so far corneal inlays have also shown problems relatively commonly.

Having said this, many presbyopes are very happy with monovision LASIK. The important thing is to allow a trial period of monovison adaptation to see if patients can tolerate it. This simulation is best done with contact lenses. If a patient does not tolerate monovision with contact lenses, then if LASIK is done both eyes should be corrected for distance and then reading glasses worn for near. Therefore it can be seen that LASIK after the age of 40 or so does not provide as much clarity of vision for all distances compared with when it is done earlier, and also involves some compromises, whether it be monovision or reading glasses for near work.

The next group of patients to consider are those 60 and above. Generally speaking, age is associated with an increased incidence of cataracts, especially with those above 60 years of age. The issue with cataract development is that once a patient has cataracts, then they are no longer suitable for LASIK, since the cataract will blur vision even if LASIK is performed. Furthermore, doing cataract surgery is also a way to correct spectacle power, giving an effect like LASIK. In some ways, you could consider cataract surgery as having the ability to reset the power of the eye, therefore, this is the point where the effects of the LASIK surgery are 'lost'.

To cut a long story short, the best age to have LASIK in my opinion is the early twenties, once spectacle power has stabilized and remains unchanged for more than a year. Patients above 40 will still benefit from LASIK, but one might want to consider certain compromises to avoid reading glasses. Generally, patients above 40 who do get LASIK done avoid progressive/bifocal spectacles, which many people find difficult to get used to. Glasses, if needed, tend to be reading glasses, or occasionally distance glasses for monovision patients who drive a lot at night.

1 comment:

  1. I totally agree with you and I am already on my twenties. I am thinking of having a lasik and already started collecting info from