Poor Eyesight

According to Dr. Tanya T. Khan, an oculoplastic surgeon and the owner of Khan Eyelid and Facial Aesthetics in Austin, Texas, vision quality is somewhat subjective. “A patient who has experienced dull colors and blurry vision due to a dense cataract [clouding of the lens] may still consider themselves to have good vision if they can accomplish their daily tasks of living, such as driving and reading,” explains Dr. Khan. “Alternatively, a pilot may notice a significant change in their ability to fly a plane due to a decrease of just one to two lines on the Snellen vision chart.”

The Snellen chart, which is printed with eleven lines of block letters that range in size, is used by eye doctors to determine vision clarity. Typically, vision that is 20/40 or below is considered suboptimal, and an ophthalmologist can help identify a reason to explain this deficit.

Eyesight quality is orchestrated by all the layers of the eye. It starts from the eyelids, which help shield the eye from external damage and refresh the tear film with each blink, and reaches the back of the eyeball, where the nerve tissue contained within the retina converts light into images in the brain. Due to the complexity of the eyes, there are various reasons that vision clarity can decline.

• Genetics. Certain eye conditions are inherited, and glaucoma is one of the most common examples of a heritable disease that affects the optic nerve and leads to slow vision loss. “We recommend all related family members have baseline eye exams and continue yearly surveillance because of the high likelihood of genetic transmission,” explains Dr. Khan.  

• Injury or disease. “In between the eyelids and the back of the eyeball, the cornea bends light rays entering the eye, and the lens serves as a clear conduit for light energy to pass between the front and back of the eye,” says Dr. Khan. “If any of these structures are deteriorating or injured, vision will likely be compromised.” Conditions like macular degeneration, glaucoma, or cataracts all affect specific areas of the eye that often result in poor eyesight too.  Age-related macular degeneration is an eye disease that occurs when the macula, located in your retina, wears down over time. Glaucoma, on the other hand, is one of the leading causes of blindness for people over the age of 60 and occurs when there’s an abnormally high pressure in your eye, which can cause damage to the optic nerve.  Cataracts can develop when aging or injury changes your eye lens tissue, causing a clouding of the lens in your eye.

• An obstructive eyelid. Bad vision could also be caused by a drooping eyelid. “If you have a very heavy upper eyelid, which is drooping down and covering part of your pupil, then it can impact your peripheral vision,” explains Dr. Jessica Lattman, an oculoplastic eyelid surgeon in New York City. “Basically, the top part of your peripheral visual field will be obstructed by your eyelid.” If, when you’re driving, reading, or at the computer, you find yourself lifting your eyelid to be able to see, your poor vision is probably caused by a drooping eyelid. 

• Age. Presbyopia, the age-related farsightedness that typically occurs in people over 40, is a very common cause of deteriorating vision in adults. Presbyopia is caused by the hardening of the lens in your eye, which naturally occurs as you age.  This condition is so common, in fact, that experts believe more than a billion people in the world have presbyopia. 

Visual impairment isn’t the same for everyone. Low vision can present itself in various ways.

• Loss of central vision. This type of vision loss usually occurs from damage to the macula, which is located in the center of the retina. People who suffer from loss of central vision will miss fine details and/or see blur spots in the central part of their vision field.
• Loss of peripheral vision. This form of vision loss will blur the things that you’d normally see on the left and right sides of your vision, but vision in the center will stay clear and bright.
• Blurred vision. This occurs when there is a total lack of sharpness in both central and peripheral vision.
• Night blindness. Those with night blindness have trouble seeing in dim light or darkness. 
• Light sensitivity. This is when the light level in someone’s environment is too bright, causing them to experience pain and unclear vision.
• Contrast sensitivity. This kind of vision loss is the inability to distinguish between an object and its background.

Treating visual impairment is entirely dependent on the type and cause of your specific vision issues. These are the most common treatment options, according to doctors and RealSelf members.

	LASEK surgical	LASIK surgical	PRK Laser Eye Surgery surgical	Ptosis Surgery surgical
Worth It Rating	100%	93%	83%	89%
Average Cost	Not yet available	$4178	$3876	$3235
Downtime	Up to 1 week of downtime	Up to 1 week of downtime	Up to 1 week of downtime	Up to 2 weeks
Anesthesia	Numbing eye drops	Numbing eye drops, oral sedative (if needed)	Numbing eye drops	Local with sedation or general anesthesia

• Laser epithelial keratomileusis (LASEK) is another type of procedure that uses a laser to precisely and permanently reshape the cornea. This allows the light entering the eye to be properly focused on the retina so your vision is clearer without glasses or contact lenses.  LASEK is a form of PRK. Before a LASEK procedure, your surgeon will apply numbing drops. During the procedure, a lid speculum holds your eyelids open and you’ll be asked to look straight ahead and focus on a target light. A circular cut is made in the corneal epithelium, using a fine blade called a trephine. The trephine leaves a small arc-shaped area of the circle uncut, so the “flap” that’s created remains attached to the eye.  The epithelium is soaked with a dilute solution of alcohol for about 30 seconds, in order to detach it from the underlying tissue. The epithelium is then gently lifted or rolled back as a single sheet, so the corneal tissue beneath it can be accessed with the laser. A tiny amount of corneal tissue is removed with each pulse of the laser. Once the cornea is reshaped, the epithelium is repositioned and smoothed with a small spatula. While the epithelium heals, your doctor will place a protective clear contact lens that should be used for four to six days post-procedure.  Find doctors who offer LASEK
• LASIK is a common choice for those wanting to improve their eyesight. “The popular LASIK procedure [is a laser that] reshapes the cornea in order to bend light rays more efficiently and lead to clearer vision,” explains Dr. Khan. Essentially, LASIK can fix any vision problem that glasses can correct. LASIK is also ideal for those who are middle-aged and older, as studies suggest that the laser is reasonably safe and efficacious for those suffering from presbyopia, the farsightedness that develops in middle age and requires reading glasses. A LASIK procedure is pretty fast and takes only about 10 minutes per eye. After your doctor numbs your eyes with drops, your eyelids will be held open with a speculum. They will then use a laser or microkeratome blade to separate the top layers of the cornea, making a thin flap. Although the procedure shouldn’t feel painful, you might feel some pressure on the eye.  Next, your doctor will lift up the flap, laser the underlying bed, and then replace the cornea flap. Afterward, your surgeon will use a second laser to vaporize the corneal bed under the lifted flap, to reshape the curvature of the cornea and correct your vision. While effective, there are still side effects associated with LASIK, with dry eye being the most common. In recent years, the procedure has even become somewhat controversial, and a former FDA advisor claimed it should be taken off the market. If you’re interested in LASIK, be sure to thoroughly discuss the risks and side effects with your provider. Find doctors who offer LASIK
• Photorefractive keratectomy (PRK) laser eye surgery is a type of laser vision correction that can treat nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. This procedure will eliminate the need for eyeglasses or contact lenses.  This procedure takes five minutes per eye, but the recovery time is slower than with other laser procedures, such as LASIK. Your doctor will apply numbing drops before the procedure, then they will remove your epithelium, the outermost layer of your cornea, by swiping the surface of the eyes with an alcohol-based solution. In the next step, your surgeon will use an excimer laser to reshape your cornea—you’ll look straight ahead, and the laser will fire for about 10 to 20 seconds.  After that, a chemical called mitomycin C is placed onto the corneal tissue for 10–20 seconds; a sterile water flush will follow, to remove it from your eye. Your doctor will place a temporary bandage contact lens onto the eye after the procedure, to help it heal. PRK is often the preferred option for those who do not meet the corneal thickness requirements for LASIK. However, your eyesight will be blurry for about a week post-procedure.  Find doctors who offer PRK laser eye surgery
• Ptosis surgery. “In circumstances where the eyelid itself is droopy, termed eyelid ptosis, it can reduce someone's ability to see well, especially in the peripheral,” explains Dr. Christopher Zoumalan, an oculoplastic surgeon in Beverly Hills, California. “When severe enough, it can completely block someone's ability to see.”  In situations where the ptosis is resulting in visual deficits, ptosis surgery is required. The procedure can involve tightening the weak or droopy muscle, or ptosis repair. The procedure repositions the underlying muscles in order to lift the upper eyelid—unlike blepharoplasty eyelid surgery, which removes excess skin and fat.  Find doctors who offer ptosis surgery

• YAG lasers can be used for various skin concerns, but they’re also used for cataract surgery. Laser surgery is often performed in order to correct the most common complication of the procedure, a thickening and clouding of the capsule (lens membrane) that's called posterior capsule opacification (PCO). In an Nd:YAG laser capsulotomy, an opthamologist uses a special lens to apply a laser beam to the capsule, creating a small hole in the intraocular lens that lets more light through. After a YAG capsulotomy, you should have clear vision by the next day.  Find doctors who offer YAG laser
• Eyelid surgery (also called an eyelid lift or blepharoplasty) tightens and lifts sagging eyelid skin. The procedure can be done on upper lids, to raise hooded or droopy eyelids, and on the lower lids, to remove eye bags and tighten loose skin. These procedures can be performed separately or at the same time. “A blepharoplasty, with or without ptosis repair, can significantly improve that patient’s field of vision, much like opening the curtains covering a window,” explains Dr. Khan. Some studies have even shown an increased visual field and improvement in headache- and vision-related quality of life too.  Find doctors who offer eyelid surgery