I've been farsighted since my teens. I started in the 2-3 Diopter range as a teen, and now I am +3.75 in my dominant eye and +5.00 in my non-dominant eye. My ADD for reading is +1.50 (both eyes). A few years ago I looked into LASIK, but was told that my eye was already too round, so making the lens steeper would result in extreme eye dryness toward the center of my eye. That was 10 years ago. I'm wondering what my options are today.
42 and +5 Hyperopia - What Are my Options?
Doctor Answers 5
Laser vision correction for hyperopia
Laser vision correction is still not an option in my opinion. You will need to consider clear lens extraction with multifocal lens implants. Technically this is not FDA approved in the US but could be possible “off label” with full discussion of risks, benefits and alternatives.
42 Years Old and +5 Hyperope-What Are My Options?
Your surgical options range from PRK to Lasik to RLE(Refractive Lens Exchange). Considering your age and the severity of hyperopia in your nondominant eye, I would most likely encourage lens based rather than corneal based surgery. A Refractive Lens Exchange is, essentially, a lens removal procedure identical to a cataract surgery(except you don't have a cataract). Once your natural lens is removed, a replacement lens can be put in place that takes away your farsightedness(hyperopia) and also corrects your need for reading glasses. There are several different lens implants available that will correct both of these issues for you, so I think this is the way to go. There is no question that RLE is a bit more invasive than Lasik, thus exposing you to a slightly increased risk, as well as increased cost, but, in my opinion, these negatives will be more than exceeded by your satisfaction. Also, when you consider that you likely have 40+ years to enjoy this new vision, it will be more than worth it!
LASIK for high hyperopia
I would encourage you to consider options to LASIK or surface ablation. In my opinion, laser refractive procedures should usually be limited to somewhere between +3 and +4. As a +5, I think that you would be better served with either contact lenses or consider clear lens extraction with a multi-focal implant. If phakic IOL's were available in the U.S. they would also be potential options. I personally do not treat +5 patients as they tend not to do well.
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LASIK for Far-sightedness
A plus(+) spectacle prescription is a far-sighted prescription. When treating far-sightedness, LASIK makes the cornea steeper rather than flatter. A high amount of far-sightedness is often difficult to treat and can result in increased dryness. Many surgeons would advise a pseudophakic lens implant (often called an implantable contact lens) rather than LASIK surgery. A pseudophakic lens implant would not require a change in the shape of the cornea and would provide the same correction as LASIK. A psuedophakic lens implant could actually correct much higher levels of near-sightedness and far-sightedness than LASIK surgery.
Why LASEK is better than LASIK for older patients because of dry eyes
you were told correctly that LASIK caused the eyes to be more dry, because when the corneal flap is cut, that cuts your corneal nerves, so you wind up staring your eyes dry. i had LASIK myself, and have to take tears for the rest of my life
this is one of the main reasons why i switched from performing LASIK to the more advanced, noncutting procedures, called ASAs (Advanced Surface Ablation) which are LASEK and epiLASEK. these do not cut flaps, so don't cut your corneal nerves, so don't make you more dry. when i was doing LASIKs, about 50% of my patients complained about long-term dryness. since i switched to LASEK 5 years ago, that has dropped to 5%, and i think these patients would have been dry anyway, even if i didn't laser them (like they're older patients)
in terms of your eye being too round, that's another LASIK concern that doesn't apply so much to LASEK. essentially, if your cornea is too steep or flat, when i cut the flap that could be a problem and you would have a botched flap, which would prevent the laser part from happening, which is actually the part that corrects your prescription (the cutting a flap part just gains access to your cornea).
just to to ascrs.org and search for a surgeon near you that specializes in refractive surgery, has completed a fellowship in that, and performs ASAs, as i think that's better for you than incisional surgery given your age
good luck and hope this helps!
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