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LASIK & Near Vision
Presbyopia: What Happens To Near Vision After Age 40?

by Craig S. Bindi, MD

As you move through your early 40’s, you’ll realize that you are beginning to develop
presbyopia when you start struggling to read a menu or when you hold a magazine
progressively farther and farther away to see clearly. This familiar event is often the first
sign of presbyopia. Symptoms include eye fatigue, headaches and blurry near vision.
Presbyopia is an inevitable vision condition in which your eyes gradually lose the ability to
see things up close. It is not a disorder or disease but rather a natural aging process of the eye.
It is important to realize that presbyopia will eventually affect everyone regardless of LASIK.
The age of onset to become presbyopic will not be different if you wear glasses/contacts,
have LASIK or are naturally 20/20 at distance. This is why over-the-counter reading glasses
and bifocals are so common after age of about 43. In our computer-centric society, near vision
is very important. Various refractive procedures, such as LASIK Monovision and Lens Implants,
can help alleviate presbyopia symptoms to help improve near vision.

What Causes Presbyopia?
When you are young, the lens in your eye is soft and flexible. The lens can easily change its shape,
allowing you to focus on objects both close and far away. After age 40, the lens gradually becomes
more rigid and cannot change shape as easily as it once did. As a result, it is more difficult for the
eye to focus clearly on close objects. Reading and performing other close-up tasks such as
threading a needle become very difficult. In clinical studies, medication, nutritional supplement
and eye exercises have not been helpful in stopping or reversing this normal aging process.

What Can Be Done To Correct Presbyopia?
Over-the-counter reading glasses help compensate for the loss of near vision. If you have good
distance vision you may only have to wear over-the-counter readers for performing close tasks.
Take off your distance glasses! If you are naturally nearsighted, you may already have clear near
vision without glasses. It is important to understand that after LASIK, your natural nearsightedness
will be removed, so near vision may seem worse after a “full distance correction” LASIK, if you are
over 40. This is why many patients consider intentionally leaving a small amount of nearsightedness
to preserve near vision after LASIK (see LASIK Monovision below).
Bifocals, Trifocals or Progressive glasses. If you already wear glasses to correct other refractive
errors, you may need bifocals or trifocals to correct for presbyopia.
Contact Lenses. If you prefer to wear contacts rather than glasses, there are two types of contact
lenses available: monovision contacts and multifocal contacts. In contact lens monovision, one eye
is focused for distance and the other eye is focused for more clear near vision so both distance and
near objects can be seen without glasses.
LASIK Monovision: Rather than target perfect distance vision in both eyes, many patients that
are older than 40 may want to consider monovision where one eye is set for distance focus and
the other eye is set for more clear near vision. With Monovision, the goal is for both distance and
near objects to be seen without glasses.
Lens Implants & Refractive Lens Exchange entail surgically inserting a clear lens implant to correct
a focusing problem. Multifocal lens implants have the ability to correct for distance and near vision,
thus providing binocular distance and near vision. “R.L.E.” is a popular choice for individuals with
developing cataracts (cloudy lens) above age 45 or in patients who seek better near vision without
LASIK Monovision.
Conductive Keratoplasty is a procedure where radiofrequency energy is applied to the cornea
to steepen the cornea and improve near vision. This is a very safe option, but is a temporary solution
and usually begins to wear off within about 1 year, limiting its usefulness.
Promising future options: Corneal implants (i.e. Acufocus) currently in phase 3 FDA clinical trials