I’m over 40 and I want out of glasses: What are my options?

As we progress through our 40s, many of us start to notice that our eyes aren’t quite what they used to be. Suddenly, we find ourselves holding a menu as far away as we can reach, or pulling out our phone flashlight, just to read it. As we age, the natural lens of our eyes loses its flexibility, which forces us to make a choice: do I want to see well far away, or up close, because I can’t have it both ways?! Welcome to presbyopia, which in Greek means “old man-eye.” Yes, it’s one of the first times for most people that they have to admit that they’re not 30 years old any longer. But what can we do about it? In this blog post, I’ll go over the current options and pros and cons of each.

LASIK After 40: What should I do?

Before we jump into the topic of “LASIK after 40,” there are some concerns and considerations that need to be mentioned. At about age 45, the flexibility in the lens of our eyes decreases to the point where we can’t change focus from distance to near. Our eyes become more “fixed focus” where if you’re nearsighted, you can see near objects but not distance. If your eyes see well in the distance, they have trouble focusing on near objects. When you have LASIK, PRK, or the EVO ICL, your surgeon can discuss, simulate, and demonstrate what you might expect after a vision correction procedure. A trial of contact lenses to simulate your vision may also be possible. Dr. Sharpe is always in favor of a contact lens trial of at least a week to see what your vision will be like in all lighting conditions, tasks, and times of day.

If you have LASIK before the age of 45, your distance vision should remain good, but the near vision will get more difficult at some time in your mid to late 40s. This is not “LASIK wearing off” but rather the result of the natural aging process causing your own lens to lose flexibility. Without that lens flexibility, the eye can’t pull the focus from distant objects to those at close range.

Older adults may have a higher risk of developing age-related eye conditions that can impact the outcome of their LASIK treatment (dry eyes, cataracts, glaucoma, presbyopia). LASIK doesn’t cause these issues, but it can’t prevent them either.

LASIK after 40 may not be a good option in patients who have other health conditions present like dry eyes, cataracts, or autoimmune disorders, but there are other options such as RLE (refractive lens exchange). The doctors at SHARPEVISION will screen you for your eligibility for surgery and help coordinate treatment for underlying conditions that may exist.

However, LASIK after 40 years old can still be an excellent option for many. It’s critical to your satisfaction with your procedure that you are as informed as possible. The best way to find out if LASIK will work with you is to schedule your consultation at SHARPEVISION to determine if you’re a good candidate for LASIK, PRK, EVO ICL, RLE or a Monovision goal for any of the above. Our mission at SHARPEVISION is to provide a vision correction option for anyone of any age or prescription.

What Is Monovision LASIK?

Monovision LASIK is a laser vision correction procedure that corrects one eye for distance vision and the other for near vision, unlike traditional LASIK which corrects both eyes for clear distance vision. Monovision LASIK after 40 years old is an option for those experiencing presbyopia, as it can provide patients with both distance and near vision without the need for glasses or contacts.

Monovision LASIK is best suited for those who have previously adapted to monovision using contact lenses and have a compatible lifestyle and visual needs. I am very reluctant to treat nearsighted people over 45 with both eyes for distance, because no amount of explaining and assurance that “I’m OK with reading glasses” will help when you wake up the next day with perfect distance vision, but can’t see up close. I’ve had patients in this situation say, “I can’t see up close. Will that get better?” And I say, “Do you remember us discussing this very issue for about 30 minutes before your procedure?” And they say, “Yes, but I didn’t know it was going to be this bad.”

With monovision, distance vision is good in one eye, and near vision is good in the other eye, but there is both a physical healing where the vision improves for weeks after the LASIK, as well as your brain adaptions. Many people ask if they’ll go around squinting, get headaches, have trouble going down stairs or have trouble with depth perception. None of those problems have been prevalent in my experience. Most people go about their days and lives without really thinking about it. One important factor with monovision is that we can reverse it. I recommend waiting at least 3 months before making a decision to reverse the monovision. I’ve found that only about 1% of people opt to reverse it. Certain circumstances might be visually challenging such as night driving in the rain or snow, seeing a concert, play, or performance. For these circumstances, at SHARPEVISION we write a prescription for glasses that focus the near eye for distance, and put plain glass in the distance eye. These can be purchased online from companies like zennioptical.com for $15-$60, and may be used 1-5% of your life, versus having to put on reading glasses every time you look at your phone.

The Pros Of Getting LASIK, PRK, or EVO ICL Eye Surgery After 40

The benefits of going through with LASIK eye surgery include:

1. Find New-found Freedom, Flexibility, & Independence. Many people who undergo LASIK eye surgery after 40 report feeling a sense of newfound freedom, flexibility, and independence. This is because LASIK can significantly reduce or even eliminate their dependence on glasses or contact lenses. After LASIK, patients can enjoy activities like swimming, playing sports, and traveling without worrying about their vision. In addition, the convenience of not having to wear glasses or contacts can improve one’s self-confidence and overall quality of life.
2. LASIK Works Across a Number of Circumstances. LASIK does work over 40 in a variety of circumstances. For example:
   a. Someone with nearsightedness and mild astigmatism can have their refractive errors corrected with LASIK after 40. They may opt for extremely sharp distance vision in both eyes and choose over-the-counter reading glasses for near tasks.
   b. An individual with great distance vision but poor near-vision, who wants to do away with reading glasses, can have it corrected with LASIK monovision.
    c. An individual with excellent near vision, who wants their moderate nearsightedness corrected, could choose Monovision LASIK. Sometimes we can treat just one eye in patients with mild nearsightedness that allows perfect near vision without glasses. This can be both more functional and less expensive, because we treat only one eye. Keep in mind that most people will still have to have both eyes treated to achieve maximum glasses independence.
3. Monovision LASIK Tackles Presbyopia & It Is Reversible. If you have age-related presbyopia, you may automatically think you’re disqualified from LASIK, but that’s simply not true. Monovision LASIK after 40 is a good option for patients who want to correct their eyesight for both distance and near vision loss, and the best part is that it’s reversible. If a patient doesn’t like the results, the procedure is reversed by performing LASIK on the under-corrected eye for distance vision. It can take a bit of time to get used to Monovision, but the vast majority of patients do well with it.

The Cons of Getting LASIK Eye Surgery After 40

While the benefits of LASIK after 40 include clear vision, ditching those reading glasses, and new-found freedom, it does have some downsides like any medical procedure.

• Will it continue to get worse?  The flexibility of the lens of our eyes goes basically to zero in our early to mid-50s. Once the flexibility is zero, we still have a depth of field and a range of clear vision that depends on a number of different variables. However, if the near eye is set to about -1.50 diopters of nearsightedness, you should be able to see all the basic things, like phone, food, computer, makeup without any glasses. Dim lighting will make the near vision more difficult for anyone over 45.
• You May Not Adjust to Monovision.  If you have presbyopia and choose the Monovision LASIK option, you may not adjust to how your new vision works. We highly recommend that those interested in LASIK after 40, select Monovision-based contact lenses (temporary solution) to see how they like Monovision before going ahead with LASIK.
• Monovision LASIK is a Compromise-but a GOOD ONE!  With Monovision LASIK, you gain greater convenience and more freedom from glasses but you won’t necessarily have perfect distance vision or perfect close-up vision – it’s a compromise. You may notice that your depth perception is slightly decreased, especially in low-light conditions (dimly lit restaurants) or during activities that require sharp vision (sports). Some patients will opt to wear a single contact lens during sports, bringing their reading eye to distance just for that event.
• You May Grapple With Dry Eyes.  A common side effect of LASIK is dry eyes, which do clear up in 3-6-months. But in those over 40, who may be more prone to dry eye syndrome, this healing process may take longer or be more problematic to deal with (longer use of eye drops needed, more follow-up appointments, etc.). All of that can cost more money, time, and frustration, but can be successfully treated
• Night Vision Disturbances.  While not specific to those aged 40+, if you’re someone who prefers to travel at night, whether that be for work or vacation, then reduced night vision may be a con. A potential side effect of LASIK is an increase in glares, halos, and reduced vision at night, which can make low-light conditions difficult to travel in. Fortunately, at SHARPEVISION, we have every technology available to choose the best option for you.
• Later Life Consideration: Cataracts.  If there is a history of cataracts in your family, you’re diabetic, or you already have cataracts, then LASIK may not be the right option for you. In these cases, it may be better to improve your vision using lens-based surgeries. Our name is SHARPEVISION MODERN LASIK & LENS for a reason, we excel at both! In addition to this, because LASIK changes the shape of your cornea, if you do develop cataracts later on in life, this cornea alteration may make it more difficult to determine the correct cataract lens to choose. But don’t worry, we have you covered there as well. We can do laser adjustments to anyone who has residual prescription after RLE or cataract surgery. This happens about 1 in 30 patients who has cataract surgery. Your eye may still change, meaning your refractive error might change. LASIK reshapes the cornea. While the cornea tends to remain stable after LASIK, other parts of your eye may change with time. If your lens changes and becomes a cataract, your vision may change and your refraction may change as well.

Is It Worth Getting LASIK After 40: How To Decide If It’s Right For You.

Is it worth getting LASIK after 40? For many patients, it is very much worthwhile. While it’s true that LASIK is not suitable for everyone, especially those with other age-related eye conditions, it doesn’t mean that it’s off the table. LASIK is transformative, and could be right for you if:

• Your current eye prescription and vision goals can be corrected with LASIK, and you are okay with wearing reading glasses when presbyopia does set in.
• You have a good medical history with no major eye health problems.
• You have realistic expectations of what LASIK can do for you, and you’re willing to follow post-operative instructions carefully and attend regular follow-up visits to monitor the healing process.
• Likewise, you understand that LASIK does come with possible risks and side effects and that your vision may change over time due to age-related conditions or factors.

To decide if LASIK is worth it after 40, we recommend a consultation with one of our experienced doctors, who will evaluate your eyes and recommend the best course of action for your vision needs. If LASIK is not the recommended course of action, then we do have alternative procedures such as RLE or cataract surgery that may work better for you.

Alternative Surgical Options to LASIK After 40

In some cases, LASIK after 40 may not be the best option for improving vision. Alternative options may include:

• PRK (Photorefractive Keratectomy): A similar procedure to LASIK that reshapes the cornea using a laser, to improve how light rays are focused onto the retina. PRK is performed to treat refractive errors in the eyes, including myopia, hyperopia, and astigmatism. Unlike LASIK, PRK does not involve cutting a flap in the cornea, making it ideal for people with thin corneas, or an active lifestyle such as martial arts, boxing, MMA fighting. PRK requires a longer recovery period than LASIK, and generally hurts for about 48-60 hours, but long-term vision quality is statistically the same. We give numbing eye drops, pain medication prescription for about 48-60 hours. Your immediate post-operative vision with PRK is similar to LASIK, but with PRK it gets worse about day 2-3 post-op, then gets gradually better. With PRK, you need to plan 3-7 days out of work. You can work in terms of lifting, bending, walking, bathing, but if your job requires perfect vision, then I recommend waiting 5-7 days before returning to work.
• Refractive Lens Exchange (RLE) is a surgical procedure that replaces the natural lens of the eye with an artificial intraocular lens (IOL) to improve vision. It’s a wonderful alternative to LASIK for patients over 40. RLE can correct nearsightedness, farsightedness, and astigmatism, and can also address presbyopia, a condition that makes it difficult to focus on close objects. While LASIK reshapes the cornea, RLE replaces your natural lens with a multi-focal IOL (Intraocular lens) that allow good distance, intermediate or near vision, providing a permanent solution to vision problems. As an added benefit, these patients will not get cataracts later in life, because you’ve already had your lens replaced. And even better is the peace of mind that these lenses have been time tested in about 5 million procedures per year in the US, and growing. Similar lenses have been in people’s eyes for over 70 years.
• Phakic intraocular lens (or implantable contact lens) (ICL) implants are a type of vision correction surgery that involves placing a small lens inside the eye to improve vision. This can be a good alternative for people over 40 who have age-related changes in their eyes that make LASIK less effective, namely dryness-the EVO ICL does not result in short-term dryness like LASIK might. The FDA approval range for the EVO ICL is 21-45. However, EVO ICL can still potentially be placed in someone over the age of 45 as long as all the risks, benefits and alternatives have been discussed, and the patient accepts the risks. There is no inherently greater risk for someone over age 45 receiving the EVO lens, but they must understand the limitations of monovision and presbyopia. The EVO ICL can improve nearsightedness, and astigmatism, but in the US they are not available for farsightedness. The EVO ICL  can be removed or replaced if necessary, but we obviously plan to avoid this. When a cataract develops in someone with the EVO ICL, your surgeon can easily remove the ICL, then proceed to remove your cataract without any additional risks.

It is important to discuss all options with an eye doctor to determine the best course of action for improving your vision

Conclusion

If you’re over the age of 40 and looking to improve your vision while reducing your dependence on glasses or contact lenses, LASIK eye surgery after 40 is definitely an option worth considering. It is highly recommended that you have an in-depth discussion with one of our qualified optometrists or surgeons to explore all available treatment options. At SHARPEVISION LASIK & LENS, we offer in-depth exams to all patients considering LASIK, PRK, EVO ICL, RLE, or cataract surgery, and we would be delighted to help you with our state-of-the-art technology, and answer any questions you may have to determine if LASIK is the right option for you. Go to sharpe-vision.com to schedule your free LASIK exam and take your first step towards clear, crisp vision.