(Sorry about the cartoon. Sometimes you just have to have a giggle.)
Are you considering laser eye surgery? If you are a lady boomer, the factors that you need to consider may be different from those of a twenty-something.
In my previous post, “Laser Eye Surgery – Here’s Lookin’ At Ya”, I talked about the reasons why I set out to investigate the pros and cons of having my vision surgically corrected. Briefly they are: my bi-focal contact lenses have gradually become uncomfortable after years of trouble-free wear; increased time looking at a computer monitor (occupational hazard of being a writer!) is aggravating dry eyes; and an active lifestyle that is not well-served with glasses sliding down my nose.
Sound familiar? If you wear glasses or contact lenses, these concerns may have you wondering about laser eye surgery as well. But ask yourself this – what do you really want to achieve by having surgery?
Do you want crisp distance vision without glasses or contacts? That sounds awfully appealing doesn’t it? Imagine eating hot soup without your vision fogging over. Or going swimming and being able to see. Or coming inside from the cold and still being able to see because your glasses haven’t fogged over. Or going camping and not fiddling with contact lens solution in a cramped, musty tent. Ah, the freedom!
Wait a minute. While laser vision correction does an excellent job of correcting distance vision, it does not correct reading vision (presbyopia). Maybe that is not an issue for you, but for those of us who have already migrated to bifocals, this is where the rubber hits the road. You see, laser eye correction for the bifocal wearer will remedy the distance problems, but not the reading vision. Post-surgery, reading glasses are instantly required. Now those fingernails that need trimming or that stray hair that needs tweezing have to wait until reading glasses are located.
For all of you women out there who love to read as I do – day and night, anywhere and anytime – the prospect of searching for glasses every time I want to read anything has about as much appeal as a going for a mammogram. Besides, trading off reading vision for distance acuity seems like exchanging one shortcoming for another. Rather like exchanging a husband who snores for one who farts – the nights might be better but the days would be unbearable!
Both Dr. Nijhawan of the Herzig Institute and Dr. Wallerstein of LASIK MD understood my concerns about reading vision and did their best to meet my objectives while remaining within the boundaries of good clinical outcomes. For each of them, safety and patient satisfaction are the main priorities. To further complicate the situation, I have scarring on my right eye from a previous failed attempt at laser eye surgery; that made both surgeons nervous about trying laser eye treatment again on that eye.
As a result, Dr. Navdeep Nijhawan of the Herzig Institute, recommended Refractive Lensectomy (RL) to correct my nearsightedness. Reasoning that I would likely develop cataracts in the future, RL would do an end run on the probability and give me better vision today. Surgery for RL is identical to that done for cataracts; the surgeon removes the natural lens from your eye and inserts an implant. Corrected for myopia, the patient has greatly improved visual acuity for distance. Reading vision? There are bi-focal implants available, however Dr. Nijhawan did not recommend them because some patients have complained of poor vision, particularly at night, after the procedure.
Alternatively, monovision could be done with the lens implants. In that case, the dominant eye is corrected with a lens for distance and the other eye is corrected for reading vision. While it may sound strange, the brain does adapt to the discrepancy in vision and suitable candidates are able to see well both near and far. To determine my suitability, Dr. Nijhawan provided me with trial soft contact lenses that would mimic monovision.
Dr. Wallerstein, a co-founder of LASIK MD, recommended different approaches. Avi (as everyone calls him) preferred Advanced Custom Wavefront (ACW) procedures with PRK for my right eye (due to the old scarring) and LASIK on the left. Under PRK, the outermost surface of the eye (called the epithelium) is brushed away so that an excimer laser can reshape the cornea. This alternative way of accessing the cornea would avoid any potential complications posed by the existing scar on my eye. It does however, take longer to heal and some people experience a degree of discomfort after the procedure.
For my left eye, the ACW LASIK procedure would start with a precision instrument cutting a thin layer, or flap, of corneal tissue. After this layer is created, the same excimer laser that is used in PRK re-shapes the cornea, and the flap is repositioned for healing. Using the LASIK technique, there is very little discomfort. Healing is quick and most people are back to their regular activities within 24 hours.
Unfortunately, while both of these procedures would improve my distance vision, neither would salvage my reading vision. In his opinion, Avi did not think I was a good candidate for monovision due to the degree of nearsightedness in my left eye; with my prescription he felt there was only a 50-50 chance that I could adapt. However, with an infectious grin and a twinkle in his eyes, he did add that others are not wrong to suggest it; after all, there is a 50 percent chance of success!
When asked why he would recommend these procedures rather than RL, Avi replied that he tends to be conservative and even though RL is an extremely safe and common procedure, he prefers the least invasive approach whenever possible.
As it turned out, Avi was right and monovision was not the answer for me. With the trial contact lenses from Dr. Nijhawan, both my distance and reading vision were blurry. I really tried to convince myself that I could adapt, but after five days of walking into large objects and squinting at my computer screen, I had to admit defeat; monovision was not going to be the solution. Bottom line – surgical procedures for me will only result in the correction of my distance vision problems and the end result would only be a frustrating exchange of bifocals for reading glasses.
This unfortunate reality is no reflection on either surgeon or their laser eye centres. Both physicians are very concerned about their patients’ satisfaction and work hard to achieve the best possible visual outcomes. In fact, if I could have retained reading vision and gained distance vision by having surgery, I would have done so immediately.
So think about it. What means more to you? Do you want to be able to have good eyesight for distance or for reading? Or are they equally important to you?
If you want both and you aren’t a candidate for monovision, then surgical correction may not be in the cards. Once past the age of about 40 years, as reading vision begins to falter, so do the advantages of surgery. The lure of distance correction is a seductive one. But stop and think – if you are currently wearing bifocals, the choice to have surgical correction may not be as clear as the vision you seek.
PS: It’s not all sad news. Because of my research into laser eye surgery, I met Roslyn O’Byrne, certified ophthalmic medicaltechnologist (COMT), who initially screened me at the Herzig Institute. Not only does Roslyn do the pre-surgical screenings, she also is an expert in contact lens fitting, particularly for people who are “difficult to fit”.
A bifocal contact lens wearer herself, Roslyn is now working with me to find contacts that will provide me with the comfort and visual clarity that I seek. Will they turn out to be rigid, gas permeables (RGP) or the disposable, soft lenses which are now available in bifocals?
Surprise, surprise – there are many pros and cons to each type! As I discover what they are, I’ll keep you “posted”!