Laser vision correction or lens exchange: which suits me?
Around the mid-forties, most people start to need reading glasses. This is called presbyopia, and it happens as the eye’s natural lens loses flexibility. If you want to be less dependent on glasses, two broad approaches are available: reshaping the cornea with laser, or replacing the natural lens with an artificial one (refractive lens exchange, or RLE).
Laser vision correction
LASIK and PRK reshape the cornea. They correct distance vision well and can also be used to set one eye for near (called monovision), though some people find monovision hard to adapt to. Laser does not stop the natural lens from ageing, so cataract will still develop later in life. See LASIK and PRK.
Refractive lens exchange
RLE is the same operation as cataract surgery, but done to correct your vision when no significant cataract is present. The natural lens is replaced with an intraocular lens chosen to suit your needs, such as a monofocal, toric, extended depth of focus or multifocal lens. Because the natural lens is removed, cataract can no longer develop. See Latest innovations in intraocular lenses.
How do they compare?
- Reading vision. Laser alone does not restore it. A multifocal or extended depth of focus lens may reduce the need for reading glasses, though some people still need them for fine print.
- Age and lens. Laser is often preferred under about 50. RLE tends to be considered over about 50, or earlier in people with high long-sightedness or early lens changes.
- Surgery type. Laser is a corneal surface procedure. RLE is an operation inside the eye, with different, and in some respects greater, risks.
- Cost. Neither is typically covered by Medicare when the aim is to reduce glasses use. Fees vary. Contact Dr Abell’s rooms for information or for a quote.
Risks specific to lens exchange
These include infection, inflammation, retinal detachment (more likely in people with short-sightedness), swelling of the macula, cloudiness of the lens capsule, glare or halos, a need for further laser or surgery, and loss of vision. Not everyone is a good candidate: people with certain eye conditions, such as significant macular disease, may do better with a different approach.
Which one for me?
There is no single right answer. Your prescription, age, corneal shape, lens clarity, occupation, hobbies and tolerance for glasses all matter. A thorough assessment and an honest discussion of the trade-offs will point to the best option, which in some people is simply to keep wearing glasses or contact lenses.
All surgery carries risk. This article is general information and is not a substitute for individual medical advice. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.
