Laser surgery in your 50s

The Star Malaysia - Star2 - - HEALTHY EYES - By Dr Yen Siew Siang

TECH­NO­LOG­I­CAL ad­vances in laser eye surgery have brought con­tin­u­ous im­prove­ment in safety and ef­fi­cacy.

Through the years, LASIK ( laser eye surgery) has be­come a main­stream pro­ce­dure for the cor­rec­tion of re­frac­tive er­rors.

Most peo­ple ex­pe­ri­ence a de­cline in the qual­ity of their vi­sion when they hit their 40s. With a very large pop­u­la­tion of baby boomers now in their 40s and above, the de­mand for cor­rec­tive eye surgery has been on the rise.

In fact, there are in­creas­ing num­bers of pa­tients above the age of 50 en­quir­ing about LASIK.

Many may won­der whether there is an age limit for LASIK. A study car­ried out by Dr Dim­itri Azar and col­leagues at Univer­sity of Illinois, Chicago, that in­volved per­form­ing eye surgery on pa­tients aged 40 to 69 con­cluded that there were no sig­nif­i­cant sta­tis­ti­cal dif­fer­ences in fi­nal vis­ual acu­ity be­tween the dif­fer­ent age groups of those aged 40 to 69.

Hence, I be­lieve that there is not nec­es­sar­ily an age limit for one to per­form LASIK. Rather, it de­pends on the state of the eyes of the pa­tient rather than his age.

How­ever, each can­di­date seek­ing re­frac­tive surgery must un­dergo a thor­ough eye ex­am­i­na­tion and be con­sid­ered on a case- by- case ba­sis.

Those in this age group should take th­ese pre­cau­tions into con­sid­er­a­tion be­fore un­der­go­ing LASIK:

The nat­u­ral lens in­side the eye has to be clear and the pa­tient must un­der­stand that LASIK will not pre­vent a cataract from de­vel­op­ing in the fu­ture.

Changes in vi­sion or pre­scrip­tion may in­di­cate an early on­set of a cataract. Pa­tients who are al­ready de­vel­op­ing a cataract and un­dergo LASIK may find their vi­sion de­te­ri­o­rat­ing in a few years. The main cause of this is not that the laser eye surgery is not per­ma­nent; rather, it is caused by the cataract.

Be aware of any signs of agere­lated eye dis­eases or a fam­ily his­tory of di­a­betes, glau­coma or corneal dis­or­ders.

An­other thing to con­sider is dry eyes. This is more com­mon in those aged above 50 due to changes in their body as well as side ef­fects of cer­tain med­i­ca­tions.

Dry eyes are a com­mon side ef­fect of LASIK, es­pe­cially dur­ing the re­cov­ery pe­riod. Dur­ing the LASIK pro­ce­dure, a sig­nif­i­cant amount of corneal nerves, which help re­duce dry eyes, is cut.

How­ever, with a tech­nol­ogy called SMILE ( small in­ci­sion lentic­ule ex­trac­tion) the corneal nerves are pre­served and the chance of de­vel­op­ing dry eyes is sig­nif­i­cantly less­ened.

LASIK is con­traindi­cated if a pa­tient is on Amio­darone ( a drug that helps keep the heart beat­ing, nor­mally used by pa­tients with heart dis­or­ders).

Us­ing Amio­darone af­ter un­der­go­ing LASIK may cause coloured haloes around lights, pho­to­sen­si­tiv­ity, blurred vi­sion, dry eyes and lens opac­i­ties.

So prior to un­der­go­ing any laser eye surgery, en­sure that your doc­tor knows of your med­i­cal his­tory and pre­scrip­tion drugs.

Pres­by­opia is a loss of elas­tic­ity in the lens re­sult­ing in the eye los­ing its flex­i­bil­ity to ad­just its fo­cus, which af­fects a per­son’s abil­ity to see fine de­tails up close. It nor­mally de­vel­ops at age 40 and above.

In LASIK, the laser treats the cornea to cor­rect my­opia, hy­per­opia and astig­ma­tism but it can­not stop the nat­u­ral lens in­side the eye from age­ing.

Hence, un­der­go­ing LASIK in your 20s will mean that you will even­tu­ally need to wear read­ing glasses at age 40 and above to see close- up de­tails.

In LASIK, pres­by­opia is com­monly ad­dressed through a method called mono­vi­sion, where one eye is cor­rected for dis­tance vi­sion and the other eye for near vi­sion. So, when both eyes are open, the brain will adapt ac­cord­ingly and the pa­tient can see clearly both far and near.

Mono­vi­sion may only work ef­fec­tively in some pa­tients so they should dis­cuss their oc­cu­pa­tion, hob­bies and other life­style is­sues with their doc­tor to de­ter­mine if the pro­ce­dure is right for them.

It is not suited to peo­ple who re­quire sharp dis­tance vi­sion, pre­cise depth per­cep­tion or pre­cise near vi­sion in their day- to- day ac­tiv­i­ties.

Some pa­tients can adapt well and fast, but some may take longer. There is also the op­tion of a full eye cor­rec­tion to re­store a bal­anced dis­tance vi­sion.

Most peo­ple can ex­pect a good out­come if they main­tain re­al­is­tic ex­pec­ta­tions. If you seek laser eye surgery to cor­rect your vi­sion prob­lems, talk to your sur­geon about the ben­e­fits and risks of surgery in­volved at your age.

Make sure that you are fully in­formed of the ad­van­tages and dis­ad­van­tages of the pro­ce­dure as well as un­der­stand the af­ter­care tips. –

Dr Yen Siew Siang is a se­nior oph­thal­mol­o­gist & laser re­frac­tive sur­geon at Op­ti­max Eye Spe­cial­ist.

Dr Yen Siew Siang.

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