“Should I Get LASIK?”

This is a question I am frequently asked by Twitter followers and second cousins at family reunions. The answer is “maybe.” Let’s break this down by age.

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In your twenties

Go for it…if you qualify…

Not everybody can get LASIK or PRK. You must have healthy eyes with thick enough corneas to accommodate the appropriate depth of ablation. The higher your refractive error, the more tissue we have to remove from your cornea to give you perfect vision. If you have thin corneas and a -8.50 prescription, you might not qualify. If you do qualify, refractive surgery is a fantastic way to get the most out of your pre-presbyopic years. You’ll have great range of vision without the need for glasses until you get into your 40s.

in your thirties

It’s great while you can still accommodate. The same rules apply regarding surgical qualifications no matter how old you are. Your eyes must be healthy and we have to make sure your corneas won’t destabilize by removing too much tissue. However, you start getting diminishing returns on refractive surgery starting in your late 30s. From age 40-45, everybody starts developing symptomatic presbyopia. We start losing our ability to focus up close and end up in reading glasses. This is as inevitable as death. There is no escape from presbyopia. Now, all you near sighted people are probably saying, “Pshh not me, I’m 50 and I can see up close just fine!" Well smartypants, that’s because your natural focal point is right in front of your face. This has nothing to do with accommodation or presbyopia. You are still developing presbyopia as a near-sighted 50 year old, but you don’t notice it because you don’t need to accommodate to see up close.

Understanding accommodation is important because if you have LASIK at age 38, you will only have a few years of glasses independence before presbyopia strikes. This is what I mean by diminishing returns. To summarize:

LASIK at 23 = 20+ years of perfect vision distance and near without glasses because you can accommodate

LASIK at 38 = 5-7 years of perfect vision distance and near, then you lose your near vision and end up back in glasses (distance will still be great though)

This isn’t meant to dissuade you from getting LASIK in your late 30s. After all, your distance vision right now is hot garbage. You just need to know that it won’t be long before you are back in glasses due to presbyopia.

in your forties

All you people lamenting your -1.5 or -2 myopia will love it when you hit your 40s. While all your friends are bitching about wearing reading glasses, you will still be chilling there with the glasses you’ve worn all your life. Nothing will seem different for you. Unless you get LASIK. Then, you will instantly need reading glasses after the surgery in exchange for perfect distance vision. There’s a reason refractive surgery over 40 isn’t very common. You like that near vision, you’re used to it, and the thought of needing glasses to read is a nightmarish prospect. The only way refractive surgery makes sense in your 40s is if you are interested in monovision, which means using refractive surgery to make one eye in focus for distance and one eye in focus for near. It’s the only way to make presbyopic individuals glasses independent without performing cataract surgery. We will trial monovision for patients using contact lenses before we operate. Your brain may not tolerate the difference in refractive error.

in your fifties

Just wait for cataract surgery. Most people have a little cataract in their late 50s. With cataract surgery, we can implant lenses that give you a wide range of vision, as opposed to LASIK or PRK which leaves you with a single focal point for distance or near. You’ve lived 50 years with glasses. What’s 10 more? When anybody over 50 brings up LASIK, I immediately try to dissuade them.

in your sixties

Did you hear what I just said? Just wait. You’re so close to the wonders of cataract surgery.

in your seventies

Is this a joke?

in your eighties

Before we discuss this any further, I want you to draw a clock. Please include the hour markers and the time set at 10 minutes to eleven.

in your ninEties

Sure, ok you’re 90. You can do whatever the hell you want.