New LASIK Procedure Sharpens Near, Middle and Distance Vision

Tired of taking those eye glasses on and off to adjust for reading and distance vision challenges? Midlife vision woes can now be corrected with a new form of LASIK surgery, called presbyLASIK, geared to the needs of the middle-aged. Robert L. Epstein, MD, an ophthalmologist at Mercy Center for Corrective Eye Surgery in McHenry, Illinois, and principal author of a recent long-term study published in Journal of Refractive Surgery, told me about this new procedure, which he says can eliminate the need for all glasses for 91% of patients aged 45 to 66 and has proven effective for at least one year in the patients who have received it.

Deteriorating vision is one of the most common complaints I hear about aging, and I am annoyed by it myself at times. Dr. Epstein told me that it is caused by stiffening in the lens of the eye, making it increasingly difficult to focus at close range. The problem, known as presbyopia, is a normal part of the aging process, he said. And as middle age advances, presbyopia advances right along with it—as the lens becomes stiffer, middle vision also begins to worsen, so most people end up requiring vision correction at all distances.


Glasses and contact lenses, including bifocals and trifocals, are helpful, but not perfect solutions. Multifocals don’t work for some people, who complain they have difficulty negotiating stairs or crossing the street with them. And many people just reject contact lenses because they don’t like inserting things into their eyes. I know several who own several pairs of glasses, using different ones for different tasks.

LASIK surgery, done the conventional way, doesn’t correct presbyopia. Monovision LASIK (correcting one eye for distances, the other to see near) can be helpful, but just for early presbyopia—it won’t work for advanced stages. “That’s where presbyLASIK comes in,” says Dr. Epstein. “It does everything that LASIK or monovision LASIK does, and more.” Currently in clinical trials, presbyLASIK is best done as a long-term fix for people 48 years old and older.


This latest development in LASIK surgery sharpens vision not only up close and at a distance, but also in the middle ranges from three to six feet. When successful, it eliminates all the disadvantages of eyeglasses and contact lenses. Many patients are thrilled with the results, Dr. Epstein told me. Most have little or no pain during and after surgery and are quickly back to their normal lives.

PresbyLASIK is performed much the same way as conventional monovision LASIK, but with one important difference. While both procedures correct the dominant eye for distance, presbyLASIK corrects the other eye for bifocal vision, by creating two curves in the cornea. The central section is reshaped for focus on middle distance and a different curvature is created for focus on close objects. So, you have one eye that sees distance, and the other eye with two roles—middle distance and reading.

Like conventional LASIK, presbyLASIK takes place on just the exterior of the eye. The procedure does not typically cause a loss of depth perception, a problem sometimes associated with monovision LASIK. Also, presbyLASIK can be adjusted, or even reversed—with a brief laser procedure—if you don’t like the results. The most common side effect noted in the study was a temporary halo experienced by half of patients. Typically, this effect faded, especially during daylight, but 15% of patients still perceived a halo during nighttime at 90 days and 7.8% at six months. As with conventional LASIK, the eyes need time to heal and vision isn’t always instantly perfect. The new and improved eyesight takes some time to get used to, in part because your brain needs time to adjust and be retrained.


If you’re 48 or older with presbyopia and want to be free of all corrective eyewear, presbyLASIK may be a solution. It can be performed on people with astigmatism as well as those who have had lens implants after cataract surgery. People with certain medical conditions, including lupus and rheumatoid arthritis, should not have presbyLASIK and neither can individuals who have a condition known as “lazy eye.” If your eyes are too dry or your cornea too thin for presbyLASIK, you may be a candidate for an alternative treatment such as PRK (photorefractive keratectomy). Results are as accurate as with presbyLASIK but the eyes take longer to heal. Conductive keratoplasty (CK), which is FDA-approved for the temporary reversal of presbyopia, is on the wane, as its effect is not long-lasting.

According to Dr. Epstein, you should look for a presbyLASIK surgeon the same way you find surgeons in general—get recommendations from happy presbyLASIK patients, look for someone with a good reputation in the community of doctors, who has board certification and good doctor-patient rapport. And, as always, the more procedures done and the longer these patients have been followed, the better.

At about $3,000 to $5,000 for both eyes, presbyLASIK is pricey and your insurance most likely won’t cover it. However, if you can see your way clear to paying that kind of money for better vision, presbyLASIK might be the solution you’re looking for.

Source: Robert L. Epstein, MD, ophthalmologist, Mercy Center for Corrective Eye Surgery, McHenry, Illinois.