In my practice, I see patients of all ages who would like to be free from glasses or contact lenses. For individuals who are free from eye disease and have good overall eye health, that result can often be achieved. Below, I will review general options based on the phase of one’s life.
The eyes grow till around age 21 or 22. Many parents are concerned that their children become increasingly nearsighted with each passing year in school. There is evidence that near-work activity and screen time (TV, tablet, phone) promote myopic growth of the eye in a way that compromises distance vision. Some studies show that dilute dilating drops can slow the development of nearsightedness in children, but it is preferable to encourage more outdoor play and less screen time.
Pre-teens and teenagers often want to wear contacts in order to be free of glasses. But the key here is the parents’ judgment—can the child handle contacts responsibly? The three cardinal rules of contact lens wear are to never sleep with contact lens on, never wear them more than ten hours at a time (so that the corneas can get oxygen) and to clean them regularly. If the child, or for that matter some adults, cannot handle these, then contacts are not an option. Contact lenses, while generally safe in most people, do have significant risks of infection and corneal scarring. Some studies indicate contact lens risks over time are higher than those of laser-assisted in-situ keratomileusis (LASIK).
Once the eyes stop growing and distance vision becomes stable, laser vision correction with LASIK or photorefractive keratectomy (PRK) can become an option. LASIK involves laser reshaping of the cornea after the creation of a protective corneal flap, while PRK involves laser reshaping without a flap. They are both generally successful and have excellent outcomes if someone is a good candidate. It takes a significant amount of time to do a proper consultation—evaluation should include the amount of correction needed, thickness and shape of the cornea, dilated examination of the whole eye and a good conversation about what to expect. If the appointment does not take an hour and a half, very likely it was not thorough.
LASIK and PRK have identical visual outcomes at six months after surgery, but differ in early recovery; both are safe but have some risks. With LASIK, most people can drive the next day, need medication drops for just five days, and don’t have pain beyond the day of surgery, which is mainly scratchiness. However, it is important that patients don’t rub the eye in the days after surgery as they may dislodge the flap. PRK avoids issues with the flap but can have a higher risk of scar tissue formation, which is mitigated by taking drops for two-three months and wearing sunglasses outside for six months. Both LASIK and PRK can worsen dry eye for a few months after surgery and can occasionally cause rings around lights at night, although these usually fade with time.
If someone is not a candidate for laser vision correction, the Visian ICL (intraocular contact lens) can be an option, especially for patients with high amounts of nearsightedness and/or thin corneas. This involves placement of a thin contact lens between the iris and the natural lens of the eye, and should be done by a surgeon with significant surgical experience inside the eye, as this procedure carries a slight risk of cataract induction or bleeding inside the eye.
Some patients are nearsighted because they suffer from keratoconus—weakening of the cornea, resulting in a cone-like shape rather than the normal spherical shape. For such patients, LASIK is not recommended. There are, however, treatments available to help slow the progression of disease, and even improve vision: Intacs support rings, placed within the cornea, and collagen cross-linking that uses a laser in combination with a vitamin solution to strengthen the structural fibres of the cornea. Used either alone or in combination, they should stabilise the cornea, reduce or prevent keratoconus progression, enable comfortable wearing of soft contact lens or glasses, and potentially enable certain types of PRK or the Visian ICL to reduce dependence on glasses.
After age 40-45, one’s vision changes again and it could lead to presbyopia, a technical term for focusing dysfunction or trouble changing focus from distance to near. This can lead to eye strain, headaches and require reading glasses or bifocals. Traditionally, the only options were reading glasses, multifocal contact lenses or blended vision using contacts or LASIK to have one eye for distance and one eye for reading. The last option requires significant effort to alternate eye attention, and can also compromise depth perception. We now have lifestyle lens implants, which can give both distance and near vision. These require actual surgical replacement of the natural lens with the artificial lenses, but can get rid of nearsightedness, astigmatism, focusing dysfunction and future cataracts with one procedure.
These lifestyle lens implants are best considered if someone has cataracts or significant nearsightedness or astigmatism. For someone who has good vision at distance but is experiencing trouble reading, the Kamra inlay or Raindrop inlay, placed in the non-dominant eye only, may be a good option if they wish to be less dependent on reading glasses.
In the late 50s, 60s and beyond, cataract formation is common. This can lead to loss of blue or yellow colour perception, trouble driving at night and blurry vision. Lifestyle lens implants and laser astigmatism correction are both options to redesign one’s vision to regain clear vision at a full range of distances.
Age, the need for glasses or contacts and changes in the eye structure can all compromise visual happiness. But fortunately, the dynamic field of ophthalmology has created tremendous strides and significant innovations that offer a wide variety of choices to customise your vision. Through a good partnership between patient and physician, you can choose the best option for your eyes.
The views expressed here are strictly those of the author and the university takes no position on these.