Q and A with Dr Holzman – “My husband had surgery 9 years ago with PRK surgery and now wants an adjustment for reading. Can he have LASIK now?”
Great question as it brings up the issue of reading glasses as we age also. Patients that have PRK can have LASIK after their PRK surgery, but only if there is adequate corneal thickness available. Many times there is not enough thickness to do LASIK since the original PRK may have removed a significant amount of cornea. When this is the case, sometimes you cannot do any adjustments, but other times you can repeat a PRK procedure. When the original PRK did not remove much tissue, then LASIK can be performed if all else looks normal in the pre-op evaluation.
This patient wants an adjustment to allow them to hold onto their reading/near vision as he ages. Normally at around age 40, the lens in our eyes begin to stiffen a bit and that starts the process of weakened near vision and the need for reading glasses. This happens to everyone, regardless if they had LASIK or not. If you have had LASIK or PRK and you have great distance vision, or if you are one of the lucky like myself to have great distance vision since birth, you will still start to lose near vision power in the 40s. If you are nearsighted and wear glasses or contacts for distance vision, you will also have weakening near vision with the glasses or contacts on and you will start to require bifocal glasses or reading glasses over the contact lenses.
If you want to keep seeing at both distance and near as you age into the 40s 50s and 60s, your best surgical option with laser vision correction is Monovision technique. We all have a dominant eye and this dominates for us seeing at distance. In Monovision technique we correct the dominant eye for distance so that the patient has good distance vision, but we adjust the non-dominant eye for a reading distance. This way the patient has distance with one eye and reading vision with the other. This sounds like it may cause trouble in adjusting to the vision, but most people, in fact approximately 85%, adapt to this without any issues. We should always try this with a contact lens trial first, as this gives the patent a chance to see if he or she likes the mono vision. If they do, we can easily adjust the surgery to mimic that. Monovision works well but also remember that it is a compromise in the overall vision as one eye is seeing distance, not two. Same for the near vision.
For the patient who asked the question, LASIK after PRK can be done, but is much safer to do with an Intralase instead of a bladed keratome. Intralase will remove less tissue in making the flap and also will not be affected by the post surgical corneas shape. Many times the corneal flattens significantly after a PRK or LASIK and if you have to make a flap in a cornea that is flat, there is far less complication risk if you use a laser to make the flap and not a blade.
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