Aging Eyes & Vision Correction: What Happens to Our Eyes as We Get Older?

What happens to our vision as we age—and when does correcting vision become about more than simply getting rid of glasses?

In Episode 2 of Wise EYES Guys, Dr. Andrew Holzman, Dr. Jonathan Solomon, and Dr. Sonny Goel explore how the eye changes with age and what those changes can mean for everyday life. Their conversation covers presbyopia, cataracts, LASIK, refractive lens exchange (RLE), ICLs, lens implant technology, surgical candidacy, and how ophthalmologists determine which vision correction approach may be appropriate for an individual patient.

The Wise EYES Guys discuss:

• How aging affects the eyes and vision
• The emerging field of oculomics and what the eye may reveal about overall health
• Research examining associations between cataract surgery and cognitive health
• Why maintaining functional vision can become increasingly important with age
• What happens when presbyopia begins in your 40s
• LASIK, PRK and SMILE for vision correction
• When refractive lens exchange (RLE) may enter the conversation
• How doctors choose between corneal and lens-based procedures
• ICLs and other alternatives for certain patients
• The importance of patient goals, lifestyle, age and prescription
• Why some patients are not candidates for vision correction surgery
• Risks, recovery and advances in surgical technology
• The lens technologies the three doctors might choose for themselves

One of the most noticeable age-related changes in vision typically begins in the 40s. The natural lens inside the eye gradually becomes less flexible, reducing the eye’s ability to focus on objects up close.

This condition, known as presbyopia, is why many people who previously had good near vision begin holding their phones farther away or relying on reading glasses.

The doctors explain that this change creates an especially interesting decision point for people interested in vision correction. A patient in their 40s may still have some natural focusing ability, while their vision needs are beginning to change. That means choosing a procedure isn’t simply a matter of correcting a prescription—it requires considering how that patient’s vision is likely to evolve.

Related: Presbyopia / RLE page

The episode begins with a discussion of oculomics—an emerging area examining how imaging and information from the eye may provide clues about health elsewhere in the body.

The doctors discuss research investigating relationships between eye health, aging, dementia and other aspects of neurological health. They also explore research examining whether restoring vision through cataract surgery may be associated with cognitive outcomes.

Importantly, the doctors themselves caution against turning those associations into claims that vision correction can prevent dementia. They emphasize that the evidence does not support telling patients that undergoing a vision correction procedure will prevent Alzheimer’s disease or dementia.

A significant portion of the episode focuses on a hypothetical 44-year-old patient seeking freedom from glasses.

Why 44?

Because this can be a gray area.

For an appropriate patient, LASIK or PRK may provide excellent distance vision, but the onset of presbyopia means that patient may still require reading glasses. Another possibility discussed is mini-monovision, where one eye is optimized for distance while the other is left slightly nearsighted to provide some near vision.

Refractive lens exchange offers another approach. RLE replaces the eye’s natural lens with an intraocular lens implant and can potentially address a broader range of vision. However, removing the natural lens also means giving up any accommodation—the natural focusing ability—the patient still has.

That’s why the doctors emphasize that there isn’t a single procedure that’s right for every patient at a particular age.

Related: RLE vs. LASIK

Dr. Goel describes patients entering the office as essentially saying, “I have a problem. Can you help me?”

From there, the job is to understand what that particular patient is trying to accomplish.

Someone who spends eight hours a day working at a computer may have different priorities from someone primarily concerned with crisp distance vision for golf or driving. Cost can matter as well, since lens-based procedures and laser vision correction can represent substantially different investments.

The doctors discuss evaluating factors including:

• Age
• Prescription
• Eye health
• Distance, intermediate and near-vision needs
• Work
• Hobbies
• Lifestyle
• Tolerance for reading glasses
• Budget
• Risks and benefits of each procedure

Sometimes, they note, the best recommendation may be not to have surgery at all.

The doctors discuss several different approaches to vision correction and why candidacy matters.

LASIK and PRK reshape the cornea and can be excellent options for appropriately selected patients.

ICL is an additive procedure in which a lens is placed inside the eye without removing the natural lens. It may be considered for certain patients who aren’t ideal candidates for laser vision correction.

Refractive Lens Exchange (RLE) removes the natural lens and replaces it with an intraocular lens. It becomes increasingly relevant as patients experience presbyopia and seek greater independence from glasses across multiple distances.

The doctors repeatedly return to risk-benefit analysis and patient selection rather than simply choosing the newest or most technologically advanced procedure.

Related: LASIK | RLE | Lens Implant Options

One particularly valuable part of the conversation is the doctors’ discussion of patients they don’t operate on.

Dr. Holzman explains that his practice finds something that makes a patient unsuitable for laser vision correction in approximately 15% of evaluations.

Screening allows surgeons to look for corneal, retinal and other ocular factors that could make a particular procedure unnecessarily risky.

As Drs. Holzman, Solomon and Goel discuss throughout the episode, the objective isn’t simply to perform surgery. It’s to determine whether the potential benefit justifies the risk for that individual patient—and sometimes the appropriate recommendation is to continue wearing glasses or contact lenses.

The episode concludes with the three surgeons discussing a particularly personal question:

What would they choose for their own eyes?

Their answers illustrate just how individualized modern vision correction has become.

They discuss refractive lens exchange, monovision, Light Adjustable Lenses, trifocal lenses and newer lens technologies. Rather than unanimously choosing one “best” lens, each doctor considers his own vision, lifestyle, professional demands and tolerance for different visual tradeoffs.

For patients, that’s an important takeaway from the episode: advanced technology provides more choices, but more choices make individualized evaluation even more important.

Dr. Andrew Holzman

Refractive surgeon and Medical Director of Holzman Laser Vision.

Dr. Jonathan Solomon

Cataract and refractive surgeon and Dr. Holzman’s partner in lens-based vision correction.

Dr. Sonny Goel

Refractive surgeon practicing in the Baltimore region.