LASIK - Am I a good candidate?
This is the first question comes to most patients' minds when contemplating refractive surgery. Here's a general guideline of what both doctor and patient will consider when making this decision.
1. Is your prescription stable?
While there is typically an age minimum of 18 years old for refractive surgery candidates, this does not mean that all 18 year olds become eligible for LASIK on their birthday. In fact, most 18 year olds with a significant prescription are still changing and needing updated glasses and contact lenses every year or two. Unfortunately while we can usually get a sense of when a patient should stop changing (based on their current prescription, rate of change in the past, school/job status, etc.) we cannot predict the exact age when the prescription will stabilize. We really only know when you're done changing after you've had a stable prescription for a few years.
2. How many birthdays do you have under your belt?
As previously stated, patients typically need to be at least 18 to undergo a LASIK procedure, so we'll use that as the minimum age. Assuming you have a stable prescription, 18 to about 37 is the first age range to consider. Patients in this range will typically benefit from great distance and near vision after the procedure. As people approach 40-43 years old, they will almost definitively begin to experience some sort of change in their near vision. This does not mean that patients will necessarily need reading glasses right away, but near vision becomes less comfortable and the near focusing becomes less efficient for nearly everyone at some point in this age range. So, going back to the age range of 18-37ish being ideal for LASIK. As you approach that 37 year old mark, and especially at 38 and 39 years old, you need to consider the near vision changes that will almost definitively take place in the next 3-5 years. And you need to be okay with the fact that you may need some sort of reading correction, and not be upset by the fact that your LASIK investment did not keep you out of glasses entirely. So for this 18-37 age range, the sooner you are able to get LASIK (again, a stable prescription being necessary) the longer you will be able to enjoy life without glasses before near vision changes begin to emerge.
Once you reach 45-50 years old we are again able to reconsider LASIK from a different perspective. Generally we will take the monovision approach for patients in this age range. Monovision basically means that one eye is focused for distance vision and the other eye is focused for near vision. The brain essentially pays attention to the eye with the better image for the task that is being performed. If you are driving, the brain favors the distance eye. If you are reading, the brain favors the near eye. The best candidates for LASIK in this age range are those that are already wearing monovision contact lenses. If you are not a monovision contact lens patient, we typically do a trial period with monovision contacts to make sure you will ultimately be happy with the vision after LASIK.
* Patients that I think are great for monovision LASIK are those that have never worn glasses or contact lenses in their life because they have had perfect distance vision, but are beginning to have a lot of trouble with their near vision. Sometimes we can ultimately just treat one eye for near and leave the other eye alone for distance and they can once again enjoy life without glasses or contact lenses.
Monovision is generally the best option for patients in the 45-60 year old age range. As you approach 60 there may be better options for you such as a Refractive Lensectomy (something that we can delve into further in a future newsletter).
3. Are your eyes healthy / Do you have a prescription that the lasers can treat?
These are obviously questions that will have to be addressed by your doctor and the answers will vary from person to person. Most patients that we see fall within the guidelines for having a safe and effective LASIK procedure. But sometimes we don't even have all the answers, and that is why your consultation with NVision is necessary. At your consultation there are 2 crucial tests that are performed to help determine your candidacy. The first is pachymetry, or a measurement of your corneal thickness. Dr. Tooma, our primary LASIK surgeon, needs to make sure there is enough corneal tissue to work with. The second test is corneal topography. This test is an integral part in the Custom LASIK procedure, but it also helps in detecting different corneal diseases that if present would likely preclude you from being a candidate.
Most prescriptions fall within the parameters of what NVision's lasers are able to treat, but if a patient has a high amount of hyperopia, myopia, or astigmatism, there may be alternative refractive procedures that are preferred. This is another question that can be answered by a consultation if Dr. Bittel thinks you are on the borderline of the laser's parameters.