Posted on December 28, 2017
The current technological advances in LASIK surgery which have made it extremely safe and effective have made ophthalmologists rethink the population it caters to. As the population worldwide ages, even the elderly demand the benefits that LASIK surgery offers the young. Everyone, young or old, wants freedom from glasses.
Even though a person’s age may influence your surgeon’s decision about the refractive eye surgery best suited for you, there are guidelines that say that someone older than a certain age cannot benefit from LASIK.
Is there an age limit for refractive surgery, especially LASIK?
Broadly speaking, the answer is no. The US FDA has approved LASIK for use in persons older than eighteen years of age, with no upper age limit. Whether a patient is eligible or not, is not dependent on his or her age at all, but merely on the state of the eye. In other words, whether the patient is suited for LASIK at any age is dependent upon that individual’s personal medical history, current visual status and needs. Also, the patient must clearly understand that there should be no cataract when LASIK is performed, and that LASIK does not provide immunity from cataract. That is, cataract is a natural process of ageing, and LASIK cannot prevent the decrease in vision due to cataract over time, which will eventually require a cataract surgery along with the implantation of an artificial lens.
What are the special considerations in seniors?
Most eye diseases have an age predilection. Cataract, glaucoma, age related macular degeneration (AMD) and dry eyes are all more prevalent in the ageing population, and so the senior citizens seeking LASIK must be evaluated carefully. Basement membrane abnormalities of the cornea are also more common in the elderly as compared to the young, and can be the cause of corneal abrasions and poor healing after LASIK. A comprehensive eye evaluation will therefore decide the suitability of the person for LASIK.
Some medications taken by elderly patients like amiodarone are a contraindication for LASIK. Amiodarone is an anti arrhythmia drug that regulates the beating of the heart. Its use, however, has been linked to light sensitivity, poor corneal healing, hazy vision, glare and colored haloes around lights.
Near vision concerns
Almost everyone over the age of forty five will require reading glasses. This is regardless of whether they have needed glasses for distance vision growing up or not, and this does not change. This need for reading or near vision glasses is called presbyopia, age related decrease in near vision due to loss of elasticity of the natural lens, and cannot be addressed by LASIK alone.
In fact, to decrease the dependence on near vision glasses, the eye doctors often discuss the option of mono-vision. In this, the dominant eye is corrected completely for distance, offering clear vision for distance under normal viewing conditions (we rarely close one eye and look in the distance). The other eye is under corrected for distance, such that it has better vision for near, enough to see the time on a wrist watch, numbers on a mobile phone, and also read not very fine print.
Seniors tend to adapt very well to mono-vision, since under normal, binocular conditions, they do not need glasses for either distance or reading.
What about Cataract?
The patients who have already started developing cataracts must be offered cataract surgery, which consists of removing the natural crystalline lens of the eye which has become hazy. In case the cataracts are not visually significant, this procedure is termed clear lens extraction, and if the cataract itself is causing vision loss, it is called cataract surgery. The procedure remains the same, and is followed by the implantation of an artificial lens, customised to the refractive needs of the eye, in the same sitting. Currently available lenses provide optimal correction for distance, including correction for astigmatism also (Toric IOLs). These lenses however do not obviate the need for near vision glasses. For this, multifocal or accommodative IOLs are better suited. These allow the patient complete freedom from glasses, for both, near or distance.
The second scenario is a senior patient who does not have any signs of cataract. He or she is eligible for LASIK, but as mentioned earlier, must be explained that the possibility of developing vision loss due to cataract remains the same, with our without LASIK. Once the cataract develops, the patient will require cataract surgery with IOL implantation, despite having had LASIK. It is also important to know that previous LASIK is not a contraindication for cataract surgery. Previous LASIK does make intraocular lens power calculation a little difficult, so your doctor will keep detailed notes, and advice you to keep them too, so as to enable measurements for the eventual cataract surgery procedure.
Also, for the subgroup of seniors who have not achieved perfect vision following cataract surgery, in an otherwise disease-free eye, LASIK is a viable option. Previous cataract surgery is not a contraindication for LASIK or any other refractive surgery. In fact, your doctor will rule out any disease related loss of vision, and if satisfied, will conduct an eye evaluation that is no different for eyes without cataract surgery. Your treating eye surgeon will then evaluate your eyes for LASIK, as for any patient, regardless of age or lens status. If you are not found eligible for LASIK due to corneal thickness or curvature, the doctor will suggest another refractive surgery which will be best suited to your needs and eye health.
What does refractive surgery offer seniors?
As senior citizens embrace the virtue of the adage that “age is just a number”, LASIK technology, along with other refractive surgeries, is providing a great supportive role in their quality of life. No longer is age synonymous with thick lenses and heavy glasses, people of all ages today can aspire to, and achieve, better vision along with freedom from spectacles and contact lenses, safely and effectively.