Should I undergo a refractive lens exchange procedure at 45?

By David Anderson
Should I undergo a refractive lens exchange procedure at 45

“I am 45 years old and struggling to read small print and see my smartphone clearly and comfortably. Should I undergo a refractive lens exchange procedure? What are my other options?”

This is a question I am frequently asked as people look into options for surgical correction of Presbyopia – the natural reduction of near vision with age. The cause of this frustration is the natural stiffening of the natural crystalline lens inside our eye with time.

In childhood and our early years, the lens is flexible, which allows it to change shape. If the eyes focus perfectly for distance without the need for correction with lenses, the lens can take care of focussing for near, allowing us to do things like read small text in books, smartphones or iPads, and see clearly enough to do things like thread a needle.

How our eyes change with age…

From our mid-forties into our 50’s, our lens naturally stiffens, allowing us to maintain distance vision but making close work progressively harder. This process will continue so that eventually, the lens not only stiffens but also loses clarity, at which point cataract is said to develop.

Typically, cataract surgery is performed in the late 60’s and mid-70 years of age onwards. Many people are frustrated by having to wear spectacles for these near tasks, particularly now that smartphones have become an essential part of life for many of us. Others dislike the use of bifocal or varifocal glasses, particularly when maintaining a good neck posture and position for screen work and so seek a surgical solution.

Whilst the natural crystalline lens remains clear and providing the spectacle correction is not extreme, we recommend first assessing whether laser vision correction is possible.

Understanding laser eye surgery

Laser vision correction changes the shape and focus of the cornea – the transparent, front coat of the eye – so that the correction does not involve surgery inside the eye and is minimally invasive. New technologies like PRESBYOND® laser blended vision are a state of the art technology enabling us to correct most spectacle correction prescriptions (near sight, far sight and astigmatism) and then apply a blended vision correction to achieve natural visual range from distance to near.

Laser vision correction produces unsurpassed quality of vision because it combines the benefit of restoring near vision to the natural optics of a clear crystalline lens. The optics of nature’s own lens cannot really be bettered by artificial lens technology, so if possible (and well-tolerated), we prefer to add to the focussing power of the eye with laser, leaving the natural lens in place.

At your medical consultation, we can demonstrate the type of vision this produces so that you can experience how things may look yourself, as well as talk through all aspects of treatment and recovery.

We provide online information about LASIK here as well as some of the specifics of PRESBYOND® laser blended vision here.

What if I am not suitable for laser?

If we establish that you’re not suitable for laser eye surgery, we can offer further options including lenses that act in addition to your own natural lens, and can provide near vision like the implantable collateral lens or ICL.

More information can be found here. Of course, we can provide refractive lens exchange or clear lens extraction as options if laser is not possible or desirable. One size doesn’t fit all, so we can offer a range of different types of multifocal intra-ocular lens (IOL) to suit you and your lifestyle needs.

There are many different types of artificial lens or IOLs available today to replace the natural lens and they all have different properties. None can provide the seamless focus from distance vision to near we enjoyed (and took for granted) as children, so there will always be some compromises to be made, and each lens type provides a range of focus through different technologies.

These technologies suit some eyes better than others but also the different requirements each of us may have.

Some people enjoy what is called a ‘distance dominant’ lifestyle, spending a great deal of time outdoors. You might enjoy walking, gardening or taking part in sports such as golf, tennis, sailing or bowls.

Here, distance and intermediate (arms length) vision will likely be more important than close vision, so this is where a lens type called an Extended Depth of Focus or EDoF or EDoF+ lens may suit you best. We recommend the Rayner RayOne EMV and Alcon Labs Vivity® lenses which use advanced optics to ‘stretch’ the range of focus. More information on this can be found here.

Other people prefer to see best up close, such as avid readers or those who like crafts such as sewing or working with fine detail. In these situations, intraocular lenses that provide optimal near vision may be preferred.

Diffractive multi-focal lenses tend to provide the best near vision in my experience, and we offer advanced technology lenses including the Carl Zeiss Meditec AT LISA® Trifocal lens or the Alcon PanOptix® lens. This is not an exhaustive list of intra-ocular lenses available but those with which we have the most experience.

What other choices to I have?

The EVO+ Visian ICL® can be used to treat a variety of spectacle prescriptions and the focus of each eye can be targeted for different functions. This is called a monovision or micro-monovision outcome.

The aim is to correct the vision so that the distance-dominant eye can see clearly for distance e.g. driving and seeing road signs, and the non-dominant eye can see objects closer too e.g. to read. This type of vision suits some people very well and they may already experience it by wearing contact lenses that produce the same effect. It can also be simulated both in the clinic and with contact lenses to see if it suits you.

Typically, we use the EVO+ Visian ICL® to correct higher prescriptions although the lens itself comes in a wide range of powers.

Spectacles or contact lenses provide a non-surgical solution to the issue of presbyopia. These can range from over-the-counter reading glasses to monovision in contact lenses to the use of multifocal contact lenses and your regular Optometrist can provide you with details of the different options available.

Medical Disclaimer

This article is for information purposes only and should not be considered medical advice. If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking it because of something that you have read on this blog, website or in any linked materials.

About the Author:

David Anderson
David Anderson is the founder and medical director at Anderson Eye Care. With over 30 years of experience, he personally performs all of our procedures, consultations and assessments.

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